Statistics collected by various writers, showing the mortality to range from 65.6 per cent. to 70.67 per cent. Shock is one of the chief causes of these re sults. Conner (Jour. Amer. Med. Assoc., Sept. 16, '93).
Immediate operation is the best and wisest course to pursue in perforated, punctured, and gunshot wounds of the abdomen. This is the rule which is fol lowed in the University of Munich. Seven gunshot wounds treated with a mortality of 58 per cent., and 22 stab wounds, with a mortality of 1S.1 per cent. Series of 30 cases treated by con servative methods between 1370 and 1590, the mortality having been 46.6 per cent. Paul Ziegler (Mfineh. med. Woeh., Mar. S. '9S).
Tn 253 cases of gunshot injuries of the abdomen the total mortality was about 52 per cent.; in 2S of the 133 fatal cases unsecured perforations or haemorrhage was found; peritonitis at the operation was found in 11 of the eases that recov ered, showing that about 5 per cent. of such eases recover even if this dangerous complication is present. H. H. Grant (Jour. Amer. Med. Assoc., Mar. 17, 1900).
The kind of weapon inflicting the in jury plays an important role in this con nection. A triple-edged bayonet is more likely to produce a serious laceration than a flat blade. Again, wounds caused by small weapons, such as a Flobert rifle, for instance, would hardly produce le sions to be compared to the old Enfield or Minie rifles, which sometimes caused a large portion of an organ to protrude through a wound of exit the size of an apple.
Portions of the solid viscera are some times cut off or shot off, leaving a gap ing tear, which greatly compromises the issue. Again, as is often the case with the liver, the bullet, or any foreign ma terial dragged in by the latter, may lead to complications which greatly reduce the chances of recovery.
An important factor is the time elaps ing between the receipt of the injury and that at which competent treatment is applied in mild cases. This is espe cially true as regards the early utiliza tion of surgical measures when these become necessary. The sooner these are instituted, the more favorable the prog nosis, especially during the first ten hours.
Statistics of 154 laparotomies for gun shot wounds: Operation five hours after traumatism; mortality. 52.7 per cent.
Operation ten hours after traumatism; mortality, 74 per cent. Operation twenty hours after traumatism; mortality, 73.9 per cent. Operation after twenty hours after traumatism; mortality, 78.2 per cent. Hcemorrhage kills early, if at all. Edouard Adler (Jour. de MM. et de Chin Prat., Sept. 25, '92).
Intestines. — The prognosis depends greatly upon the nature of the lesions. Stab wounds opening the intestine lengthwise, if small, often heal of their own accord; transverse wounds are more serious, while complete section of the bowel is a very dangerous complication. Gunshot wounds show a great fatality. Prior to the introduction of antiseptic surgery the mortality exceeded 90 per cent.; since then, the mortality has been decreased to 43 per cent. in cases oper ated during the first twelve hours. When all surgeons will handle the intestines with gentleness, operate quickly, and otherwise reduce the chances of shock, it is probable that the prognosis will be greatly improved. Perforations of the descending colon and sigmoid flexure are seldom fatal; those of the transverse colon give a worse prognosis, by the for mation of fistula=, adhesions, and abnor mal communications. Again. diathetic conditions may compromise recovery.
other conditions greatly reducing the chances of recovery, recoveries are occa sionally obtained.
The omentum, although it does not contain unstriped or striped muscular tissue, has power of mobility, and applies itself over lesions that may occur in the cavity of the peritoneum. Thanks to the omentum, aseptic surgical wounds of the ureter, bile-ducts, etc., can be left to heal without sutures, since it practically walls in the wound. Milian (Gaz. des Hop., July 1, '99).
Case of abdominal injury caused by the horn of rhinoceros in which a por tion of several knuckles of gut pro truded through the opening, two inches above Poupart's ligament. The gut was cleansed and returned and the parietal peritoneum, skin, and superficial fascia then closed by different sets of sutures. In eleven days was up and around. K W. Waters (Brit. Med. Jour., Nov. 3, 1900).