Stomach. — Uncomplicated wounds of this organ frequently yield without trouble when the bullet, blade, or other instrument causing the perforation is small, especially if the stomach was empty at the time the injury was flicted. The mucous membrane bulges out and forms a plug which obturates the hole until reparative processes have sealed the aperture on the peritoneal side. Complicated cases, in which the lesions are extensive, soon reach a fatal issue if deprived of timely surgical inter vention.
An individual shot when the stomach is distended with food will have a better chance to recover if subjected to an oper ation and the peritoneal cavity washed out. The probability is that during efforts at vomiting part of the contents of stomach will be extruded through per forations into peritoneal cavity. R. B. Hall (Cincinnati Lancet-Clinic, May 7, '98).
Liver. — The prognosis of wounds of the liver depends mainly upon the corn plications. If the patient does not die from hannorrhage soon after the receipt of the injury, he is still exposed to the results of extravasation into the peri toneal cavity, the presence in the liver of a foreign body,—the bullet and what material it may have forced into the wounds,—etc. Peritonitis, hepatitis, and abscess are, therefore, dangers to be taken into consideration. Hepatitis and abscess are much less to be feared, how ever, from stab wounds, no foreign body being left behind, unless, as in dueling, the sword-point strike the spinal column. causing the blade to break. In such an event, however, the hremorrhage would probably prove mortal very rapidly.
As to mortality, the statistics of Edler, Mayer, and others show it to average about 50 per cent., including the cases attended by complications.
Records of 272 cases of wounds and injuries of the liver. Cases divided into those due to direct and those due to in direct violence. Direct injuries. 164 cases, with 5S deaths,—a mortality of 35.3 per cent.; indirect, 10S cases, with 92 deaths. —a mortality of S5.2 per cent. The for mer class again divided into two groups, of 54 punctured or incised wounds, 24. or 44 per cent., proved fatal, while of 110 gunshot wounds only 34. or 30 per cent., were mortal. Of the 272 eases, 150, or 50.5 per cent., died. These figures cor respond very closely with the tables of Edler, which showed a mortality of 39.1 per cent. after shot wounds and 55 per cent. of all eases. Homer Gage and R.
Lorini (Boston Med. and Surg. Jour., Apr. 2S, '92).
Spleen.—Slight punctured wounds of the spleen are not mortal unless compli cated with laceration of a large artery. They are sometimes followed by ab scesses which heal after a prolonged period in the great majority of eases. Severe punctured wounds are dangerous in proportion, but if the primary ln.em orrhage is not such as to cause an early fatal issue, the chances of recovery are about those of slight wounds.
Gunshot wounds are much more seri ous as a result of rupture of the spleen taking place under the concussion, when the bullet is large and its velocity is great. Fatal quickly en sues. Rupture of the spleen may also occur during convalescence.
Case of wound in the right hypochon driac region from which the spleen was protruding. Wound had been exposed to soiled clothing and a septic process feared. The entire spleen was removed.
Recovery followed and in two weeks the wound had completely healed. O. St.
John Moses (Lancet, Jan. 27, 1900).
Dm•ng the War of the Rebellion the proportion of deaths was 93 per cent. In civil life, however, the weapons used are, as a rule, less powerful, and it is probable that the mortality, especially since antiseptic surgery has been gener ally utilized, is much smaller. The predi lection of this orsran for abscess greatly darkens the prospects of recovery.
Kidneys.—Complications are also to be feared in lesions of this organ. namely: peritonitis, nephritis, and secondary hmn orrhage. Again, the position of the kid ney makes it probable that other organs are also injured in the majority of cases. The direction from which the bullet or stab came, the length of the penetrating blade, etc., are important factors when the nature of the injury is to be deter mined.
Bladder. — Gunshot wounds of the bladder are always serious as far as com plications are concerned, rectal. vaginal, perineal, and scrotal fistula being very frequent.
As to the mortality of penetrating wounds of the bladder, it is not so great as in lesions of any of the other ab dominal organs. Stab wounds are more frequently mortal than uncomplicated bullet wounds, the proportions being 29 per cent. in the former and 17 per cent. in the latter. When, however, osseous lesions are also present, penetration or fracture of the pelvis, etc., the mortality reaches 29 per cent.