Experiments in cats in which large openings in the stomach we successfully closed by means of an otnental plug. The surrounding mucous membrane always prolapsed freely and the piece of omen tum, already fixed to the serous coat close to the seat of excision, was sewn around the wound, the ()mental tissue being fixed to the serosa. A process of omenturn was then sewn over the whole, this being necessary in the case of eats, owing to the thinness of the omentum. The transplantation not only succeeded, but the °mental tissue gradually as sumed the character of gastric mucous membrane. Well-formed glands devel oped. Enderlen (Deut. Zeit. f. Chir., Apr., 1900).
when the history of the case seems to indicate the possibility of a lesion of this organ is careful watch ing imperatively demanded, owing to the violent ha norrhages which they in volve. Either this complication or peri tonitis having been recognized, the ab domen should be opened at once in the middle line. The abdominal wound should be large enough, if possible, for the surgeon to see the liver, but in every case he ought to make a careful explora tion with his finger, especially directing his attention to the convex and posterior surfaces of the organ.
When a rupture is found, the wound may either be cauterized, plugged, or sutured.
Paquelin's cautery can hardly arrest from large vessels in deep wounds of the liver; here the suture may be used. The blood-pressure in the liver-vessels is low; hence arrest of lnemorrhage can surely be obtained by the tampon. The Wound in the liver can also be better observed where the tampon is used. Three personal eases in which the measures were successful. Weidler (Deutsche med. Woch., Sept. 13. '94).
Where the wound is a large one the combination of sutures, mattress-sutures, and tamponade may be necessary; but, as a rule, the tampon should be used only in cases where sutures have failed to check the haemorrhage. Of the three methods the thermocautery is of least value; it will check only moderate parenchymatous haemorrhage, is of no value in extensive wounds, and is apt to be followed by secondary luemor rhage.latter (Annals of Surg., Apr., '97).
A jet of steam to control haemorrhage from the contused liver or omentum, first recommended by Sneguireff, has antiseptic as well as hmmostatic virtues. When the tampon is employed, the sur rounding peritoneal cavity should be shut off by a few sutures. Doyen (Le
Progres Med., Oct. 30, '97).
Plugging with antiseptic or aseptic gauze seems to give the best results, one end of the gauze being left out at the angle of the abdominal wound. The plug should be removed not earlier than the forty-eighth hour, lest there should be a recurrence of the haemorrhage, and not later than the fourth day, lest a bil iary fistula should be formed. When the bleeding is very severe sponges mounted on holders appear to produce more satis factory pressure than simple plugging, which is, perhaps, better reserved for slighter injuries. Hot-water irrigation may be of advantage in these cases. A ligature should be applied to any large vessel which is seen to have been torn. Sutures are particularly useful when the laceration extends deeply into the sub stance of the liver, since by their means the edges of the wound may be brought lightly together and the bleeding can be controlled. Drainage of the pelvic pouch, by an opening just above the pubis, serves best to give free passage to subsequent discharges. The capsule should be included in the stitches. The prognosis is very unfavorable when peri tonitis has occurred, but something may still be done to prevent the fatal issue by opening and afterward draining the abdominal cavity.
Two cases of rupture of the right lobe in a woman of 21 years struck by a train. Rent found in the under surface of the liver, 2 'A inches long, and inches deep; also several small rents in the spleen. Wound closed. Rapid recovery. Case of a man, 44 years old, caught be tween two cars. Rent in the under sur face of the liver. Hmorrh?ge was checked by pressure with gauze, and the abdominal wound closed. Rapid and good recovery. II. B. Delatour (Med. News, Feb. 17, 1900).
Ruptured liver in a man of 25 upon whom a case of glass, weighing half a ton, fell. Collapse, pain, and tenderness in the upper part of the abdomen, and increased liver-dullness. Almost pulse less within three and one-half hours. Intravenous injection of saline solution given, and the abdomen opened. Found full of blood, and across the under sur face of the liver was a laceration ex tending from the gall-bladder to the posterior part. The laceration was packed with iodoform gauze, and the wound was approximated. The patient remained pulseless nearly thirty hours, but gradually recovered. Thomas Car ?ardine (Lancet, May 12, 1900).