On two cases of traumatic rupture of the colon : with some remarks on the cases of rupture of the intestine treated in the wards of St. Thomas's Hospital, London, between the years 1889 and 1898, inclusive / by George Henry Makins.

  • Makins, George Henry, 1853-1933.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: On two cases of traumatic rupture of the colon : with some remarks on the cases of rupture of the intestine treated in the wards of St. Thomas's Hospital, London, between the years 1889 and 1898, inclusive / by George Henry Makins. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    19/39 (page 16)
    important diagnostic sign, and in the second would no doubt have been of diagnostic aid, had the patient not been oper- ated upon before it had had time to extend freely. Its sig- nificance is undoubted as pointing to injury of the bowel beyond the limits of the peritoneal coat. I would again advert, under this heading, to the great difference noted in this class of case, and that in which the perforation is secondary to ulceration, in which latter escape of intestinal contents often gives rise to signs not only of free fluid, but also of gas in the abdominal cavity. (7) Pulse and Temperature.—On these points I may be brief. In all cases the pulse shows a steady tendency to rise in frequency and to lose in strength, practically in an identical manner to that in which it behaves in other cases of perito- neal septicaemia. I shall again advert to this sign as the most important single one in the question of deciding on abdomi- nal exploration. The bodily temperature is usually low soon after the in- jury, sometimes reaching the extreme shock limit; later it tends to rise, but the rise is often not striking, amounting to toi° to 1020 F. at the most. Some remarks as to the frequency of respiration have alreadv been made under the heading of abdominal rigidity and immobilitv, and its twofold significance adverted to. f8) Lastly- certain other symptoms need to be men- tioned. although the cases under consideration offer little in- formation on them. Onlv one patient, a young boy, expressed an urgent desire to defecate shortly after the occurrence of the injury, and in none is the passage of blood or the presence of tenesmus mentioned. None the less, these signs, if pres- ent, mav be of definite importance. Diagnosis.—Consideration of the above analysis of the symptoms supports the view that the diagnosis of rupture of the intestine must, in the great majority of cases, be made by the method of exclusion, and then, in view of the necessity of prompt action, often needs the evidence afforded by an ab- dominal section to confirm it.