Forensic medicine and toxicology : A comprehensive work on medical jurisprudence / By W. Bathurst Woodman and Charles Meymott Tidy, with eight full-page lithographic plates and one hundred and fifteen other illustrations.

  • Woodman, W. Bathurst (William Bathurst), 1836-1877.
Date:
1882
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Licence: Public Domain Mark

Credit: Forensic medicine and toxicology : A comprehensive work on medical jurisprudence / By W. Bathurst Woodman and Charles Meymott Tidy, with eight full-page lithographic plates and one hundred and fifteen other illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    1040/1100 (page 1030)
    The. authors have seen several such cases, in which the liver was thus torn, as it were, almost in half—one or two others of injuries to the spleen and kidneys. Dr. Taylor gives a number of such cases (vol. ii, pp. 648-9), Guy, and Beck, and Casper give others. Indeed, it is not now necessary to multiply quotations. Rupture of the liver usually proves fatal in about forty-eight hours or less. But life has been prolonged for several days (eight days in a case known to Dr. Taylor). Haemorrhage takes place internally. The result is collapse, coldness of the extremities, hoarse, whispering voice, feeble pulse, intense weakness, the abdomen swells up, and is generally very tender and tense. Consciousness is usually retained. Dr. Barnes insists much on this fact, as distinguishing abdominal collapse from cerebral symptoms. In rupture of the liver or gall-bladder, jaundice may set in if the patient lives long enough. In ruptured kidney, blood is found in the urine. Generally speaking, the bladder is filled with almost pure blood instead of urine. It may be necessary to pass a catheter to prove this. Medical men have been asked how fast the blood would flow into the abdomen from a case of this kind (of ruptured liver, spleen, or kidney, etc.). It is not easy to give a categorical answer, as much will depend on the extent of the rupture, the size of the bloodvessels, the for- mation of clots, whether the injured person is moved, etc. In some of the recorded cases, the person thus suffering has walked some distance, and this would hasten death. From a few ounces to several pints of blood may be poured out inside the abdomen. Dr. Machlachlan (Medical Gazette, vol. xxxvii, p. 968) records a case of ruptured gall-bladder which happened to an old man from falling out of bed with great violence on to the floor. He died of peritonitis in forty-eight hours. The gall-bladder was ruptured and a large gallstone was found in the cystic duct. The authors have two or three times known the gall-bladder ruptured by forci- ble compression in artificial respiration, performed by over-zealous sur- geons, to obviate the effects of an overdose of chloroform. The stomach and intestines may be torn or ruptured by contusions of the abdomen, from blows, kicks, etc., or by wounds with swords, bayonets, daggers, bullets, or small shot, etc. To a bullet-wound of the stomach in Alexis St. Martin, a young Canadian, we owe much of our knowledge of digestion, thanks to Dr. Beaumont's researches. You must remember that in certain diseased conditions (as in ulcers of the stomach, duodenum, ileum, or the large in- testine; or softening and degeneration of these organs), death may occur more or less suddenly from the ulcer bursting into the peritoneum, and thus the contents of the viscus escape into the peritoneal cavity ; or the ulceration invades the artery (as in typhoid fever), and death occurs from hemorrhage. During the cholera epidemic of 1866, some cases of sudden death from this cause were at first erroneously attributed to the collapse of cholera morbus. As St. Martin's case shows, all wounds of the stomach are not fatal. There has, within the last year, been a successful case of gastrotomy, or artificial opening into the stomach, to preserve life, which proved successful.* In recent wars, particularly the French-German war of 1870, there were several cases of recovery from bullet-wounds with fis- spontaneously in Coolies when thus diseased, and Dr. Norman Cheevers was quoted as an authority in proof. The Chief Justice said that, even if diseased, there could be little doubt that the violence (which was not denied) must have accelerated the rupture. The superintendent was, therefore, condemned to eighteen months' imprisonment, with hard labor. * This operation is indicated when the oesophagus or pharynx is blocked by cancerous growths or other strictures, so that food cannot reach the stomach, or only in insufficient quantities. It has, in general, been deferred until life was almost extinct, to the discredit of the operator.