Wounds in war : the mechanism of their production and their treatment / by W.F. Stevenson.

  • Stevenson, William Flack, 1844-1922.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Wounds in war : the mechanism of their production and their treatment / by W.F. Stevenson. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    gasps for air, apparently from a sense of want of oxygen, though his respiration is unimpeded; and the face is pallid. The dependent portions of the abdominal cavity become filled with blood, and dnlness on percussion becomes per- ceptible in the flanks. This dulness varies in position as the patient is turned to one side or the other. Retention of urine is present in about 50 per cent, of the cases, though not necessarily indicating damage to any portion of the urinary tract. Haemorrhage is usually the result of rupture of the liver or spleen, sometimes of laceration of a vessel in the mesentery or of one of the large abdominal arteries or veins; but it seldom occurs to any great extent from intestinal rupture. When the internal lesion is in a hollow viscus, the primary symptoms continue or become more marked, and gradu- ally have included with them those of peritonitis. The pain becomes more general, the vomiting increases, and tympa- nites, tenderness, and distension with rigidity of the muscles of the abdominal walls make their appearance. Jobert has drawn attention to the importance of the occurrence of sudden tympanites, produced by the escape of the intes- tinal gases into the general cavity of the peritoneum, as an early sign of rupture of any portion of the intestinal tract; but tympanites may result from paralysis of the gut due to the blow on the abdominal walls, and it is likely to be general if this condition occurs low down. It has also been pointed out—I believe, by Flint, an American surgeon, but I am unable to give the reference—that a slight escape of flatus from a ruptured intestine may cause the liver dulness to disappear by insinuating itself between the upper surface of the liver and the abdominal walls. Upon these symptoms, or upon varying combinations of them, the surgeon must rely for data on which to found his diagnosis of visceral lesion in cases of abdominal contusion unaccompanied by wound of the parietes ; and it is incum- bent on him to be acutely watchful for their appearance, for upon the promptness with which he recognises them, and acts on the indications supplied by them, will the lives of patients injured in this manner hang. The Treatment of a case of contusion of the abdomen should be carried out at first by the use of the usual means