. Medical and surgical therapy . BDOMEN association ; he died on the 31st day from hepatisa-tion of the right lower lobe, and from gangrene of thepulmonary tissue. Laparotomy had nothing to dowith this, and if anaesthesia by ether can be suspectedof aggravating the pulmonary complication, that isan argument for rejecting ether, but not againstlaparotomy. (B) The same remark applies to Sterns patient(Obs. 1) who was placed under a window always keptopen, who got up, and died from pneumonia on the following day. The case ofRouvillois () lends itselfto discussion,but the fact ofour placing
. Medical and surgical therapy . BDOMEN association ; he died on the 31st day from hepatisa-tion of the right lower lobe, and from gangrene of thepulmonary tissue. Laparotomy had nothing to dowith this, and if anaesthesia by ether can be suspectedof aggravating the pulmonary complication, that isan argument for rejecting ether, but not againstlaparotomy. (B) The same remark applies to Sterns patient(Obs. 1) who was placed under a window always keptopen, who got up, and died from pneumonia on the following day. The case ofRouvillois () lends itselfto discussion,but the fact ofour placing it incategory B provesthat we admitthe possibilityo f spontaneoushealing. It was acase of an abund-ant hgemoperito-neum caused bya wide lacerationof the anteriorborder of theliver, extendingfrom the vesi-cular notch tothe falciform lig-ament ; a frag-m e nt of theliver as largeas two thumbs was almost entirely detached ; therewas also a wide perforation of the gall-bladder, and asecond wound 5 cm. long in the inferior surface of. Fig, 25.—Deaths by abstention, Sencert[2], To compare with the preceding figure. TREATMENT TO ADOPT IS LAPAROTOMY J07 the right lobe of the liver. The sutures only heldpartially. Death on the fourth day was caused by awell-localised focus of sub-hepatic peritonitis. Con-sidering the good general condition of the patient, beforeintervention (Pulse 64), and the diminution of pain,is it possible that he might have recovered, in spiteof the blood in the peritoneum and the bile in theperitoneum ? Still, intervention does not appear tohave caused the peritonitis, as the latter remainedlocalised to the liver, without spreading to the restof the peritoneal cavity when theexplorationswere extendedto the conclusionto be drawnfrom this caseis that it is ad-visable to bemore cautiousin making sur-gical interven-tion in the regionof the liver. The same con-clusion as re-gards the colonis drawn fromour own unfor-tunate case (seeits case-report onp. 488)
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
