Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . ses is small, certain lessons can be drawn from myobservations which may aid in the future treatment ofthis class of cases. Our experience is limited to thirteenabdominal cases, four of which were the results of tuber-culous peritonitis and nine cases of post-operative sinusesafter laparotomies. Sinuses Following Tuberculous Peritonitis. Two of the four cases in which tuberculous peritonitiswas the cause of the sinuses were not in the least bene- 110 SINUSES FOLLOWING CERTAIN OPERATIONS. 1 1 1 fited by the
Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . ses is small, certain lessons can be drawn from myobservations which may aid in the future treatment ofthis class of cases. Our experience is limited to thirteenabdominal cases, four of which were the results of tuber-culous peritonitis and nine cases of post-operative sinusesafter laparotomies. Sinuses Following Tuberculous Peritonitis. Two of the four cases in which tuberculous peritonitiswas the cause of the sinuses were not in the least bene- 110 SINUSES FOLLOWING CERTAIN OPERATIONS. 1 1 1 fited by the bismuth treatment, gradually wasted, anddied. Both cases belonged to the most malignant type,and each had a fecal fistula besides the suppuratingsinuses. The first case, shown in Fig. 44 (a young man aged 23), took fromthe beginning a most violent course, simulating acute suppurative ap-pendicitis, but a positive ophthalmo reaction and other symptoms con-vinced us that we had to deal with tul ^rculous peritonitis. Withinsix months the patient was emaciated to a skeleton, and a sinus. Fig. 44. Sinus and fecal fistula in tuberculous peritonitis. formed just below the umbilicus, in the line of incision, and soonthereafter a fecal fistula complicated this condition. A violent eczemaaggravated the already unbearable condition, and thus he succumbedto the disease. Six injections had been made into the sinuses withoutany effect. The second case was that of a young man who was referred to usby his physician after the abdominal sinuses and fecal fistula? hadalready existed for several weeks. Following the first few bismuthinjections he seemed to improve and began to walk, but soon afterrelapsed and gradually wasted away and died. A post-mortem wasobtained. It proved to us the futility of this or any other treatment 112 BISMUTH PASTE IN CHRONIC SUPPURATIONS. in cases which have reached this stage. The disease had invaded theentire abdominal cavity to such an extent as to convert the int
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