. Medical and surgical therapy . —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 latt
. Medical and surgical therapy . —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). A late-ral wound of theascending colon,. Fig. 26.—^Recoveries by abstention. Sen-cert [2], To compare with the followingfigure. a tunnel-wound caused by a bullet, with very localisedreaction, was treated by lateral laparotomy ; we foundthe rent in the middle of a sanguineous infiltration of 408 WOUNDS OF THE ABDOMEN the meso-colon; at that very moment intestinalcontents escaped. The patient died of peritonitis,which perhaps would not have occurred without inter-vention, as the closure of the laceration seemedestablished. In any case, a mistake of operative procedure hadbeen made; be-fore the lapa-rotomy, as thepassage was solateral, and theintra-perito-neal penetra-tion of the colonwas not cer-tain, I oughtto have ex-plored thecourse of thewound andconfined myselfto a freeopen-ing-up of theextra-perito-neal focus: weare well awareof the difficultyand the uncer-tainty of extra-peritoneal su-tures of thelarge intestine!From thecases that Ihave just col-lected and ana-wounded who,have recovere
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
