Internal abdominal injuries : being the annual oration delivered before the Medical Society of London / by W.H. Battle.

  • Battle, William Henry, 1855-1936.
Date:
1910
Catalogue details

Licence: In copyright

Credit: Internal abdominal injuries : being the annual oration delivered before the Medical Society of London / by W.H. Battle. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    18/34 (page 18)
    occupying three-quarters of the abdomen, would be about 25 per cent., and the remainder, from a half to a quarter enlargement.” If a Chinaman is found with a larang upon him he is at once tried and imprisoned, because it is known what intention he has. It is rarely found, e.xcept in the case of intoxication, or the finding of a Chinaman in close proximity to a dead man. I do not know of any other instance in the history of the peoples of the world, in which advantage has been taken by the criminal of the pathological opportunities of the district in which he lives. Rupture of a nonucal spleen is found as the result of considerable violence, and is met u’ith clinically under two conditions. From its position under the shelter of the ribs, where it is well guarded in the adult, it is a comparatively rare injury. It is not surprising to find that amongst the published cases there is an unduly large proportion of j’oung people, whose ribs are more elastic and yielding, no less than 15 out of 23 being under 20 years of age, nearly all of whom were “run over” in the streets. It was formerly held that there must be adhesions between the spleen and diaphragm before rupture can take place, but this theory has been disproved in recent years. Ever}' rupture of this organ is not fatal, healed cicatrices have been found during necropsies by Ayres, Neville Jackson, D’Arcy Power, and others. There are some cases in which life is said to have been much prolonged after this injury, but \uifortunately, the condition of the abdomen, as given in the report, does not always carry conviction that the diagnosis was correct. Statistics are, therefore, of little value, but Edler computed the mortality at 82‘3 per cent, in the uncom- plicated cases. The symptoms produced by this injury may be immediate and alarming, or they may be delayed in their development. Barrallier summed them up in these words: “ pdritonisme,” “ I’h^morrhagie,” “ syncopie,” but probably referred to the rupture of a malarial spleen. Rupture of the malarial spleen may be compared to the rupture of an aneurysm, and that of a normal spleen to the wound of a large artery. The amount of shock varies very considerably when a healthy spleen has been ruptured, and does not help in the diagnosis, but I am inclined to think it greater when the spleen.