THE PATHOGENESIS OF CHOLERA

T.J Maclagan
1893 The Lancet  
anus. 113 The patient died on the following day from diffuse septic peritonitis, which seems to be the great danger of this method of procedure. As regards safety, I am inclined to think ,that the order of precedence of these operations will be as follows—tncision, incision and amputation, resection and immediate suture, extrusion and artificial anus without resection, and artificial anus preceded by resection. However, .3,S I have already said, the data are wanting for a final judgment. The
more » ... al judgment. The relative merits of resection and immediate suture .and of extrusion and artificial anus require to be carefully .weighed. Resection with immediate suture is an ideal opera--tion. If it succeeds the patient is cured without further operation. Shock seems to be the chief danger, but with decreasing knowledge, better appliances and more skilful and , , -rapid operating successes will soon have to be recorded. The history of laparotomy for the reduction of intussus-' ' , ceptions affords encouragement in this respect. Since Mr. ' , Lawford Knaggs19 gave a table of eight cases of intussusception cured by laparotomy I have met with records of ' , -others by Mr. Annandale,2O Mr. Bruce Clarke,21 and Mr. ' , Carver, although in the latter the symptoms were somewhat .chronic, and doubtless there are many which have escaped ,my notice. Time is, as I have already said, the most essential element I f -for success in acute intussusception. Delay ought not to be occasioned by difficulties in diagnosis. The signs of acute intussusception are clear and unambiguous and ought not to be mistaken. They are acute intestinal obstruction, plus the discharge of blood and mucus from the bowel, plus a tumour. Blood is passed in half the cases and a tumour is equally often felt either by the rectum or in the abdomen. 23 By acute intestinal obstruction is implied the non-passage of Cseces or of flatus, followed by vomiting. These symptoms ;alone would not point to any particular kind of mechanical obstruction, but the coexistence of the other two or of one of them would leave but little doubt that the obstruction was -due to intussusception. I have refrained from referring to other symptoms which systematic writers discourse upon because they are equivocal And are of subsidiary importance and tend to confusion.
doi:10.1016/s0140-6736(02)05763-x fatcat:i44sfl6uwfcspel3bjn3ux5uka