TUBERCULOSIS OF OS SACRUM TREATED WITH BISMUTH PASTE
Journal of the American Medical Association
explained), or even fecal. Diarrhea is said to occur in 40 per cent., frequently bloody. Early death from col¬ lapse before symptoms of peritonitis develop is the most common termination, the lowered vascular tone due to primary shock being so great that there is little or no absorption of septic products, though peritonitis some¬ times develops from gangrenous perforation in infarc¬ tions involving small areas. As there is nothing in the symptomatology to indicate the extent of infarction, the
... of infarction, the abdomen must be opened before this can be determined, and even in these few favorable cases where a probable diagnosis can be made early, portions of intestine that are apparently healthy but with a circulation seriously compromised may be left which will later become necrotic and cause the patient's death, or the primary shock may be so extreme as to make immediate operation extra hazardous and the sur¬ geon may be persuaded to wait for a reaction that, as a rule, never occurs. There have been instances of spon¬ taneous recoveries just as there are records of operative recoveries, but the mortality is dishearteningly great. If on opening the abdomen the entire small intestine is seriously involved, operative measures are obviously use¬ less.