Reviews and Notices of Books

1884 The Lancet  
Under the care of Mr. KOUGH.) FOR the following notes we are indebted to Mr. J. W. Batterham, B.S. Lond., house-surgeon. J. J-, aged twenty-six, while at work as a " shunter " on July 24th, 1884, at 12'30 A.M., was crushed between a railway engine and the buffer of a "goods" van. When admitted into the hospital half-an-hour after the accident, he was conscious, and complained of thirst and of great pain over the lower part of the abdomen. The skin generally was cold and pallid but the face was
more » ... f a dusky hue. The pulse was just perceptible. No fracture of the ribs or pelvis was discovered ; the abdominal walls were extremely retracted; there was dulness on percussion over the hypogastrium and the flanks. A few drops of bloody urine were drawn off by catheter. The patient had no desire to pass urine. There was no vomiting or retching, and only once did the patient complain of nausea. He became rapidly weaker, and died about two hours after admission. Neeropsy, thirty-six .hours after death.-A few abrasions were noticed on the trunk and thighs. There was very little post-mortem congestion of the dependent parts, the skin being remarkably exsanguine. Abundant punctiform ecchymoses weie noticed over the upper sternal region, neck, and face ; these ecchymoses ended abruptly about the middle of the forehead, being absent over the part presumably covered by the cap. There was a slight effusion of blood beneath the skin of the eyelids, as well as beneath the ocular and palpebral conjunction. On opening the thorax about two pints of blood escaped from the pleural cavities. The heart, which contained very little blood, was normal in appearance. No ecchymosis of the pericardium or endocardium was noticed. The lungs were shrunken, crepitant, and bloodless. On removing the thoracic viscera, suopleural extravasations were seen about the roots of both lungs and beneath the right costal pleura. Two extensive lacerations of the diaphragm were now apparent, one about five or six inches long, extending across the right division of the central tendon ; and a second, about an inch less in extent, extending through the muscular fibres behind the left division of the tendinous portion. Protruding through the rent on the right side was the posterior half of the right lobe of the liver. This portion of the liver was devoid of peritoneal covering, which appeared to have been reflected from it as it was thrust through the ruptured diaphragm. On the under surface of the right lobe was a small laceration an inch long and half an inch deep. Through the rent on the left side of the diaphragm had passed the spleen and the stomach. The latter, which was partially distended by fluid food, was intact. The left kidney was found lying in the rent. Very little blood was found free in the abdominal cavity, but there was extensive retro-peritoneal extravasation around the duodenum and kidneys. Both kidneys and spleen, more especially the former, presented lacerations extending in a radiate manner from the hilus. The pancreas was not lacerated, but presented several interstitial haemorrhages. The intestines, which were almost empty, were unruptured, and no part except the duodenum showed any signs of bruising. The bladder was intact, and contained about two ounces of bloody urine.
doi:10.1016/s0140-6736(02)27109-3 fatcat:yjowelzubbfabnmbhdhclpq7bm