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Storer has given an abstract in the first number of this Journal, there was only one instance of fatal puerperal peritonitis.
Again, the opium masked the case dreadfully; for it produced vomiting at that stage of the case when there should have been no trouble with the stomach at all, and induced a tympanites that was mistaken for the same state brought on by peritonitis.
On 15th and 20th, two who did well. On 25th, I attended another. This was a severe labor, and followed by unequivocal puerperal fever, or peritonitis. She recovered. August 2d and 3d, in about twenty-four hours I attended four persons.
The point of rupture, however, then closed, and partly perhaps to the action of fresh infectious and toxic material, perhaps only to the perforation of the appendix, may be ascribed the exacerbation of the peritonitis, that is, a renewed attack which caused the death of the patient." Please note particularly: The appendix was found in a pus cavity a perityphlitic abscess.
The autopsy showed a gangrenous appendix and general peritonitis. How can these apparently anomalous cases be explained?
Colostomy, an operation designed to make a fistulous opening in any portion of the rectum, was first practiced by Littre. In early times the mortality of inguinal colostomy was about five per cent, but has been gradually reduced until Konig reports 20 cases with only one death from peritonitis, and Cripps 26 cases with only one death.
The patient died the fourth day after the operation, from peritonitis, and an autopsy showed the perforation and agglutination of the two intestinal curvatures. Getchell relates the description of a calculus in the vagina, formed about a hair-pin as a nucleus.
Here we were dealing with a well known and familiar phenomenon; if this occurs in the peritoneum the effects are particularly well marked; similarly as in the case of a phlegmon which rapidly disappears with the discharge of pus even although the inflammation extend beyond the pus focus, the symptoms of diffuse peritonitis promptly disappeared after the rupture.
Some of the more common diseases that call for a complete cessation of eating are: The acute stage of pneumonia, appendicitis, typhoid fever, neuralgia, sciatica, peritonitis, cold, tonsilitis, whooping cough, croup, scarlet fever, smallpox and all other eruptive diseases; colics of kidneys, liver or bowels; all acute alimentary tract disturbances, whether of the stomach or of the bowels.
The woman died in a few days from peritonitis. The gall-bladder was found close to the femoral ring, and showed a marked constriction. The liver was misshapen from tight lacing, elongated and drawn downward toward the ring. There was no evidence that any portion of intestine or other structure besides the gall-bladder had passed through the ring.
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