Evening star. [volume] (Washington, D.C.) 1854-1972, 1881-07-12
Here Similar. Cases
WHAT Dir. DEArER SAYS.

WHAT DIR. DEArER SAYS.
DIR. Dexter. Of this city. has compiled the fol-
lowing cases of gunshot wounds and other iuiu-
ries sustained by the liver which are of interest
at this time
TO the Editor Of Ehe G6r:-T forward to you
two or three cases of gunshot wounds and other
Injuries sustained by the liver, which may be of
interest to the general public at this time.
Of me following case which had the privilege
dent. was published I'm New York Medical Times
1881. by Ir. Leroy. resident surgeon under the
title OF "Punctured Wound of the Liver Fol-
lowed by Recovery"
VIM Craddock. aned q. New York. seaman.
admitted into New. i ork hospital July 4th 1851.
tDr. Post IN attendance.) with penetrating
wound OF the abdomen. caused by the premature
discharge OF horse pistol from which he was
endeavorlng to withdraw the ramrod. The rod
passed between his hands and struck the abdO-
men little to the right of tie metlian line
about an inch below the common cartilage of
the false ribs on that side. Upon Introducing
the niger and tracing the course Of the wound.
the liver could be: distinctly felt and on passing
It's extremity over the surface OF the organ a
laceratlon of 1t was detected that coTesponded
with the external opening. From the nature Of
the injury. its precise depth could not he ascer-
tanned Patient had on at the time of the acct
dent common c0lored shirt. with a red one be-
Meath it. The fragment of red flannel was
removed by the physician who attended him
previous To ms admission into the hospital. The
portions OF the cOlored garment were supposed
TO nave been carried in with the ralnred. Has
vOmlted several times since the accident: at
present suffers no pain; some difficulty in resp-
ration: Slight venous hemorrhage from the
wounds; pulse natural This was condition of
patient when admitted into hospital. July sxh-,
Iatlent passed comfortable night. July eth
Sllght tympanites had made It's appearance.
July 12th-No symptoms Of an argent character
presented themselves. The edges of the wound
snow signs of healthy granulation. Removed
several pieces Of cotton, which proved to
6e the missing portions of the coored shirt.
July 2Oth-Has had several paroxysns of pain
over the region OF the liver. and in the tight
shoulder; most intense in the evening. Respira-
tlon labored q per minute Pulse alternating
between u and 50. No undue excitement July
2lst-TO-day had his first chill. being the seven
teenth day after the accident July 22d-Another
chill, followed by great prostratiOn. July 23d-
GeherA condition very unfavOrable. countenance
ha2gard = hot surface = inspiration labored.
cough, with pain in the side. Pulse 90. Pros
tratlon continues. July 24tlh-The graver sylnl,-
toms controlled under the adopted treatment.
YET complains of pain in the side and difficult in
spiratlon July 3Oth-Has had four distinct c,,illS
during the last "a hours, patient greatly pros
trated Wound entirely healed. August 4th-
No chills for the past four DAYS The whole sur
face of the trunk covered with suppurating boils.
occasionmg great constitutional irritation. upon
tnelr subsiding, marked improvement occurred
ana patient commenced gaining in flesh August
l6th-Snce last date an abscess has formed and
pointed IN the original wound. opened sponta-
neousiy gave exit to a greenish discharge. pus
apparently tlnged with bile; upon its ceasng the
wound again closed, and he was discharged
cured.
Another case reported by j. C. Massie. NJ. D.,
Houston. TeXas-New Orleans Med. and Surg.
Journal, 1S52-"WOund of the Liver; ExcisiOn
OF Large Portion of the Right Lobe-recovery"
Was summoned the fourth day after the ecc-
dent to youth seven years of age, the whole
load OF large shot from a gun having passed into
the right hypOch0ndrium and mostly out about
the region of the spigastrium. Found him i'm a
very deplorable situation; the anterior margin
OF the right lobe of the liver was prOtruding
through the cavity on the right and a few
lines above the nmbiGcus it was in gam
grenous condition, with a portion of the omen
tum attached; the substance of both was so
much altered it was really difficult to tell what
the prOtruding portion was: the abdomen very
tense and hard. the least pressure giving severe
pain: great arterial excitement. high infiani-
matory fever. My friend DR.. Black, as well
as myself. regarded the case in hope
less condition. informed his friends. after
making known to them the danger of
the operation that would remove the
gangrenous portion OF the liver. and give him all
the possible chance there could be left for his
life. The external character and appearance of
the wound Indicated that gangrene might have
extended within the abdominal wallis Having
enlarged the wound or external opening found
two shot had passed at least two and a quarter
inches from the inferior border of the liver pen
etIating through it, the substance of the liver
winch was In 1uxtapOsition to the wounds had a
thick, grumous appearance. with gangrenous
portions Under the circumstances determined
to excise every portion of the liver which had
the appearance here described The operation
resulting in the removal of One-half OF the right
lobe OF the liver. yet the patient made speedy
and positive recovery.
case which came under the observation of
Dr. Eve, while in India. is of interest A Hin
doc, aged between 60 and 20. was brought
distance OF SIX mites to HOwrah with spear
wound in the abdomen about three inches
above the umbiIicus and two inches to it's right.
through which triangular portion of the liver
protrnded, of about the size and shape of the
four fingers of the hand, lying side by side The
wound itself did not exceed an inch in length,
ana was completely chOked up by the liver The
man stated that he had been stabbed in the
dark about twelve hours previously, and that
the liver came through the wound as the smear
was drawn out. 1t was added that there had
been very copiOus hemOrrhage. but the liver
Itself was not wounded, though the patient
was in considerable pain, the pulse was very
little depressed. My friend. Dr.. c. NJ. Hender-
son. who was present, agreeing that it would be
impossible to return the protrusion without en-
larging the wound to the extent of several
inches, it was resolved rather than wait for the
tedious process of sloughng. to remove it by
the knife TO prevent hemorrhage ligature
was applied tightly round the base of the pro-
trusiOn, which was then cut Off
No attempt was made to return the portion of
the liver which still filed up the wound. as it
was desirable to prevent all risk of blood or of
bile being eXtrayasated into the cavity of the
abdomen. In nine days the ligatures came
away with a small slough of liver the wound
granulated and healed. and the man returned to
his home in three weeks. No bilious discharge
occurred from the graduating surface of the
liver. The portion of liver removed. after
having lost its blood, and being in spirits for
some weeks, weighed ~ ounces. Dr. Eve
takes occasion to remark that it is unnecessary
to aiude to the wounds of the abdomen gen.
orally of the liver in particular or to the ex-
traOrdinary recOveries from almost every variety
OF them. Such cases are innumerable