The Indianapolis journal. [volume] (Indianapolis [Ind.]) 1867-1904, 1885-02-01
EXPLORING THE 1NrEsTrNEs.
Remarkable Surgical OperatiOn-Skillful
Treatment of a Serious Wound.


Treatment Of Serious Wound.
New York Tribune.
The abdominal cavity of man has always been
avoided by surgeons. Men of greater or less
emlnence, who would look with certain degree
OF professional pleasure upon an operation III
almost any other portion of the body, nave nesl
tated when the question of exploring this region
was raised and have listened to and shaped their
action upon the principle. when there is a
wound In the bowels from whatever cause, IL is
bad surgery to touch or probe 1t" ms posltlon
is not unreasonable when it is considered that
statistics show that of all the injuries inflicted
by bullets in peace or war, those received In the
abdomen have been most fatal In times OF war
there is, of course, better opportunity to Judge
of the effect of wounds made by bullets or
other means, and the records OF the Crlmean
and Franco-Italian wars and the civil
war In this country show that the mortality was
about 80 per cent. in cases whore the abdominal
cavity was penetrated, and Dr. OTIS IN the
Surgical History of the Rebellion" says thar
in cases where the intestines have been known TO
be pierced by ball there was not single recov-
cry. Surgeons generally say that more than nine
out of ten die from such an injury.
This great mortality is caused by the infiam-
nation of the abdominal cavity--peritonitis-
which follows the wound. The coats of the in
testines beingperforated by a bullet the contents
thereof escape, and the peritoneum THE mem
brane lining the interior of the abdomen and
covering the organs contained thereln) becomes
fatally. Some wonderful cases have been re-
corded whore patients have recovered from
wounds of this description, but they are
exceptional and the rule is that persons
shot in the abdomen die in spite of the most
sklllful and assiduous surgical treatment.
For many years surgeons in all countries have
discussed the propriety of exploring these
wounds searching for the bail, extracting 1T and
closing up the wounds in the bowels or stom-
ach after thoroughly cleansing the abdominal
cav witt pti III fud a
en- authorities among them DIR. Otis. OF the
United States army, and the late DR.. Sims. adj
vocate this bold method The great preponder-
ance of authority however has always been
against it, the argument being that it was much
more prudent to leave the patient to the mercy
of nature and trifng chance OF recovery than
to extinguish the chance entirely by surgical in
reference, which could only result in death from
peritonitis. So great is the antipathy to touch
ing these wounds that surgeons are advised by
some eminent experts that the examination of
them by the finger probe should never be
made for fear of causing inflammation This
subject was thoroughly discussed at the time
that James Fisk was shot by E. S. Stokes. and
at the trial of Stokes several surgeons testified
that it was bad practice to probe or examine the
abdominal cavity.
In the last few years. however. surgeons have
grown more bold, and surgery has consequently
made great advances, particularly In dealing
with tumors situated in the abdomen. Surgeons
of another age would have tainted at the sug-
gestion of sinking knife into the abdomen and
removing tumor, yet to-day the operation is
frequently performed and the death rate is not
more than ten ia one hundred cases. Even por-
tions of the bowels have been cut out and the
severed ends united by stitches in removing tu-
mors, and recovery has followed in large mum
Der OF cases. But the most brilliant case yet
recorded where newer methods of surgery were
prominently brought into use, is operation
recently performed at the Chambers street
Hospital In this case precedent was openly de-
fed and the attending surgeons with courage
and boldness equalled only by their skill and
delicacy, saved hnman life in all probability.
and performed an operation of kind that never
before had been attended with success.
William McEroy. truck-driver. age twenty
four, was accidentally shot in the liquor store,
No. 20 Essex street. Nov. 2, 1884, with thirty
two caliber pistol. He fell to the floor, but re-
manned conscious. An ambulance took him to
the Chambers street hospital, where exami-
nation showed that the ball had entered the alb
domen about two inches 20 the left of and a little
below the navel. The external wound was slight,
and the ball had stopped tat some point within
the abdominal cavity. The patient was put to
bed, suffering greatly from shock, and carefully
watched. Within few hours signs of extrava
sation appeared. His features were pinched.
his pulse feeble and tremulous. Excruciating
pains radiated from the seat of injury over the
whole abdominal region. and were attended
with signs of collapse. The muscular effort of
breathing was confined to the thorax, and there
was evident that the dreaded peritonitis
would soon be fully developed A consultation
was held, it was determined that death would
speedily enSue unless relief was afforded in
some manner, and heroic treatment was decided
upon. Within twenty hours after being shot
McElroy was transferred to the operating table.
Ether was administered and he soon became I'M
conscious Elaborate precautions were taken to
prevent the introduction of disease germs into
the wound. spray of vapor of carbolic acid
was played constantly into the room, which. to
maintain the temperature OF the body, was kept
at uniform temperature of eighty degrees.
The knives, forceps, needles and spongcs that
were to oe used were kept in warm solutions
An incision was first made into the external
wound and it was found to extend into the alb
do1ninal cavity. Considerable hemorrhage be-
gan, but the blood was absorbed by sponges
The incision was then increased to about eight
inches through the abdominal wall. the wound was
opened wide, and the intestines were exposed The
flow of blood increased and it ran into the alb
dominal cavity. After the hemorrhage was
brought under control the cavity was sponged
out and the search for the ball begun. small
section of the intestine was drawn carefully
through the opening at a time. thoroughly in
spected for decorations, and laid upon the breast
between layers of cloths that had previously
been wrung out of warm water. This process
was continued until the entire intestines were
taken out of the body. The bullet was found in
the last section and removed. 1t was found to
have penetrated the intestine in seven places.
AS fast as each wound was discovered, further
search was stopped until the lacerated portion
was sewed with extremely fine silk thread The
knots made in drawing the wounded surfaces to-
gether were left in position.
After al the wounds were closed the cloths
were carefully removed from the intestines and
they returned to their proper position within the
abdominal walls. The large incision was then
closed, and it as well as the bullet wound was
sewed up with silk. The operation lasted two
hours, and the patient was kept under the infiu
ence of ether the whole time Measures were
at once taken to prevent peritonitis. Morphine
was given in small doses by hypodermic iniec-
tons. A large coil of rubber tube was placed
the abdomen. through which stream of ice
water was constantly kept running. For two
days no naurishment was given through the
mouth the patients strength being kept up by
enemata of beef juice. This was done
to allow the stomach and bowels to rest,
and permit the wound made by the
bullet to heal. As soon as food could be given
properly McElroy gained strength, and in a
ivaly chopt TINA obl e;f -.