[Reprinted from 
The Philadelphia Polyclinic, 
Vol. IV, Nov. 30, 1895, No. 48.] 
A CASE OF ABDOMINAL SECTION FOR MULTIPLE GUNSHOT WOUNDS OF THE 
INTESTINE, COMPLICATED BY TUBERCULOUS PERITONITIS. 
BY THOMAS S. K. MORTON, M.D. 
John H., aged 32 years, colored, was ad- 
mitted to the Pennsylvania Hospital November 
3, 1893, at 1.30 a.m. He had been shot at 
close range with a 32-caliber revolver and 
had walked half a mile to the hospital a few 
moments after the shooting. Upon admission 
he was found to be conscious, but much intoxi- 
cated. There was a wound y2 inch below 
and y2 inch to the right of the umbilicus, 
through which a probe entered the abdominal 
cavity. Temperature was but by the 
time that I reached him this had mounted 
to 98° under active applications of heat and 
stimulation. Evidences of a large amount of 
blood in the peritoneal cavity were developed. 
Ether was administered and a five inch in- 
cision in the median line was made, having 
the umbilicus for its center. At once upon 
opening the peritoneum a great quantity of 
arterial fluid blood and some darker clots 
gushed forth. This was quickly found to 
originate from wounds of the mesentery. 
The incision was increased to eight inches 
and an assistant's hand was placed upon the 
aorta within the abdomen at as high a point 
as possible. This effectively controlled the 
hemorrhage while the bleeding vessels were 
taken up and ligated. Six wounds of the 
mesentery, ten of the small intestine, and 
one of the meso-colon over the origin of the 
internal iliac vein upon the left side, were dis- 
covered by systematic search. It was also 
noted that the man was suffering from tuber- 
culous peritonitis; the entire peritoneum be- 
ing studded with the typical nodules of that in- 
fection. Numerous old adhesions were found 
scattered throughout the abdominal cavity 
and considerably hindered the necessary 
Professor of Surgery in the Philadelphia Polyclinic and College for Graduates in Medicine. 
manipulations. There was free extravasation 
of the contents of the small intestine. The 
entire alimentary canal was loaded from 
esophagus to anus with undigested food and 
feces, which poured out* of the intestinal 
wounds upon the slightest handling. The 
bleeding from the mesentery was controlled 
by a few ligatures and through-and-through 
continuous sutures of silk. The intestinal 
perforations were closed with Lembert sutures 
of the same material. The ball was traced 
into the left psoas muscle, but was not further 
followed, as no bleeding came out of the mus- 
cular wound. A thorough irrigation of the 
entire abdominal cavity was made with hot 
salt solution. Glass drainage was employed. 
The time consumed by the operation, from 
incision to end of dressing, was one hour and 
fifteen minutes. 
Death upon the table was narrowly averted, 
but a lethal issue resulted four hours later 
from shock, incident, probably, to the great 
loss of blood before hemorrhage could be 
checked by pressure upon the aorta, compli- 
cated by the previously existing tubercular 
peritonitis. 
Post-mortem examination revealed no addi- 
tional wound and no more hemorrhage had 
occurred. All the wounds were found ade- 
quately sutured. The peritoneal cavity was 
absolutely clean and dry, save the tuberculous 
process and adhesions. The ball followed 
the psoas muscle, into which it had been 
traced at the operation, until near the pelvic 
brim, when it entered and lodged in the 
muscular mass of the pectineus and adductor 
muscles in the upper portion of the thigh.