A Case of Abdominal Nephrectomy for Cystic Kidney; Recovery

Abstract

4) Finally, we have certain signs more or less special to drowning which, taken in connection with the signs already referred to, make our diagnosis in many cases positive. Some, perhaps all, of these signs, yet require investigation to thoroughly determine the limits to which their value is confined ; and I shall take the liberty, even in this assemblage of experts, of calling some attention to this part of the subject.(1) Bilateral lacerations of the sterno-cleido mastoidei and pectorales majores. These are mentioned by Paltauf only; more observations are needed.(2) Liquid in the pleural cavities ; lesions to which this might be due being absent. Comparative analysis ought to be made of this fluid, of pleural effusions, and of the liquid that collects in the pleural cavities in consequence of putrefaction.(3) A fine-bubbled, watery, whitish or rosy froth, non-adherent to the walls of the air-passages, in which it is found. Inasmuch as the most eminent authorities are not agreed that this can, by any physical characteristics, be distinguished from the similar froth found in other forms of suffocation and in certain diseases, let us make comparative analyses of all these froths and determine, if we can, any chemical differences that exist between them.(4) The presence of the drowning fluid in the very small bronchi and the alveoli, with or without suspended foreign substances. The question still at issue here is, How deeply can fluids penetrate into the bronchi after death ?(5) An infiltration of the pulmonary parenchyma with fluid. The presence of pleuritic adhesions will enable us to distinguish this conditiou from edema in many cases.(6) Subpleural extravasations of the drowning fluid mixed with a little blood.(7) Increase in the volume of the lungs, associated with increase of absolute weight, increase of specific gravity and a peculiar doughy consistence.(8) Demonstration of hemorrhagic foci where the bronchioles enter the alveoli.(9) Presence of water in the stomach. The very fact that this may enter after death is still contested, and we only know in regard to the conditions necessary for such entrance that it is favored by pressure, for example, by the body being sunk deep in the water.(10) Water in the intestine. Unless great pressure is brought to bear on the body, water will not pass from the stomach to the intestine. How much pressure is required and the influence exerted by putrefaction upon this pressure, we have yet to learn.(11) A special and extreme hydremia of the liver. I cannot believe that it accords with the true scientific spirit to ridicule, as some authors do, the statements of Lacassagne on this point. Careful comparison of the condition in this respect, of livers of persons dead of all sorts of violent deaths would be much more to the point.(12) An actual dilution of the blood with the drowning liquid.In conclusion, gentlemen, I wish to say that I have refrained from enumerating my sources of information, with the object of shortening the time required for the reading of my paper. I sha...