Book Description

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1900 edition. Excerpt: ...he concluded that one case in every seven or eight, or about 13' 4 per cent., terminated in this manner. This estimate has been generally accepted by subsequent writers, notwithstanding the fact that the calculation is vitiated by several obvious sources of error. Thus, in the first place, it is probable that the proportion of recoveries from the disease is far more than 50 per cent., a modest estimate being that two out of every three ulcers heal during life (p. 34). Secondly, the method of collecting isolated cases of the disease is open to serious objection, since it is only when some striking event, like perforation or fatal haemorrhage, occurs that the case is deemed worthy of publication. Lastly, many of the authors whose statistics Brinton accepted made no distinction between perforation with general peritonitis and that which gave rise to localised abscess. Welch came to the conclusion, from the study of a large number of autopsies, that the accident occurs in about 6% per cent. of all cases, while Engel estimates its frequency at 5% per cent., and Miquel at about 2 per cent. Owing to our inadequate knowledge of the frequency with which cicatrisation takes place, all computations based upon post-mortem statistics must necessarily be imperfect. A more trustworthy method is to observe the number of times perforation occurs in a large series of clinical cases. Thus, out of the 252 cases which came under the care of Lebert, nine, or 3'5 per cent., died from perforative peritonitis, and in our own series of 265 cases of chronic ulcer the death rate from this cause amounted to 51, -per cent. If due allowance be made for those that are lost sight of before a cure has been effected, and for that not inconsiderable class where secondary...