That a toxemia other than bacterial is a factor in the mortality of extraperitoneal rupture of the duodenum, an observation of two cases has convinced me. The fact that there was something different from the ordinary type of death from peritonitis was evident. The notes on the history sheets were made independently, and it was only later that the similarity of the observations was appreciated. The picture was especially emphasized in the second case in which the following statement was made evidently as a summary before the history was filed:
The appearance of the patient was almost suggestive of delirium tremens or more of an active toxemia. There were no positive signs of peritonitis, no vomiting and the bowels moved freely. The patient presented the appearance of death from toxemia other than bacterial.
The well-known observations and studies of Maury,1 Matthews2 and others give emphatic support to this
KANAVEL AB. DUODENAL TOXEMIA FOLLOWING RUPTURE OF THE DUODENUMWITH REMARKS ON EXTRAPERITONEAL RUPTURE AND A REPORT OF TWO CASES. JAMA. 1914;LXII(10):759–761. doi:10.1001/jama.1914.02560350019006
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