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MEDICAL HISTORY OF THE CASE AND REMARKS BY DR. MUSSER.
I have reported with Dr. Wharton a case that was in many respects similar to this. In that case operation was done within ten hours after perforation, which accident fortunately took place while the patient was fasting, an incident corresponding to the course of the second case. In the second case the operation was done five and one-half hours after perforation. The first patient had not had solid food for twenty hours, and only a small amount of coffee eight hours before perforation. The second patient had been without solid food, and had taken only albumin water for from forty-eight to sixty hours. No opportunity to make a gastric analysis was given in the first instance, although it is presumed hyperchlorhydria was present, an extreme state of which was found in the second. Doubtless this excess of acid, unneutralized, contributed
MUSSER JH, KEEN WW. PERFORATING GASTRIC ULCER; POSTERIOR GASTRO-ENTEROSTOMY; FOWLER'S POSITION.. JAMA. 1904;XLII(11):691–692. doi:10.1001/jama.1904.92490560001001
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