Kausch has found that it is impossible to determine whether or not the
intestines or other viscera have been injured, by the discovery of free
air in the abdominal cavity. This is an almost certain sign of
perforation, according to his experience, which has been wide and
varied. The army corps to which he is consulting surgeon has served in
turn in Belgium and France, Alsac, Galicia, Russian Poland and Serbia. A
very small incision will reveal whether there is free air in the
abdominal cavity. He makes the exploratory buttonhole for the purpose in
the epigastrium under local or general anesthesia. The thicker the
abdominal wall, the longer the incision, from 1 to 3 cm. The peritoneum
need be only punctured; a pinhead hole is enough. If air streams out, he
proceeds at once to a regular laparotomy. If not, the patient is spared
a major operation for the time being at least. He has had cases in which
a bullet passed through the abdomen, front and rear, without perforating
the gastro-intestinal tract. When there was perforation, death was
inevitable without operative relief, and he is convinced that his prompt
operating saved a certain proportion of such cases. No one was ever
harmed by the operation after an abdominal wound. Kausch was kept
informed by telephone where fighting was under way, so that he was on
the spot, ready to operate, before the wounded began to come in.—_The
Journal of the Amer. Med. Asso._