The after-treatment of cases of abdominal section / by Christopher Martin.

  • Martin, Christopher.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: The after-treatment of cases of abdominal section / by Christopher Martin. Source: Wellcome Collection.

    23/60 (page 15)
    in hopeless cases to an inky black. The darker the colour, the worse the prognosis; and all the cases with black vomit die. Lastly, the vomiting may be due to true intestinal obstruction. This, in my experience, is a very rare complication, in spite of what some writers assert. I am of course aware that peritonitis paralyses the bowel and brings about a passive obstruction; but then it is the peritonitis which kills, and the peritonitis which calls for treatment. Where, however, true obstruction occurs, vomiting is a marked feature, and becomes faecal in appearance and smell. The vomit of peritonitis may be coffee-brown, but is never faecal. DISTENSION. One great advantage of the simple form of dressing described is that the whole abdomen can be kept under constant observa- tion by the nurse, and any change at once noted. Where it is hidden beneath multitudinous layers of gauze and wool and bandages, the early signs of peritonitis are apt to be missed and the all-important time lost. Acute general peritonitis, fully established, is as fatal a disease to-day as it was in the early days of ovariotomy. We know more of the causes of the disease and how to avoid them, and we know how to check the disease in its early and curable stage. It is therefore of supreme importance to at once recognise its onset, and treat it promptly. In nine cases out of ten the first sign of peritonitis is distension. The nurse must during the first week be constantly on the out- look for it, and as soon as it appears must commence antiperi- tonitic treatment. But not every case with distension has peritonitis. There is the passive distension of atony. A feeble elderly woman has a large ovarian tumour removed. Apparently the sudden relief of pressure favours the formation of gas in the bowel. Coil after coil becomes distended, and can be seen and felt through the thin flaccid abdominal wall. Now and then slow peristaltic movements can be observed creeping from coil to coil The distended abdomen is painless, perfectly soft and yielding to the hand, and does not yield the drum-like percussion note of peritonitis. The patient has no bad symp.