Essays on surgical subjects / by Sir Berkeley Moynihan.

  • Berkeley Moynihan
Date:
1921
Catalogue details

Licence: Public Domain Mark

Credit: Essays on surgical subjects / by Sir Berkeley Moynihan. Source: Wellcome Collection.

    250/284 page 232
    them; they may be of the utmost density, \ inch in thick¬ ness, so firm and strong that a separation with the finger alone is quite impossible. I have several times had to cut away, with the scissors, plates of lymph as thick as felt before I could liberate the compressed lung. As such ad¬ hesions are removed, the lung is seen to expand. It has been my practice always to separate every adhesion as the first part of the intrapleural stage of the operation. I have felt, rightly or wrongly, that the restriction of the free expansion of the lung by adhesions was to be con¬ sidered as perhaps the most essential point of the opera¬ tion. The separation of adhesions, except those of the toughest sort, is best carried out by the procedure of “gauze stripping” which is adopted in the separation of a hernial sac. On separating adhesions, cavities containing old blood-clot may be found. On one occasion such a cavity contained not less than a pint and a half of old blood-stained fluid of the colour and consistency of thick cocoa. On two occasions I have found the remains of an empyema which had not been opened. These conditions could not be discovered unless the adhesions were method¬ ically and habitually separated. The adhesions bleed freely, but the haemorrhage is very easily and rapidly checked by the pressure of hot moist swabs, one or two being left in the cavity while the operation proceeds. I have sometimes felt the projectile drop into my hand as the adhesions were being separated; the foreign bodies lay not so much in the lung tissue as in adhesions binding the two pleural surfaces together. When the lung is freed the projectile may be sought. It is easier to find a metallic foreign body in the lung than in any other part of the body. When the organ is gently grasped in the fingers a local hardness is felt at once. The
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