A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (Volume 1).

  • Cooper, Samuel, 1780-1848.
Date:
1810
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    umes at the very lowest part of )hc sheath of the rectus muscle, and ihi*, as soon as the lodgment of matter ■ ily ascertained. Superficial wounds of the abdomen are to he treated on the same principles, as similar wounds in other situations. The indications are to prevent inflam- mation as much as possible, and, if •suppuration should be inevitable to let out the matter by a depending opening-, as soon as the abscess is known to ex- ist. The inflammation is to be check- ed by general and topical bleeding, low diet, emollient clysters, diluent beverages, rpiietude, and the mildest, and most simple dressings. (See In- ^animation.) Whenever the abdominal muscles are wounded, it is desirable to relax them; but, this object should not lead us to put the patient out of a horizontal po- sition. A very important point, in the treatment of wounds, which interest the parietes of the abdomen, is to afford a certain degree of support to the wounded part, when there seems the smallest chance of their being too weak to resist the pressure of the visce- ra. The parietes of the abdomen are almost wholly composed of soft parts, which easily yield. No part of the front, or sides, of the abdomen, is supported by the stability of a bony structure, and, as the viscera are, for the most part, more or less moveable, and close- ly compressed by the abdominal mus- cles, and diaphragm, they are very apt to be protruded, whenever the resist- ance of the parietes of the abdomen is not sufficiently potent. Thus very pe- rilous cases of hernia: ma}' originate. For the above reasons, all wounds of the abdomen, especially those in which both the integuments and muscles have been cut, demand strict attention to the precaution of supportingthe wound- ed part, and this, though the peritone- um itself should not happen to be divi- ded. The patient ought to keep as much as possible in a horizontal posi- tion, while suitable compresses and bandages should be applied to the si- tuation of the wound. In order to guard against the occurrence of hernia, the part should be supported, in this way, a considerable time after the wound is healed. The peritoneum being connected by means of cellular substance, with the inner surface of the abdominal muscles, there is always some risk of the inflam- mation of these muscles extending to the membranous lining of the abdomen. The occurrence must be averted by the rigorous employment of the anti- phlogistic treatment. What renders the event still more dangerous is, that when one point of the peritoneum is affected, the inflammation usually spreads with immense rapidity over its whole extent, and too often proves fa- tal. As superficial wounds of the abdo- men are to be treated on the general principles, applicable to all other wounds of this sort in other situations, it is hardly necessary to state, that union by the first intention is always, when pos- sible, to be attempted. OP WOUSDS PENETRATING THE CAVITY OF THE ABDOMEN. In these cases, the first thing, w hicli the surgeon is generally anxious to knowr, is, whether the wound penetrates the cavity of the abdomen, and whether any of the viscera are probably injured. When the wound is extensive, and any of the bowels protrude, the first part of the question is at once decided. But, when the wound is narrow, and allows none of the viscera to protrude, it is often exceedingly difficult to as- certain, whether the injury extends in- to the abdomen.) or not. An opinion, however, may usually be formed, by carefully examining the wound with one of the fingers, or a probe, after ha- vingputthe patient, asexactlyas possi- ble, in the posture in winch he was at the time of receiving the accident; by observing, if possible, the shape and dimensions of the instrument, with which the injury was done; how much of the weapon has entered the flesh ; the direction in which it was pushed, by attending to the quantity of blood, which the patient has lost, the state of his pulse, &.c. and, lastly, by observing whether there is any discharge of bile, faces, or other fluids, known to be na- turally contained in some of the abdo- minal viscera. When the wound is sufficiently large to admit the finger, we may always as- certain whether the injury extends into the cavity of the abdomen, because the viscera may then be easily felt. There is only one chance of deception, and that arises from a possibility of the practitioner's mistaking the inside of the sheath of the rectus muscle for the