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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    tavity of the peritoneum. When the examination is made with a probe, we should be particularly cautious, in form- ing a judgment; for, the parts are so soft and yielding, that a very little force will make the instrument pass a consi- derable way inward. Every examination of this kind should always be underta- ken, if possible, when the patient is ex- actly in the same position, as he was at the time of receiving the wound. Injections have been employed for ascertaining, whether wounds pene- trate the cavity of the abdomen. This absurd experiment, however, has now been most justly exploded from prac- tice. It is well known to the moderns, that the space termed the cavity of the abdomen, is, in fact, completely filled with the various viscera, and that a fluid would, in general, not so easily find its way into the bag of the perito- neum, 4as an unreflecting person might suppose. If the injection were propel- led with much force, it would be quite as likely to insinuate itself into the cellular substance of the parietes of the abdomen, or, perhaps, into the sheath of the rectus muscle. The least tortuo- sity of the wound, or a piece of bowel, or omentum, lying against the internal orifice of the injury, would completely prevent an injection from passing into the abdomen. When a considerable quantity of blood issues from a wound of the abdo- men, we may pronounce, almost with certainty, that some large vessel, with- in its cavity, is injured. Excepting the epigastric artery, which runs in the forepart of the abdomen, along the in- ner surface of the rectus muscle, there is not one very considerable vessel, dis- tributed to the muscles andinteguments. At the same time, it is deserving of particular notice, that a very large ar- tery may be opened in the abdomen, and, jet, not a drop of blood mav be discharged from the external wound. A very huge quantity may accumulate in this manner, even without there be- ing any palpable swelling of the belly. In such cases, the subsequent symp- toms very quickly lead us to suspect a\ hat has happened. The patient com- plains of extreme debility and faintness ; .his pulse faulters; he has cold sweats; and, if the bleeding should not speedily cease, these symptoms are, in general, soon followed by death. Sometimes, the first glimpse is enough to shew, that the wound ex- tends into the cavity of the abdomen. The event is indicated by the escape ol chyle, bilious matter, fa:ces, or other fluids, known to be contained in some of the viscera. The same information may also be obtained from seeing a considerable quantity of blood vomited Up, or discharged by stool. The urine, however, may flow from a wound, which does not actually penetrate the abdomen, for the kidneys, ureter, and bladder may be said to be out of the abdomen, because they are really on the outside of the cavity of the perito- neum. When no symptoms of the above de- scription occur, when neither the fin- ger, nor probe, can be introduced; when none of the fluids, known to be contain- ed in the various receptacles in the ab- domen, are emitted from the wound: when the pulse remains natural, and the pain is not excessive, there is reason to hope, that the wound has not injured parts of greater consequence, than the integuments, and muscles. Encyclope- dic Methodique, Partie Chirurgicale. We have now taken a survey of such criteria, as are commonly noticed by surgical writers, for the purpose of in- structing the reader how to discrimi- nate a wound, which has penetrated the abdomen from one which has not. It is our next place to warn the practition- er, that too much solicitude to deter- mine this point, is very frequently pro- ductive of serious harm. It may be set down, as an axiom in surgery that whenever the probing of a -wound is nol rendered necessary by some particular ob- ject in view, it may, in general, be judi- ciously omitted. A narrow, oblique wound may enter the cavity of the ab- domen, without there being any parti- cular method of ascertaining, whether it has done so, or not. This, however is of no practical importance; for, when there are no urgent symptoms, evincing- the nature of the case, the treatment ought obviously to resemble that of a simple wound; and whether the wound is deep, or superficial, the antiphlogis- tic treatment is equally indicated The edges of a wound penetrating the abdomen, but, unattended with any obvnws injury of the viscera, are to be brought together by sticking-plaster just in the same way as common wounds. In this situation, sutures are more frequently proper, than i„ most others. Particular care is also to be taken to keep the bowels from protrif