On some complicated cases of abdominal section / by John D. Malcolm.

  • Malcolm, John David.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On some complicated cases of abdominal section / by John D. Malcolm. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    days later a large tender mass was felt behind the uterus. There was also a very tender point close to the fundus of the uterus, between it and the anterior abdominal wall. The pain here was greatly aggravated by any upward pressure on the cervix. On the twelfth day the mass in the pelvis was larger, and elongated towards the left loin. There was some abdominal distension, and always much pain before flatus passed. The wound was completely healed over, but the temperature had gradually risen since the eighth day to 102 *4°. I stopped all food by the mouth, and ordered rectal feeding, with twenty minims of tincture of belladonna every six hours. Next day there was much pain, and opium was substituted for the belladonna. The bowels were repeatedly moved by enema. The abdominal distension and the mass in the pelvis both diminished, but the tenderness on touching the uterus continued. The temperature gradually fell, till on the eighteenth day it was below 990 in the vagina, the pulse being then 64, and flatus passing without pain. Rectal feeding was now discontinued. On the twentieth day the wound reopened and several drachms of pus escaped, appa- rently from between the uterus and the abdominal wall. After this pressure on the uterus caused no pain. The dis- charge soon diminished, and the temperature did not again rise above 990 in the vagina. The wound finally healed on the twenty-sixth day. The large mass behind the uterus was now quite soft and free from tenderness. It gradually became imperceptible, being evidently bowel distended by feces. Of these patients, the three who got well were all delicate women, and in this respect were in marked contrast with the fatal cases. Yet they recovered in spite of the occur- rence of deep-seated suppuration. A study of such cases seems to show that so long as the lumen of the bowel remains open and peristalsis is effective, an inflammation in the neighbourhood of the peritoneum, or even within the peritoneal cavity, if there be no fistula, is not more dangerous than any other deep-seated inflammation of like extent. This view gives the best key to the explana-