On abscesses of the anterior abdominal wall / by J. Manley.

  • Manley, John.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: On abscesses of the anterior abdominal wall / by J. Manley. 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.

    1/12
    W A L L. i'f/ ON ABSCESSES OF THE ANTERIOR ABDOMINAL By J. MANLEY, M.D. PHYSICIAN TO THE CITY DISPENSARY. Read on Thursday, March 6, 1851. Of abscesses of the abdominal parietes Prof. Velpeau* remarks that they present so many vailed points for consideration, (tant de nuances a etudier), that a spe- cial treatise would be required to eluci- date all their peculiarities. A no less eminent authority, in this country—Mr. S. Cooperf—says “that abscesses be- tween the peritoneum and abdominal muscles, or between the layers of these muscles and under the integument, are attended with considerable variety, ac- cording as they happen to be acute or chronic, circumscribed or diffused, small or extensive.” The object of the present communica- tion is to call attention to those abscesses only of the anterior abdominal walls which are situated in or near the umbi- lical region. The following history of a case which last year fell under my observation may serve as introduc- tion :— Sarah Collins, setat. 3^, a child of dark complexion, well developed, with a fair proportion of adipose tissue, but of a somewhat lymphatic appearance, and with a naturally tumid belly, came under my care, at the City Dispensary, in the beginning of January 1850. She had been an out-patient since June 0th, 1849, presenting, as far as could be as- certained from the mother's imperfect report, symptoms of hectic fever,—viz., gradual loss of flesh and strength, with thirst and hot skin, but from what cause * Lemons de Clin. Chir., tom. iii. p. 377, Paris, 1841. t Diet, of Pract. Surg., p. 3, 7th edit., Lon- don, 1838. did not appear: during this state the bowels were reported to have been regu- lar. Towards the middle of December, 1849, and when her recovery was cousi dered nigh complete, her health again began to decline, and she frequently complained of pain in the abdomen, which became tense and swollen; the pain increased in severity, and, about a fortnight after the tumefaction of the abdomen had first attracted notice, a copious discharge of purulent fluid took place spontaneously through the umbi- licus : this has continued up to the pre- sent time (Jan. 14th). On examination, the umbilical region is found to be full and prominent; the integument has a dusky brown colour, as commonly ob- served in the vicinity of an abscess of some duration ; a discharge of purulent fluid, not exactly homogeneous, and of a yellowish colour, arises from the centre of the umbilicus, which no longer pre- sents the usual depression, but is pout- ing, and has the same dusky brown red colour as the surrounding integument. The quantity of discharge is now mode- rate. On pressing the swelling close to the umbilicus, pus is poured out in a thick stream through the fistulous open- ing, accompanied by small bubbles of a gaseous fluid. This circumstance pre- sented itself twice during the examina- tion : it had never been observed by the mother, probably from her never having attempted to make any pressure on the tumour. Pressure not only in- creased the discharge, but showed, also, that the pus did not come from the immediate vicinity of the umbilicus, but at some distance to the right of