Volume 1

A treatise on foreign bodies in surgical practice / by Alfred Poulet.

  • Poulet, Alfred, 1849-1888.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on foreign bodies in surgical practice / by Alfred Poulet. Source: Wellcome Collection.

    30/290 (page 16)
    through seven or eight metres of the intestines without any detriment to the economy. It is not necessary to regard these examples of tolerance under the same head as those in which the object, after having traversed half the body without any accident, attracts attention by appearing upon the sole of the foot. The tolerance of mucous membranes really exists, therefore, whether the foreign body is movable or confined to a district which it does not leave. It is true, however, that the latter variety has furnished the most astonishing examples; upon numerous occasions, physi- cians have been greatly surprised at finding in the stomach of a lunatic, or other person, knives, forks, stones, and fragments of all kinds, the presence of which had been unknown. If pains are taken to examine the vermiform appendix in all cases, we do not doubt that a large number of examples would be found in which nuts, seeds, etc., are lodged in its in- terior. Absolute indolence in such cases is not a rare event, and a six livres piece has been found in one case, and a shoe-buckle in another, which had not been voided for more than twenty-five years after inges- tion. Tolerance of Migratory Bodies. Foreign bodies which traverse a certain distance in the tissues with- out producing any symptoms, and which have therefore been termed mi- gratory, arise from two different sources ; some, introduced through the natural passages, only enter the tissues after having perforated the walls of the canal from within outward ; the others belong to the groups of foreign bodies from effraction, and have perforated the skin. They include especially pins and needles, or similar bodies which are pointed at one end, and which may also progress without irritating the parts and even without wounding them : the spikes of grasses, and gran- ules of lead may also act in the same manner. It is more difficult to ex- plain the presence of large bodies, such as a piece of spoon, under the skin ; in a case of this kind, reported by an author, migration could alone account for its presence in the scapular region. A few general laws govern all these cases, such as the following : a. All migratory foreign bodies travel along the thickness of the tis- sues, and especially in the cellular tissue without being surrounded by a protecting envelope. b. The direction in which they advance is not always indeterminable, and they have a manifest tendency to obey the action of gravity, and also to approach the skin. c. Their harmless?iess is so much the greater, the more deeply they are situated. These propositions require further explanation. When migratory foreign bodies are found lost in the tissues upon autopsy, they are very rarely enclosed in an envelope, at least if they are not superficial. In all cases it is impossible to follow the track of the path which they had pur- sued through the tissues. Not alone that the patient possessed no knowl- edge of it, but even perforation of organs as sensitive as the intestines has given rise to no symptoms. Nevertheless, in some cases the number of the foreign bodies was so great that the body was literally covered with cicatrices caused by their extraction. Villar's1 patient had upon the 1 Diet, en 60 voL, T. VII., p. 66.