Proceedings of the Westminster Medical Society. Nos. 1-3 (session 1848-1849).

  • Westminster Medical Society (London, England)
Date:
[1848-1849]
Catalogue details

Licence: Public Domain Mark

Credit: Proceedings of the Westminster Medical Society. Nos. 1-3 (session 1848-1849). 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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    rule of good practice, of common sense even, appears to have been violated in the treatment of these cases. When strangulation took place, instead of early reheving the stricture, the patient was left until almost dead; the surgeon, in the meantime, torturing him in all manner of ways, in order to prevent the necessity of an opera- tion, which was at last obliged to be performed under every dis- advantage, the gut being bruised, inflamed, or mortified, and the patient in a state of collapse, worn out by suffering, and the pro- longed yet abortive attempts at reduction. When the intestines, from the injury sustained, had lost their power of action, they were still more irritated and injured by the exhibition of purgative medicines, both before and after the operation; and yet those who pursued this practice, would most strenuously have deprecated the employment of purgatives in cases of idiopathic enteritis. Again, notwithstanding the patient was almost in a state of collapse, from the severe constriction exerted upon the intestine, his vital powers Avere still more depressed by the exhibition of tobacco, either in solution or in fumes, tartar-emetic, and other equally destructive agents. These points have been all lost sight of; even mortifica- tion and rupture of the intestines, and disease of vital organs, have been overlooked; and deaths occurring under such circumstances have been ascribed, not to their true cause, but to the opening of the sac, and classified accordingly. With respect to the remark made by Key, that in the usual operation, the majority of fatal cases are consequent upon the exposure of the inflamed or strangulated portion of the bowel caused by opening the sac, Mr. Hancock observed, that the history of strangulated hernia proves, by every-day experience, that the peritoneum may be cut with impunity. He is as willing to admit that, if the healthy peritoneum is cut or irritated, peritonitis may be induced, although this even does not always occur; but he argued, if an inflamed peritoneum is cut, the inflammation does not necessarily increase, especially when that inflammation results from some exciting cause removable by the incision. The operation then becomes a relief to the patient; whereas, when made in healthy peritoneum, it inflicts a violence on the part. He is supported in this belief by the observations of Sir Charles Bell, that a peri- toneum, when diseased, may be cut with greater impunity than when in health. The abdominal sections in ovariotomy prove this; the removal of large portions of omentum prove it; the operations of paracentesis abdominis prove it; and the success which attended the author's case of caecal disease also tends to strengthen the posi- tion. Again, in reply to the question, is the general peritoneal cavity laid bare by opening the sac ? the author observed, that the communication between the sac and abdomen is completely closed by the protruding gut or omentum, and that, even when the intes- tine is returned, it lies so close to the ring, that very little, if any, air can gain access to the abdominal cavity, even should it prove injurious in so doing, of which he had great doubts, having had patients under his care who, from wounds, have had the abdominal