Researches into the action of mercury, podophylline, and taraxacum on the biliary secretion : being the report of the Edinburgh Committee of the British Medical Association / by John Hughes Bennett, chairman and reporter.

  • British Medical Association. Edinburgh Committee.
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: Researches into the action of mercury, podophylline, and taraxacum on the biliary secretion : being the report of the Edinburgh Committee of the British Medical Association / by John Hughes Bennett, chairman and reporter. 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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    9. Introduce a portion of india-rubber tubing of the abovo calibre into the aperture in the gall-bladder, put a silk suture through it, and fasten it to the ligatures holding the fundus to the linca alba, in order that the tube may be kept from coming out. 10. Close the wound in the abdomen by interrupted sutures, placed deeply in the linca alba, and then connect the edges of the skin in the same way. The skin should not be closed completely around the tube, but should be left open for an inch or so, in order that blood maj' be prevented from accumulating. 11. The projecting extremity of the tube should be cut within a quarter of an inch from the abdominal wall, in order that when the dog lies on its face there may be less danger of closing the tube by its being bent upon itself. 12. The tube should be removed at the end of forty-eight hours or so, for then adhesions will in most cases have taken place between the gall-bladder and linea alba, which the continued pressure of the tube would only tend to break up. The dogs operated upon by the Committee were never kept muzzled after the operation, and no dog ever interfered with the elastic tube. 13. The operation should always be performed when the stomach is empty, for if distended it is a most serious-impediment to the operator. Yery soft sponges, perfectly freed from all sandy particles, should be used, and the greatest care should be taken to prevent hairs from getting inside the peri- toneum. 14. In male dogs the urine is apt to be discharged into the wound during the operation, and against this the operator must carefully be on his guard. 15. Great care should be taken to prevent bleeding into the peritoneal cavity. Any accumulation of blood inside the abdomen gives rise almost certainly to peritonitis. In all cases a little bile escaped into the peritoneum, but it seemed to produce no injurious effect. 16. The ligatures around the common bile-duct usually become encysted. The wound almost always heals by first intention; this union is very rarely permanent in the cutaneous wound, however; commonly pus is formed be- tween the skin and the wound in the linea alba. When such is the case, sutures must bo removed from the cutaneous wound to give free exit to the purulent matter. Ho lotions or othor dressings arc necessary for the wound. The bile as it flows over it forms an excellent dressing, under which healthy granulation proceeds, in most cases with rapidity. 1' • Tor two days after the operation the animal should be fed on milk, given in small quantities at a time, so that the abdomen may not be distended. The above mode of performing the operation differs from those described by other operators in two particulars :—1. The mode of fixing the fundus of the gall-bladder to the abdominal wall. Bernard recommends a clamp to fix the fundus to the edges of the wound, and act as a canula also. 2. In the non-removal of any portion of the common bile-duct. Other operators re- commend that two ligatures be applied to the common duct, one close to the duodenum, the other close to the junction of the cystic with the hepatic duct, and that the intervening portion should be excised. The object is to prevent as much as possible the reestablishment of the duct, a contingency which appears to have been very liable to occur in the experience of other observers. The shock produced by cleaning and removing the whole duct is very great, owmg to the extensive injury of the sympathetic nerves; and the danger from htemorrhage is most serious. Since the removal of any portion of the common bile-duct has been aban- c oned, the success attending the operations of the Committee has been un- precedented. In only two out of the thirty-three dogs operated on has the