The surgery of Egypt / [Frank Cole Madden].

  • Madden, Frank Cole.
Date:
1919
Catalogue details

Licence: Public Domain Mark

Credit: The surgery of Egypt / [Frank Cole Madden]. Source: Wellcome Collection.

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    the peritoneum is incised and opened up to the length of the skin incision. On incising the peritoneum blood may well up at once, generally in large clots, or in a steady stream. The masses of clot must be at once removed with sponges soaked in hot normal saline and a rapid but systematic search made for the bleeding point, starting at the liver and working across to the spleen and thence down the course of the colon on each side. Finally, the root of the mesentery is defined and the fan of this structure with the small intestine to which it is attached examined. All necessary repairs are done as they are found and ‘the pelvic cavity is cleared of blood and its various organs carefully investigated. In the course of this examination of the contents of the abdomen, bleeding points must be dealt with on sound surgical principles and, after a final swabbing out of the various pockets where blood clot might lodge, the abdomen is closed without drainage in the usual way. If pus or faeces is found in the perito- neal cavity search must be made for the torn or otherwise injured gut and the necessary repairs done; after which the case is treated entirely like a septic peritonitis and the abdomen freely drained, as will be more fully mentioned with appendicitis. All sponges must be counted and accounted for. Whenever it is possible to do so the abdomen is closed without drainage ; the peritoneuum being sutured with fine catgut on a round needle, the sheath of the rectus or linea alba with stronger catgut and the skin secured with clips. The after treatment of the patient is most important and, though it must vary, to some extent, with each individual patient, there are cer- tain broad lines, applicable to all abdominal operations, which have been gradually worked into a system with us and include most of the possible ordinary complications as well. I can strongly recommend the perusal of an article in the Practitioner for March 1910 by Herbert Paterson on the subject which, though I have only recently come across it, very closely follows the scheme our experience here has gradually evolved. I shall quote largely from this article as many of the points to be observed are so © clearly expressed. After the operation the patient must be lifted from the table to the stretcher, and from that to the bed, with the greatest possible care and gentleness. In this way the onset of vomiting may be prevented. The bed has been already warmed and properly prepared with hot-water bottles and the patient is put in it lying on the back, partly on the side, and well packed round with hot-water bottles. It is much more comfortable for the patient to put him not absolutely on the back but with his head turned to one side and a pillow under the opposite shoulder. As soon as he is sufficiently roused from the anaesthetic to be able to support himself to some extent, he is put into the Fowler’s position, either by means of a specially constructed bed made in three pieces, or by being sat up with a bed-rest, and a bolster placed under the bent knees and tied by ropes at either end to the head of the bed. At night he may be turned on the side to sleep but still kept up. The Fowler position should be maintained for four days at least, and most patients find it so ‘comfortable that they ask to have it left for many days longer. It is the best position for all abdominal operations; but especially for suppurative peritonitis in which the peritoneal cavity has been drained, asit allows all