Disease of the Fallopian tubes and histories of fourteen cases operated upon and reports on specimens.

  • Wylie, W. Gill (Walker Gill), 1848-1923.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Disease of the Fallopian tubes and histories of fourteen cases operated upon and reports on specimens. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Either medium silk or silver wire is used in sutures for the abdominal walls. If the abdominal walls are thick from adipose tissue, as a rule, the peritoneum will be found tense, and require more than usual care in closmg properly. In such a case, after jnitting in from three to six silk sutures through the skin, fascia lata and peritoneum, the peritoneum should be carefully closed with catgut sutures, and the fascia lata also separately closed in the same way. Then the first silk sutures should be closed, leaving room between them, in two or more spaces, for short drainage-tubes placed upright so as to drain the adipose tissue between the fascia and the skin. Or if the walls are closed by silk sutures in the usual way, the skin, a little to the side of the cut, should be punctured so as to give vent to the grease that is certain to escape from the more or less bruised adipose tissue. I have seen mural abscess caused by this free fat, and it might enter the peritoneum and cause greater trouble. After sewing up and clean- ing the wound, it should be freely sprinkled with iodo- form and covered with a layer of absorbent cotton that has been squeezed out in one to five thousand mercuric bi- chloride, and over this several layers more of dry absor- bent cotton, so that the whole abdomen will be evenly compressed when the adhesive straps and band are put on. Over the cotton a folded towel and mackintosh are placed, and firmly compressed by adhesive straps and a bandage. Except where a drainage-tube is inserted, this dressing can remain until the eighth or ninth day, when the sutures are removed, unless oozing appears through the dressing, or a rise of temperature takes place indi- cating septic poisoning, etc. In cases with extensive ad- hesions or in pyo-salpinx, especially where the tissues are infiltrated, we must expect a moderate rise of temperature during the first two or three days, caused by the small amount of septic material left in the pelvis ; but this is readily absorbed and the local peritonitis caused by it soon subsides, and on the fourth or fifth day the tempera-