Volume 3

Elements of surgery / by Robert Liston.

  • Liston, Robert, 1794-1847.
Date:
1831
Catalogue details

Licence: Public Domain Mark

Credit: Elements of surgery / by Robert Liston. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    drawn upwards previously to making the incision, in order that they may afterwards overlap the wound. A cautious opening is then made through the inter- costal muscles, and the pleura punctured. This is im- mediately followed by forcible ejection of fluid. The wound of the pleura is then enlarged by a probe- pointed knife. The thrust of a trocar, or sharp- pointed bistoury, is here inadmissible, as in some cases the diaphragm, perhaps the liver or stomach, or even the lung, might be wounded. The fluid at first escapes rapidly; afterwards it is ejected chiefly during expiration. After its discharge, a tent is placed in the wound, over which a compress, and the chest is firmly bandaged. The closure cannot be maintained safely longer than twenty-four hours; the dressing must be undone, the tent removed, and the matter again allowed to flow. I would certainly not recommend any attempt to heal the wound by the first intention. In consequence of continued closure, the secretion soon becomes very profuse, mixed with blood, and of a putrid nature ; irritative fever is established. The treatment principally con- sists in obtaining gradual, and at the same time free evacuation of the fluid, restraining the motions of the chest, and supporting the general strength. As the discharge ceases, the lung may in part expand; it may, however, continue collapsed, become consoli- dated, and the chest fall in. In neglected cases, ab- sorption of the intercostal substance takes place ; the integuments bulge outwards, and distinct fluctua- tion is perceived. The skin has been allowed to be-