A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1823
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    ived by another portion, introdu- ced by the other finger. The second piece be kept up, in (he same way, bv the finger used to return it; and so on,'till the displaced parts have all been put into their natural situation. In attempting to reduce a piece of pro- truded intestine, the patient should be placed in the most favourable posture : the head and chest should be elevated, and the pelvis raised with pillows. Nothing can be more absurd, than the advice to put the thorax rather lower than the pelvis, in order that the weight of the viscera may tend to draw inward the protruded parts.' This is another erroneous idea, arising from the ridiculous supposition, that a great part of the abdomen is actually an empty cavity. The relaxation of the abdominal muscles is a much more rational and useful object. When this is properly attended to, and the above directions observed, and the wound is not exceedingly small, in relation to the bulk of the protruded viscera, the parts may generally be reduced. But in addition to what has been already stated, it is neces- sary to remark, that the pressure should be made in a straight direction into the abdo- men ; for when made obliquely, towards the edges of the wound, the parts are liable to suffer contusion, without being reduced, and even to glide between the layers of the abdominal muscles, and become strangula- ted. When the wound is in the front of the abdomen, pressure made in this unskilful way may force the viscera into the sheath of the rectus muscle, and cause the same perilous symptoms as arise from an incarce- rated hernia. (See Hernia.) When the reduction seems complete, the surgeon should assure himself of it, by in- troducing his finger into the cavity of the abdomen so as to fee! that the parts are all actually reduced, and suffer no constriction between the edges of the wound and the viscera in the abdomen. A difficulty of reduction may arise from the protruded intestines being distended with feces or air. In this circumstance, the contents of the gut may frequently be made to pass by degrees into thitYkpflr.tson of the intestinal canal, which is within the abdomen. In order to accomplish this pur- pose, the surgeon must press the contents of the bowel toward the wound ; and, if he succeeds in emptying the part, he will com- monly experience equal success in his next attempt to replace it in the abdomen. Sometimes, in cases of narrow stabs, considerable pieces of intestine protrude, and cannot be reduced without doing im- prudent violence to the bowel. Under these circumstances, the dilatation of the wound is indispensable. However, when the reduction seems almost a matter of im- possibility, on account of the smallness of the wound, if the surgeon be careful to re- lax the abdominal muscles, draw a little more intestine out of the wound, and gently press the contents of the bowel through the constriction into the. abdomen, he will fre- quently succeed in reducing the parts, with- out using the knife. When such operation is unavoidable, the dilatation should be made in a direction which will not endanger the epigastric ar- tery, and, if possible, in the same line as the muscular fibres. We are also advised to make the incision upward rather than downward, when it can be done with equal convenience, be- cause it is supposed the first direction will be followed by less danger of hernia. (Sa- ba! ier, Mtdeeinc Operaloirc, T. 1, p. 220, Ed. 2. Callisen, Si/st. Chir. Hod. T. 1, p. 705.) If, however, the upper angle of the wound correspond to the direction of the suspensory ligament of the liver, writers advise making the dilatation at the lower angle, in order to incur no risk of hemor- rhage from the umbilical vein. In the adult, this vessel is generally obliterated, and turned into a ligamentous substance : though it would appear that, in a few in- stances, it remains pervious to the navel. Hildanus saw a young man die instantly in consequence of a stab in the belly between the false ribs and the umbilicus ; and, on opening the body, he found blood effused from a wound of the umbilical vein. It has been feared, also, that cutting the suspen- sory ligament of I be liver might give rise to such a displacement of that viscus as would interrupt the freedom of respiration, or obstruct the circulation of the blood in the vena cava. But the apprehension is un- founded ; for Riolan found this ligament ruptured and retracted ton ards the liver in a nimble Ethiopian female dancer, whose respiration had not suffered any particular disturbance (luring her lifetime. (Sabrttier, Med. Optratoire. t. 1, p. 220, 221, Ed. 2.) The incision should never be larger than absolutely requisite, as hernia is much dis- poned to occur wherever the peritoneum has been divided. The operation may be done with a curved bistoury and a director, much in the same way as is done in cases of strangulated ruptures. (Sec Hernia.) , After the battle of Waterloo, many cases presented themselves in which the bowels and omentum protruded, and in several of these examples the reduction could not be effected before the wounds had been en- larged. So tightly also were the parts girt, that the operation was sometimes far from being easy. Instead of enlarging wounds of the abdo- men, it has been proposed to let out the air from the protruded intestines, by making small punctures with a needle, so as to lessen their volume sufficiently to make them reducible. The suggestion first origi- nated with Pare, who declares that he has practised the method with success. Rousset, his contemporary, also informs us that the plan was adopted by another surgeon in an instance where the epigastric region wa? wounded, and a large portion of the intes- tines protruded in a strangulated state. Pe- ter Lowe, an English surzeon, likewise azures us, that he frequently adopted the