Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

    14/1282 (page 2)
    painful point, hardness, or elevation can be de- tected, the abscess may remain eoncealed until a large prominence, or the extension of the matter down the thigh, lameness, &c. make the nature of the case completely manifest. As the perito- neum, adjoining the abscess, is always thickened by the preceding inflammation, Conradi assures us, that there is no danger of the collection of matter bursting inwards. Some abscesses, indeed, have been so enormous, that the matter actually pushed the viscera out of their places, yet all this happened without any inward bursting of the disease. The whole danger depends upon the duration of the complaint, and the extent to which the matter spreads. the nature of the case, the use of emollient ap- plications, and the making of an early opening, generally bring the disease to a speedy and fa- vourable termination.— (See Arnemann’s Maga- zin fiir die Wundarzneiwissenschaft, 1 B. p. 175. 8vo. Gott. 1797.) Chronic tumors of the mesentery, which, in scropbulous children, sometimes terminate slowly in suppuration, and diseases of the ovary, and other abdominal viscera, bringing. on the forma- tion of matter, are often the cause of purulent extravasation, great emaciation, hectic symptoms, and death. However, sometimes salutary ad- hesions are produced between the viscera, by which means an outlet is obtained for the matter through the bladder, anus, or vagina. ‘Thus (says Lassus) in the case of a woman who had had for a long while pains in the right lumbar region, supposed to proceed from suppuration of the kidney, because pus was voided with the urine, the right kidney was found after death in the natural state; but there was an abscess in ‘the right ovary, which was adherent to the bladder, into which the pus had passed through an ulcerated communication. In another patient, who had voided pus by the anus, the right kidney suppurated, and adhered to the colon, with which ‘it communicated by a preternatural aperture. For many years, a woman had a hard tumor of considerable size in the abdomen: at length, the pain of it became intolerable; and just at the moment when her death was apprehended, an immense quantity of pus was suddenly discharged from the vagina. The pain abated ; the swelling ef the belly subsided ; merely the remains of the induration were now perceptible ; and the woman’s health was perfectly re-established. (Lassus, Pathologie Chir. T. 1, p. 138.) The abscesses, which sometimes form between the peritoneum and abdominal muscles, or be- tween the layers of these muscles, or under the integuments of the abdomen, are attended with considerable variety, according as they happen to be chronic, or acute; circumscribed, or diffused ; small, or extensive. Those of the acute or phlegmonous kind sometimes follow stabs, and ‘contusions, and are particularly noticed in’ the article Wownds. They are cases, which demand “especial care, because, if not checked, they may prove fatal, many examples of which are upon record. (See Commerc. Literar. Noric. 1741, RP. 100; Eller, Medic. and Chir. Anmer- Hard indigestible substances, after being swal- lowed, are not unfrequently discharged from ab- scesses in some of the abdominal regions. (See De La Grange, in Museum der Heilkunde, 4 B. P. 154: a fish-bone, which had been swal- lowed, found in the abscess; Petit, Traité des Mal. Chir. T. 2,.p. 226: an awl, without a handle, extracted from an abscess of the abdomen ; and many other analogous cases.) Encysted tumors are sometimes formed be- tween the peritoneum and abdominal muscles, and _ attain an immense size, before they burst; a re- markable specimen of which is detailed by Gooch. (Chirurgical Works, Vol. 2, p. 144, &e. 8v0. Lond. 1792.) In this case, the spontaneous opening in the navel was enlarged with caustic, and the cyst extracted; but, before a cure could be effected, it became necessary to make a de- pending opening, and introduce a seton. Swell- ings of this nature, however, are only noticed here, on account of their resemblance to circum- scrited chronic abscesses of the parietes of the abdomen. Abdomen, Pulsations in the. From the article Aneurism, the reader will understand, that, though it be the common nature of this disease to be at- tended with throbbing, it is not every pulsating tumor that is an aneurism. The cases, usually called abdominal or epigastric pulsations, often furnish a proof of the correctness of the preceding remark. The authors, who have treated of the latter affection with the greatest discrimination, are Dr, Albers, of Bremen, and Mr. Allan Burns, of Glasgow, two gentlemen, whose high reputa- tions and useful labours will long survive the recent termination of their meritorious lives. Some of the pulsations, here referred to, are the consequence of organic disease, and capable of demonstration by dissection; while the rest are not attended with any such appearance, and have therefore been regarded as nervous. ‘The pulsa- tion is not always produced by the impulse com- municated to some solid tumor, or substance between the hand and the artery, but was con- ceived by Mr. Burns to be sometimes dependent on a nervous affection of the vessel itself. (On Discases of the Heart, p. 263.) Hippoerates, in his book *¢ De Morbis Popularibus,”” makes mention of three patients, affected with extraor- — dinary pulsations in the abdomen. As one of these cases seemed to depend upon obstructed menses, it was probably not the result of any organic disease. (JZippocratis Opera Omnia, - ex edit. Festi. Francof. 1621. lib. 5. sect. 7. p. 1144.) In order to remove a difficulty in be- lieving, how an- artery, not affected with aneu- rismal enlargement, can communicate to the su- perincumbent parts such movements as are fre- quently remarked in cases of abdominal pulsations, a fact pointed out by Mr. Hunter should be remembered: in speaking of the actual dilatation _ of an artery, he says, that when the vessel is ‘* covered by the integuments, the apparent effect is much greater, than it really is in the artery itself; for, in laying such an artery bare, the — nearer we come to it, the less visible is its pulsa- _ tion; and when laid bare, its motion is hardly to kungen, P. 108, &c.) As for chronic external abscesses of the abdomen, they should be opened early, and treated on the principles explained in - the article Leunbar Abscess. be either felt or seen.’’ (Treatise on the Blood, &¢. p. 175. 410. Lond. 1794.) And this ob- servation will apply to all tumors and indurations | situated over a large artery. In the epigastric |