Volume 1

Cooper's dictionary of practical surgery and encyclopaedia of surgical science.

  • Samuel Cooper
Date:
1861-1872
Catalogue details

Licence: Public Domain Mark

Credit: Cooper's dictionary of practical surgery and encyclopaedia of surgical science. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    DICTIONAEY 03? PEACTIOAL SURGERY. ABD Abdomen. The Belly. if the pelvis be reckoned as part of the abdomen, the latter maj'- be said to extend from the diaphragm, which fomis its upper boundary, down to the levatores ani, and, from the transversales muscles in front, to the spine, quadrati lumborum, and iliaci behind. Thus comprehensively viewed, the abdomen ap- pears to contain and protect all tlie organs of digestion situated below the oesophagus, together with the urinary and interna] organs of generation. Anatomists divide the abdomen into different rpQions,t\ie terms allotted to which are so frequent in the language of surgery, that some account of them in this Dictionary seems indispensable. In fact, without the knowledge of them, the patholo- gist can neither direct his inquiries witli precision, nor communicate clearly the results of his investi- gations to others. The abdomen has been divided into as many as nine compartments or regions, by four lines drawn arbitrarily between certain points, readily distinguishable on the surface, two of these lines are imagined to pass on either side from the cartilage of the eighth rib down to the centre of Poupart's ligament,—thus dividing the anterior surface of the abdominal paries into three longitudinal compartments,a central and two lateral. Each of these is again subdivided into three others by two lines extended transversely, the one between the lowest level of the costal car- tilages, the other between the highest level of the iliac crests of opposite sides, cutting the former per- pendicular lines at right angles. Partitions corre- sponding with these four lines are supposed to pass through the abdomen from its anterior to its poste- rior boundary, marking out the positions of the nine conventional compartments or regions into which the abdominal cavity is supposed to be divided. Enumerating from above downwards the three central of these regions are named the Epigastric, the Umbilical, and the Hypogastric ; the lateral are termed the Hypochondriac, the Lumbar, and the Iliac. The epiyasiiic region contains the middle part and the pyloric extremity of the stomach, the left lobe of the liver, the hepatic vessels, the lobulus spigelii, the pancreas, the cadiac axis, the semilunar ganglia, the aorta, the vena cava, and the crura of the diaphragm. The left hi/poc/iondrium contains the large end of the stomach, the spleen and narrow extremity of the ABD pancreas, part of the colon, the renal capsule, and the upper portion of the kidney. The right hi/pochon- driiim contains the right lobe of the liver, the gall- bladder, part of the duodenum, some of the ascend- ing colon, the renal capsule, and upper portion of the kidney. In the umbilical region are situated the transverse colon, the transverse portion of the duodenum, the aorta, ,the vena cava, and the con- volutions of the jejunum. The riglit lumhar region contains the ascending colon, the lower half of the kidney, and part of the duodenum. The left contains the descending colon, and the lower half the kidney. In the hypogastric region are the convolutions of the ilium, the bladder in children, and, in adults, both the bladder and the uterus, if distended. The right iliac contains the coscum, the ureter, and spermatic vessels, and the left iliac, the sigmoid flexure of the colon, the ureter, and the spermatic vessels. Although the upper boundaries of the abdomen are completely determined internally by the diaphragm, they remain quite undefined externally. The diaphragm being a movable partition between the chest and the abdomen, alternately ascending and descending in respiration, must by such changes have the effect of occasioning a corre- spondent enlargement or diminution of one of these cavities at the expense of the other. Without attention to this fact, mistakes in diagnosis would be very frequent. A sword, entering at the same point, and in the same direction, may penetrate the thorax, or the abdomen, or both cavities, ac- cording to the position of the diaphragm at the moment of the injury. The functions of the abdomen essentially re- quire that its capacity should be continually vary- ing ; and had its cavity been circumscribed by an osseous case, like that of the cranium, or by a construction like that of the parietes of the chest, such an arrangement would have been totally in- compatible with the offices of the abdominal vis- cera. So convinced is Crnveilhier of the facility with which the abdomen accommodates itself to the varying quantity of its contents, that he re- gards the doctrine as perfectly erroneous wliich refers the irreducible state of some hernia; to insuf- ficiency of space within the peritoneum. What! says he, can we suppose a cavity incapable of receiving the bowels again, which will allow of B