A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (Volume 2).

  • Samuel Cooper
Date:
1810
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Licence: Public Domain Mark

Credit: A dictionary of practical surgery: containing a complete exhibition of the present state of the principles and practice of surgery, collected from the best and most original sources of information, and illustrated by critical remarks (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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    new irritation and inflammation must be unavoidably produced, by handling and sewing an influmed part. (P. 199.) Instead of such practice, this gentle- man very judiciously recommends di- lating the stricture, and leaving the subsequcnt progress of the cure entire- ly to nature. Tiie sloughs will be cast of]', and the ends of the gut are retain- ed by the adhesive process in a state of apposition to each other, the most fa- vourable for their union. Thus, there is a chance of the continuity of the in- testinal canal becoming established again. However, in recent wounds of the abdomen, attended with a protrusion of a portion of intestine, cut completely across, the bowel is as yet neither in- flamed, nor adherent to the vicinity of the wound in the peritonaeum, so that it is proper practice to connect the ends together,(as advised in the article Abdo- men, Wounds of the Intestines,) by means of a few stitches with silk, or thread, and a small sewing needle; and to con- fine the wounded part of the intestine, near the breach in the peritonaeum, un- til adhesions have had time to form. Mr. A. Cooper has recommended this mode of proceeding in cases of her- nia, attended with mortification of the whole diameter of the bowel; but, for reasons already stated, and many facts, referred to in Mr. Lawrence's work, it is to lie hoped, that the plan of sewing the intestines in these cases will be forever abandoned. OPERATION FOR VERY LARGE IN- GUINAL hernia:. When the tumour is of very long standing, is exceedingly large, perhaps extending half way down to the knees, and its contents have never admitted of being completely reduced, the indica- tion is to divide the stricture, provided a strangulation takes place; but without laying open the hernial sac, or attempt- ing to reduce the parts. The reasons, against the common plan of operating, under such circum- stances, are, the difficulty of separating all the old adhesions; the hazardous in- flammation, which would be excited by- laying open so vast a tumour, and the probability that parts, so long protrud- ed, might even bring on serious com- plaints, if reduced. J. L. Petit, and af- terwards, Dr. Monro, advised the sac not to be opened in operating on certain cases. (See Mai. Clur. torn. Il.p.372 Description of Bursa: Mucosa.) OPERATION FOR THE HERNIA, WHEN IT IS SO SMALL THAT IT DOES NOT PROTRUDE EXTERNALLY THROUGH THE RING. In this kind of case, there is little appearance of external tumour; conse- quently, the disease is very apt to be overlooked by the patient and surgeon, and some other caase assigned for the series of symptoms. The manner of operating, in this form of the disease, differs from that in the common scrotal hernia; the incision is to be made paral- lel to the direction of the spermatic cord, and the stricture will be found at the internal ring. (A. Cooper on Inguinal Hernia.) TREATMENT AFTER THE OPERA- TION. Evacuations from the bowels should be immediately promoted by means of glysters, oleum ricini, or small doses of any of the common salts, dissolved in peppermint-water. For some time, the patient must only be allowed a low diet. When symptoms of inflammation of the bowels and peritonaeum threaten the patient, general bleeding, leeches ap- plied to the abdomen, fomentations, the warm bath, blisters, doses of the oleum ricini, and glysters, are the means deserving of most dependence, and should he resorted to, without the least delay. When all the danger of perito- neal inflammation is past, and the pati- ent is very low and weak, bark, wine, cordials, and a generous diet, must be directed. The effervescing saline draught, with opium, is the best medi- cine for quieting sickness, after the operation. Opium and cordials are the most eligible for checking diarrhoea. As the operation does not usually pre- vent the parts from becoming protrud- ed again, a truss must be applied before the patient gets up again, and worn constantly afterwards. PROPOSALS FOR THE RADICAL CURE OF THE BUBONOCELE. We shall just mention the principal plans for this purpose; some of them are perfectly absurd and cruel; others may deserve more extensive trial. Of castrating the patient, applying caustic, or of the operation of the punctunj au-