Remarks of the management of cases of abdominal section / by John D. Malcolm.

  • Malcolm, John David.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Remarks of the management of cases of abdominal section / by John D. Malcolm. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    septics have been carefully used in a fairly simple case, but I have seen suppurative peritonitis resulting from a simple operation when no antiseptic had been used. The fourth point, namely, the precautions by which all unnecessary interference with the functions of the parts concerned may be avoided, especially in relation to abdominal surgery, is the subject to which I desire shortly to invite attention, the measures to be adopted to secure this end being of interest to every practitioner, whether engaged in general or special practice. The preservation of function in the parts operated on should never be neglected by the surgeon, although the cases are, unfortunately, only too numerous in which a sacrifice must be made. The pectoral muscle, for instance, must sometimes be removed in the operation for complete extirpa- tion of a carcinoma of the breast; but when the surgeon has to remove the glands of the axilla, he should most carefully avoid interference with the large vessels and nerves in this neighbourhood, because their division might involve not only the loss of power in a part of the arm, but perhaps also the , loss of the whole limb, or even of the patient’s life. So, in operating on the larynx, means must be taken to prevent a flow of blood down the trachea ; in operations on the eye, vision must be preserved, if possible; and certain portions of the brain must be for ever exempt from surgical interference, j The surgery of the abdomen may in some respects be i compared to that of a large joint, for example, the knee. ] When any operation is performed which involves opening the j serous cavity of this joint, the surgeon, besides removing the i disease, endeavours to ensure the healing of his wound, and either the restoration of free movement in the limb or its fixation in the position likely to be most useful to the patient. ‘ In abdominal surgery, it is also necessary that those parts which are naturally movable on each other should be so treated as to remain movable, or to become fixed in such positions that their functions will not be seriously interfered with. But there is this important difference in the two cases, that the worst effect of a want of movement in a joint is a loss, more or less complete, of usefulness of the limb; ' .