The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare.

  • Edward Martin
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The surgical treatment of wounds and obstruction of the intestines / by Edward Martin and H.A. Hare. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    and renewal of distention, and ]>rovision slioidd be made for re- l)eatcd irrigation with hot (100-110° F.) sterilized salt .solution (sevea-tenths of one per cent.), several tubes being carried to the various parts of the al)dominal cavity, and the latter l)eing flushed out ever}: hour until the formation of adhesions prevents this. Nothing should be given by the mouth except intestinal anti- sejjtics such as naphthol, salol, or salicylic acid. As stimulants are most important they should be given freely, either by the rectum or, better, by means of hypodermic medica- tion, thus saving this portion of the bowel for the absorption of peptonoids and other nutrient enemata. For this purpose an ounce of brandy may be dissolved in eight ounces of sterile water and slowly injected by means of gravity into the subcutaneous or mus- cular tissues of the buttocks, abdominal walls, or other thick, fleshy region. For sudden prostration, hypodermics of ether, twenty minims pure, forced directly into the muscles, and re- peated six or eight times at short intervals, will be found most efiicacious. Progressive Suppurative Peritonitis. — The advice of Treves in the treatment of this condition, as developed by in- flammation about the caecum, that is to open and evacuate the purulent collections without breaking through the wall which separates them from the rest of the abdominal cavity, should dominate the surgeon in the treatment of this form of peritonitis, no matter what its origin or seat may be; and it is to the neglect of this practice that many deaths must be ascribed. Mikulicz operated upon five cases of this character. On two of these cases he operated several times, opening each new accumulation of pus as it was discovered. The cavities were washed out ^vith salt solu- tion ; even if the gut was perforated, no attempt was made to suture it unless the wound was accessible; drainage was provided for by iodoform gauze tamponade; a few sutures were placed in the parietal wound. The two cases thus treated recovered, while three treated in the usual manner perished. In these cases there is often no great urgency; the course is one of weeks or even months. Suppuration is denoted by hectic or simply by night-sweats and by loss of flesh and strength. Sooner or later dulness on percussion, local pain or tenderness, and the