A dictionary of practical surgery: comprehending all the most interesting improvements up to the present period: also an account of the instruments, remedies, and applications employed in surgery; the etymology and signification of the principal terms; a copious bibliotheca chirurgica; and a variety of original facts and observations / [Samuel Cooper].

  • Samuel Cooper
Date:
1818
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements up to the present period: also an account of the instruments, remedies, and applications employed in surgery; the etymology and signification of the principal terms; a copious bibliotheca chirurgica; and a variety of original facts and observations / [Samuel Cooper]. Source: Wellcome Collection.

    1088/1134 (page 1064)
    whether the weapon has penetrated the chest, or not. An opinion may be formed on this subject, by attending to several circumstances. 1. Surgical writers re- commend, tor this purpose, placing the wounded person in the same posture, in which he was, when he received the wound, and then carefully examining with a finger, or probe, the direction, and depth of the wound. 2. We are also ad- vised, if possible, to get the weapon, with which the injury was inflicted, and, by the bloody part, judge how far it has penetrated. 3. We are advised to inject some liquid into tlie orifice of the wound, and to observe, whether it regurgitates im- mediately, or lodges in the part. 4. The colour and quantity of the blood, emitted from the wound, are to be noticed, and whether any is c«ughed up. 5. We are to examine, whether the circumference of the wound becomes emphysematous, or any air escapes from its orifice in respira- tion. 6. Lastly, the state of the pulse and breathing is to be attended to. In treating of wounds of the abdomen, I have cautioned surgeons against being too officious in probing such injuries, merely, for the sake of gratifying their own curiosity. The same advice is equally applicable to the present cases. Surgical authors have, perhaps, dwelt too much on the subject of probing wounds of the ab- domen, and thorax, and their readers im- bibe an opinion, that, until they have traced the wound, with their finger, or probe, to its very bottom, and termination, they are not qualified to put in practice any surgical measures. The only advan- tage of knowing, that a wound penetrates the chest, is that the practitioner imme- diately feels himself justified in having recourse to bleeding and other antiphlo- gistic means, and thus averts inflamma- tion of the pleura, and lungs, which af- fection, when it has made progress, often proves fatal. However, there can be lit- tle doubt, that if the nature and depth of the wound cannot be readily detected, with the eye, the finger, or a probe, it is much safer to bleed the patient, than to put him to useless pain, irritate the in- jury with the introduction of instruments, and waste opportunities of doing good, which too frequently can never be recalled^ In short, it is better, and. more advantage- ous, for all patients, that some of them should lose blood, perhaps, unnecessarily, than that any of them should die, in con- sequence of the evacuation being omit- ted, or delayed. Almost all the writers, who have taken pains in directing, liow wounds of the thorax should be probed, conclude with remarking, that, however advantageous a knowledge of the direction and depth of wound may be, much harm lias fre- quently been done by pushing the at- tempts to gain such information too far, It is. perhaps, #f greater’ importance to ascertain, by some kind of examination, tiie extent of a wound, which does not reach beyond the integuments, or inter- costal*., than to know, whether the wound extends into the cavity of the chest. For, even when the pleura is found to be di- vided, if the wound is attended with no urgent symptoms, the information is of no practical use, if we make it a rule to adopt, without the least delay, a strict an- tiphlogistic plan of treatment, in all cases, in which there is any doubt, or chance of the parts, within the chest, being wound- ed, and likely to inflame. Besides, very frequently, the symptoms are more urgent and alarming, than they could be, were only parts on the outside of the thorax injured ; and, in these instances, it is ob- vious, that the employment of a probe can- not be necessary for discovering, that the wound extends into the chest. We have above adverted to inspecting the weapon, with which the wound was inflicted, as a mode of gaining some in- formation, concerning the probable depth of the wound. Enquiry may also be made, in what direction it was pushed j and, sometimes, the blood on the instru- ment will denote how deeply it penetrat- ed. It is clear, however, that though information ot this kind may be obtained, in a few instances, in genera], it is other- wise. U hen, by any of the above means, it cannot be learnt, whether the wound pene- trates the chest, or not, various authors recommend the injection of Iuke-warm water. It the water regurgitates at once, they conclude, that the injury is only su- peificial; but, when the fluid, either wholly, or in part, continues in the wound, without producing any external swelling, tney infer with certainty, that an opening has been made in the pleura. This plan of examining the state of parts, however, is much more objectionable, than the em- ployment of a probe ; for, if the liquid be propelled, with a certain degree of force, for the purpose of driving it to the bottom of the wound, parts, which were not be- fore hurt, will in this manner become in- jured. The fluid may also be injected into the cavities of the cellular substance, and may seem to be passing through the track of the wound into the chest, while, in reality, not a drop does so. Besides, is it a warrantable proceeding to try to insinuate any quantity, or kind, of liquid, whatever, between the pleura and lungs, m<o a situation, in which it must neces** sarily obstruct the important function of respiration, and caase serious inconveni- ence ? When air issues from the wound in