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.

    1116/1134 (page 1092)
    tine ; for, in a wound, there is, as we should suppose, no time for adhesion, nothing to keep the parts in contact, no cause, by which the adhesion might be produced. But, in an ulcer, there is a slow disease, tedious inflammation, adhesion first, and abscess, and bursting afterwards; some- times a fistula remains discharging feces, aud sometimes there is a perfect cure. If a nutshell, a large coin, a bone, or any dan- gerous thing be swallowed, it stops in the stomach, causing swelling and dreadful pain; at last, a hard firm tumour appears, and then it suppurates, bursts, the bowel opens, the food is discharged at every meal, till the fistula gradually lessens, and heals at last. But, where the stomach is cut with a broad wound of a sabre, the blood from the wounded epiploic vessels, or the food itself, too often pours out into the ab- domen, and the patient dies,” &e. (Dis- courses on Wounds, p. 321, edit. 3.) The au- thor afterwards proceeds to explain, how the compact state of the containing and contained parts, and the incessant and equable pressure, which the viscera sus- tain, frequently hinder effusion in cases of penetrating wounds. Which of these gentlemen is most cor- rect on the subject, I cannot pretend to say. Mr. Travers has certainly adduced a few cases, in favour of his own statement. Whether they are deviations from what is most common, can only be decided by a comparative examination of a greater num- ber of facts. When the intestines ulcerate, and thus rid themselves of foreign bodies, the general tenor of the cases on record un- doubtedly affords us little reason to be ap- prehensive of extravasation. Yet, with respect to ulceration of the intestines from other causes, circumstances may be very different. Mr. Travers’s account of the sub ject has very lately received some confirmation from an interesting case, published by Dr. John Crampton, assistant physician to Steevens’Hospital, Dublin. It is an in- stance of rupture of the stomach, and fatal effusion of its contents into the cavity of the abdomen. The patient was a young lady, aged 29. She was suddenly taken ill with spasm in her stomach, and other severe symptoms, and died in about twelve hours. “ On opening the abdomen, the stomach was observed to be pale, flaccid, and empty. Its contents, amongst which were recognized oatmeal and castor oil, had escaped into the cavity of the abdo- men, through a round aperture situated on its anterior surface, at the union of the cardiac and pyloric portions. This per- foration of the stomach was perfectly cir- cular, about the size of a pea, and appear- ed to be the result of an ulcer ou the raucous surface, which had gradually pene- trated the other coats. This ulcer was hollow and circular, nearly the size of a shilling, and had the appearance, as if it had been made with caustic, with the ori- fice in its centre.” (J, Crumpton in Med. and Ckir. Trans. Vol. 8, p. 230.) To the pre- ceding, Mr. Travers has annexed some additional facts: one is an example of a rapidly fatal effusion of the intestinal contents, through an ulcerated opening about a finger’s breadth below the pylorus. The foramen had a peritoneal margin, and proved to be the centre of an irregu- lar superficial ulcer of the mucous coat. Another case is that of a similar ulceration of the small intestines, and fatal extrava- sation of their contents. In another ex- ample, a circular aperture of the perito- neum, large enough to admit a crow’s quill, was found after death atthe junction of the duodenum and stomach. It also was the centre of an ulcer, that had destroyed the villous and muscular coats of the bowel to the extent of half an inch. For many other ingenious observations, I must refer the reader to Mr. Travers’s paper, who con- cludes with remarking, that the chief diag- nostic symptoms of these hopeless cases appear to be: 1. Sudden, most acute, and unremitting pain, radiating from the scrobiculus cordis, or the navel, to the circumference of the trunk, and even to the limbs. A peculiar pain, the intensity of which, like that of parturition, absorbs the whole mind of the patient, who, within an hour from the en- joyment of perfect health, expresses his serious and decided conviction, that if the pain be not speedily alleviated, he must die. 2. Coeval with the attack of pain, re- markable rigidity and hardness of the belly, from a fixed and spastic contraction of the abdominal muscles. 3. A natural pulse for some hours, until the symptoms are merged in those of acute peritonitis, and its fatal termination in the adhesive stage. (Travers, in Med. and Ckir. Trans. Vol. 8, p. 231, et set].) Blood is more frequently extravasated in the abdomen, than any other fluid. Ex- travasations of this kind, however, do not invariably happen, whenever vessels of not a very considerable size are wounded. The compact state of the abdominal viscera, in regard to each other, and their action on each other, oppose this effect. The action alluded to, which depends on the abdominal muscles and diaphragm, is rendered very manifest by what happens, in consequence of operations for herniae attended with alteration of the intestines, or omentum. If these viscera should burst, or suppurate, after being reduced, the matter which escapes from them, or the pus, which they secrete, is not lost in the abdomen ; but is propelled towards the wound of the skin, and there makes its exit. The intestinal