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
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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.

    1117/1134 (page 1093)
    matter, effused from a mortified bowel, has been known to remain lodged the whole interval, between one time of dressing the wound and another, in consequence ol the surgeon stopping up the external wound with a large tent. When the abovemen- tioned action or pressure of the muscles, is not sufficient to keep the blood from mak- ing its escape from Ihe vessels, still it may hinder it from becoming diffused among the convolutions of the viscera, and thusthe extravasation is confined in one mass. The blood, effused and accumulated in this way, is commonly lodged at the inlerior and anterior part of the abdomen, above the lateral part of the pubes, and by the side of one of the recti muscles. The weight of the blood may propel it into this situation, or perhaps, there may be less resistance in this direction, than in another. In opening the. bodies of persons, who have died with such extravasations, things may put on a different aspect, and the blood seem to be promiscuously extravasated over every part of the abdomen. But, when such bodies are examined with care, it will be found, that the blood does not insinu- ate itself among the viscera, till the mo- ment when the abdomen is opened, and the mass previously lies in a kind of pouch. This pouch is frequently circumscribed, and bounded by thick membranes, especi- ally when the extravasation has been of some standing. (Sabatier Mtdecine Optra- toire, Tom. ], p. 28—50.) It is of the highest consequence to a practical surgeon to remember well, that all the parts contained in the abdomen are closely in contact with each other, and with the inner surface of the peritoneum. This is one grand reason, why extravasa- tions are seldom so extensively diffused as one might imagine; but, commonly lie in one mass, as Petit, Sabatier, and all the best moderns have noticed. The pressure of the elastic bowels, of the diaphragm, and abdominal muscles, not only frequently presents an obstacle to the diffusion of ex- travasated matter, but often serves to pro- pel it towards the mouth of the wound. The records of surgery make mention of numerous instances, in which persons have been stabbed through the body, without any fatal consequences, and sometimes without the symptoms being even severe. In Mr. Travers’s publication many cases, exemplifying this observation, are quoted from a variety of sources; Fab. Ilildan. Obs. Chirurg. Cent. 5. Obs. 74- (Euvresde Pare, liv. 10. Chap. 35. Wiseman’s Surgery, p. 371. La Motte’s Traite Complet de Chirurgie; &c. &c. In such cases the bowels have been supposed to have eluded the point of the weapon, and this may per- haps in a few instances have been actually the fact; but, in almost all such examples, there can be no doubt, that the bowels have been punctured, and an extravasation of intestinal matter has been prevented by the opposite pressure of the adjacent vis- cera. Such resistance and pressure may, also, have occasionally obliged intestinal matter, or blood, actually extravasated, to pass through the wound of the bowel into its cavity, and thus be speedily removed. Certain it is, such copious evacuations of blood per anum have followed stabs of the abdomen, as could hardly proceed from the arteries of the intestines. This way of getting rid of an extravasation must be rare, however, compared with that by ab- sorption. The pouch, or cyst, including extrava- sated blood, or matter, as mentioned by Sabatier, is formed by the same process, which circumscribes the matter of ab- scesses. (See Suppuration.) It is,in short, the adhesive inflammation. All the surfaces in contact with each other, and surrounding the extravasation, and track of the wound, generally soon become so intimately con- nected together by the adhesive inflamma- tion, that the place in which the extrava- sation is lodged, is a cavity entirely desti- tute of all communication with the cavity of the peritoneum. The track of the w ound leads to the seat of the etfused fluid, but has no distinct opening into the gene- ral cavity of the abdomen. The rapidity with which the above adhesions form is often very great, almost incredible. It should be known, however, that extra- vasations are occasionally diffused in va- rious degrees among the viscera, owing to the patient being subjected to a great deal of motion, or his having violent spasmodic contractions of the intestines, arising from the ix-ritation of the extravasated matter. Urine and bile are more frequently dispers- ed to a great extent among the abdominal viscera, than blood. The latter fluid, in- deed, must often coagulate; a circumstance that must tend both to stop further hemor- rhage, and confine the extravasation in one mass. SYMPTOMS AND TREATMENT OF EXTRAVA- SATIONS IN THE ABDOMEN. ]. Blood. Wounds of the spleen, and of such veins and ai'teries, as are above a certain size, almost always prove fatal from internal hemorrhage. The blood generally makes its way downwards, and accumulates at the inferior part of the abdomen, unless the existence of adhesions happen to oppose the descent of the fluid to the most depend- ing situation. The belly swells, and the fluctuation of a fluid is perceptible through the anterior part of the abdominal parietes. The patient grows pale, loses his strength, is affected with syncope, and his pulse be- comes weaker and weaker. In short, the