Volume 1
A textbook of pathology : systematic & practical.
- Hamilton, David James.
- Date:
- 1889-94
Licence: Public Domain Mark
Credit: A textbook of pathology : systematic & practical. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![first be removed. If it be adherent to other viscera, remove the whole en masse and examine the parts when the} are spread out on a convenient surface. They should of course have been previously described as they lay in j)Osition. Where a person is suspected to liave died from poison, the method of removal of the stomach and duodenum, or it may l)e tlie whole, intestine, is of ]irimary import- ance, and tlie operator should attend to the following points:—{a) Pass a douhh piece of waxed strong twine round the upper part of the pharynx. Tie it in several knots, twist it again round the pharynx, and tie a second time. Leave a long end, so that there is no danger of the knot coming loose. (/>) Ligature tlie lower end of the duodenum in the same way. (c) Remove the cesojdiagus, stomach, and duo- denum, having previously ligatured the intestine. {d) Procure a perfectly clean wide-mouthed bottle which has not been previously used for any purpose. Cut the duodenal ligature, and place the end of the duodenum in the bottle. Raise the cesophagus gently and allow the whole contents to flow into tlie bottle, (e) Put the stomach and attached jiarts into a second bottle. Cut the cardiac ligature and open the lesser curvature of the organ by an incision about 3 inches long. Introduce a cone, and measure the two orifices. Complete the incision in the lesser curvature by con- necting it to the cesophagus on the one hand, and to the duodenum on the other, so that the organ is laid open from duodenum to oesophagus along the lesser curvature. Look over the mucous membrane, noting the amount of lilood within it, the colour of congested parts, erosions, ulcers, or any other appearances which seem to be abnormal. If there is any unusual colour, describe this with care. A dark slate colour or a black precipitate is usually due to the patient having taken some metallic compound, medicinally or otherwise, which is decomposed by sulphuretted hydrogen. Grasp the pyloric ring and feel whether it is in any way indurated or otherwise altered. After carefully noticing the condition of the omentum and mesen- tery while the intestine is still attached to the latter, remove the in- testine with the sectio knife by seizing the most prominent loo}) (any loop), and cutting off the mesentery close up to its insertion. Do not leave portions of the mesentery adherent, as they throw the in- testine into coils when it is being washed out, and prevent its being easily opened with the bowel scissors. Detach the small from the large inte.stine about I foot above the ileo-colic valve. In typhoid fever it not infrequently happens that the lowest Peyer’s patch is the enlarged and ulcerated one, and hence if the small in- testine is cut off immediately above the valve this is a])t to be destroyed. Wash out the contents of the intestine by attaching the bowel to a water tap, and notice the colour, consistence, etc., of the faecal matter. Lay the bowel open with the bowel scissors while water is running through it, pulling the intestine against the scissors and not pushing the scissors into the intestine. Cut on the mesenteric side, as it is not desirable to wound the Peyer’s patches which lie oppo.site. Always begin the examination of the mucous membrane at the](https://iiif.wellcomecollection.org/image/b24990607_0001_0046.jp2/full/800%2C/0/default.jpg)
