On abscesses of the anterior abdominal wall / by J. Manley.

  • John Manley
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: On abscesses of the anterior abdominal wall / by J. Manley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    to differ in nothing from that of acute peritonitis. Dr. Bernutz lias remarked, that at this period, the abdomen, far from being distended, is hard and retracted ; a cir- cumstance which might assist in dis- tinguishing the case from one of peri- tonitis or enteritis. Afterwards, when the tumour becomes more or less apparent, the difficulty attendant upon the diagnosis is con- siderably diminished ; and at a still more advanced period, when a sponta- neous or artificial opening has shown that the tumour was formed by a collec- tion of pus, it is no longer a matter of practical interest to determine the pre- cise nature of the case, as all we can do for its cure is to abandon it to nature, abstaining altogether from useless and unnecessary probing. The therapeutical indications in these cases are few. In the incipient stage, and when the symptoms are similar to those of acute inflammation of the abdo- men, we should all instinctively, and without hesitation, resort to the usual antiphlogistic remedies. Upon detection of pus forming a col- lection, the early but cautious cutting down upon the tumour with a view to its evacuation would be advisable. In the case of the opening, produced either by nature or by art, remaining fistulous, I do not know that it would be prudent to apply any but the mildest means to attempt the closure of it. As an instance of an ingenious and innocent mode of applyingcompression for the obliteration of the fistulous track, although availa- ble only in the fair sex, the following from Boyer stands probably unique : — A female, aged 22, was affected after her first confinement, which was long and laborious, with inflammatory symptoms in the hypogastric region, followed by the formation of an enormous abscess, which burst just below the umbilicus: the opening remained fistu- lous, and Boyer made a counter open- ing just above the symphysis pubis, after ascertaining that a probe passed from the upper opening down to this spot. The upper opening soon healed, but the lower one in its turn remained fistulous. Now Boyer, seeing that to obtain the adhesion of the walls of the fistula it would be necessary to keep them in contact by a permanent com- pression, was struck with the idea that this might be accomplished by the pressure of the gravid uterus upon the walls of the abdomen at the period of gestation, when it rises above the brim of the pelvis; and agreeably to this view he recommended a second pregnancy. The patient had some difficulty in understanding that a second pregnancy was to be the means of curing a com- plaint which had been brought about by a first one; but wisely yielding to the advice of her surgeon, again became enceinte: before the expiration of the sixth month of her pregnancy the fistula was completely and solidly cica- trized.
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