Intestinal surgery / by N. Senn.

  • Nicholas Senn
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Intestinal surgery / by N. Senn. Source: Wellcome Collection.

    48/290 page 34
    INTESTINAL SURGERY. tion. The depressing effect of this anesthetic on the action of the heart is well known, and as the force of the circulation is almost without exception seriously impaired in these cases, its prolonged use might result in dangerous consequences. The best course to pursue is to follow the use of chloroform by ether. The retching and bronchorrhcea are prevented by placing the patient first under the influence of chloroform and the deleterious effects of the prolonged use of this agent are avoided by keeping up the narcosis during the operation with ether. From the time the first incision is made until the abdominal wound is closed, the patient must be kept profoundly under the influence of the ansesthetic, inasmuch as any interruption will cause an unnecessary delay in the operation and may result in complications which are not easily remedied. Irrigation of the stomach should always precede the administration of the ansesthetic, as evacuation of the stomach by preventing vomiting, will guard against the entrance of foreign material into the larynx and trachea, which might produce asphyxia during the narcosis, or pneumonia later. c. Incision. Differences of opinion still exist among surgeons as to the size and location of the abdominal incision. The advocates of exventration argue in favor of a long incision through the median line. Kunimell advises that it should be carried from the ensiform cartilage to the pubis for the purpose of affording free access to every part of the abdominal cavity. On the other hand, a number of distinguished surgeons, among them Madelung, Czerny, and Obalinski, are in favor of a small incision. Polaillon1 is strongly in favor of a lateral incision in opening the abdomen for the relief of intestinal obstruction in all cases where the seat of obstruction can be reached more directly by such incision. He also claims that in cases where extensive meteorismus is present, the distended intes- tines are more prone to prolapse and are more difficult to return through a median than a lateral incision. He thinks that this is due to a lesser degree of intra-abdominal pressure in the iliac than in the middle abdominal region, and that in the former the muscular fibres keep the margins of the wound in contact. He opens the abdomen in the ilio-inguinal region by an incision parallel with the fibres of the external oblique muscle, and if occasion requires, this can be made 1 Gazette Medicale de Paris. April 25, 1885.
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