Volume 1

The cyclopaedia of practical surgery, comprising a series of original dissertations on operative medicine / by an association of physicians and surgeons ; edited by W.B.C.

Date:
1837-1841
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopaedia of practical surgery, comprising a series of original dissertations on operative medicine / by an association of physicians and surgeons ; edited by W.B.C. Source: Wellcome Collection.

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    two lateral regions, the right and left hypo- chondria, and a central one, the epigaster. This last (1) occupies the space between the diverging ribs ; at its upper part, the xiphoid cartilage is felt. The aponeurosis here is thin and weak; its resistance to protrusions is, however, suflicient, there being but little pres- sure from the internal organs, except under circumstances of great distension. Abscesses of the mediastinum sometimes point here ; its own cellular tissue may also be the seat of a purulent collection, which may fuse in the direction of the linea alba. Distressing pulsa- tions simulating aneurism are sometimes felt here, particularly by hypochondriacal and nervous persons; they may arise from the throbbing of the cceliac artery, or what is much more common from nervous twitchings, similar to those which occur in other parts of the intestines, the caecum and colon more es- pecially. We shall notice the other two re- gions, when we speak of their relation to the internal organs. ; The second zone, the umbilical, is sub- divided into a central, (3), and two lateral regions, (4,4). The umbilicus is placed in the centre of this zone; the skin is inti- mately adherent to this organic remnant, in consequence of which, when the walls of the abdomen become loaded with fat, it sinks in, and forms a funnel shaped depression. The obliteration of the umbilicus is often so im- perfect at birth and in the early months of existence, that the intestines, by passing into the unobliterated cul de sac, elevate it into a tumour, which gradually diminishes as the child grows; later in life, the umbilicus pre- sents a fibrous knot, so much more resisting than the surrounding parts, that Scarpa be- lieved the protrusion of any part of the intes- tinal tube through it, to be impossible. The surrounding parts, however, and especially after excessive distension, may be very much weakened, and their fibres so separated, as to facilitate protrusions. The fatty herniz, of _ which we have already spoken, are liable to occur in this region, owing to the small open- ings occurring here and there in the tendinous layers of the muscles (See Hernia); the tendinous intersections of the rectus muscle are remarkable in this region ; Velpeau consi- ders, that they quintuple the strength of the muscle. The arteries of this region possess some surgical interest, in the operations of paracentesis, and hysterotomy (see those arti- cles). When incisions are had recourse to, it is a rule to cut in the direction of the fibres, which being straight in this region, the in- cisions should be straight also. The iliac ves- sels on the lateral limits of the region may be of such a size, as to furnish a good deal of blood. Incisions on the median line may generally be entitled to a preference, and even Sir A. Cooper has been heard to regret, that he had not made his incision in this situation, upon the occasion in which he tied the ab- dominal aorta. The two lateral portions of this zone are, the lumbar regions; they oc- cupy the open space between the margins of the false ribs, and the crista of the ilium, extend- ing backwards under the longissimus dorsi; a part only of it therefore is seen in the front view of the abdomen. Its entire extent is shown in the next figure (1), together with the left hypochondrium (2), and a portion of the epigastric (3), umbilical (4), and hypo- gastric (5) regions in profile. The cellular tissue of this region communicates : under the twelfth rib with s that of the cavity of the thorax, and may be the seat of congestive abscess in consequence of caries, either of the ribs or ver- tebree. Other abscesses of a nature less serious oc- curring in this situation may be confounded with one of a symptomatic cha- racter. Velpeau mentions two cases of chronic idio- pathic abscess, in one of which the life of the patient was saved by a free opening, followed by speedy cicatrization of the sides of the puru- lent cyst. At the back part of this region, there is a weak space sometimes left behind the thin edge of the internal oblique, and the trans- versalis, which with the thin lumbar aponeu- rosis may yield before the pressure of the abdominal viscera. J. L. Petit mentions his having seen a case of hernia in this situation. Callisen, from having observed the thinness of the abdominal covering at this point, proposed selecting it as a proper place to establish an artificial anus, in the case of infants born with imperforate rectum. Anthrax and phlegmon are not unfrequent in this region, which is clearly attributable to its abounding in cel- lular tissue. Urinary fistule from the kidney is sometimes, though rarely, observed in this region. Moxe, issues, &c. are some of the surgical applications that may be here em- ployed. The third zone is the lowest, and may also be divided into its centre ( (2), plate 1) the hypogastric, and right and left inguinal regions. Some of the most important operations in sur- gery are performed on these regions: for in- stance, the operations for strangulated hernia, for puncturing the bladder, the high operation of lithotomy, &c. Secondary abscesses from violent cystitis, sometimes occur in the cellu- lar tissue of the hypogaster ; matter formed after psoitis, or from disease of bone, as in congestive abscess, often point in the inguinal regions. (See Grorn and Hernia.) In the posterior view there is nothing to correspond, with the upper and lower zones, observed in the front view. Here, strictly speaking, there is but one zone for the abdo- men contained within the limits of the curved line which separates it from the thorax above, and the gluteal regions, marked by two arched lines extending from the median line of the
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