A dictionary of practical surgery : comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments and remedies employed in surgery : the etymology and signification of the principal terms : and numerous references to ancient and modern works, forming a "catalogue raisonné" of surgical literature / by Samuel Cooper.
- Samuel Cooper
- Date:
- 1825
Licence: Public Domain Mark
Credit: A dictionary of practical surgery : comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments and remedies employed in surgery : the etymology and signification of the principal terms : and numerous references to ancient and modern works, forming a "catalogue raisonné" of surgical literature / by Samuel Cooper. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
1265/1282 (page 1253)
![tion. All the,[surfaces in contact with each other, and surrounding the extravasation, and track of the wound, generally soon become so intimately connected together by the adhesive inflammation, that the place in which the ex- travasation is lodged, is a cavity entirely destitute of all communication with the cavity of the peritoneum. The track of the wound leads to the seat of the effused fluid, but has no distinct opening into the general cavity of the abdomen. The rapidity, with which the above adhesions frequently form, is almost incredible. It should be known, however, that extrava- sations are occasionally diffused in various de- grees among the viscera, owing to the patient being subjected to a great deal of motion, or affected with violent spasmodic contractions of the intestines. Urine and bile are also gene- rally dispersed to a great extent. As for blood, its disposition to coagulate must often tend both to stop further hemorrhage, and confine the extravasation in one mass. Symptoms and Treatment of Extravasations in the Abdomen. 1. Blood. —Wounds of the spleen, and of very large veins and arteries, in the abdomen, almost always soon prove fatal from internal hemorrhage. The blood generally makes its way downwards, and accumulates at the inferior part of the abdomen, unless the presence of adhesions happen to oppose the descent of the fluid to the most depending situ- ation. The belly swells, and a fluctuation is perceptible. The patient grows pale, loses his .strength, is affected with syncope, and his pulse becomes weak and scarcely distinguishable. In short, the symptoms, usually attendant on pro- fuse hemorrhage, are observable. As the viscera and vessels in the abdomen are compress- ed on all sides, by the surrounding parts, the blood cannot be effused, without overcoming a certain degree of resistance; and unless a vessel of the first magnitude, like the aorta, the vena cava, or one of their principal branches, has been wounded, the blood escapes from the ves- sel slowly, and several days elapse, before any considerable quantity accumulates. In these cases, the symptoms which, perhaps, had disappeared, under the employment of bleeding and anodyne medicines, now recur. A soft fluctuating tumor may be felt at the lower part of the abdomen ; sometimes on the right side ; sometimes on the left; but, occasionally on both sides. The pressure made by the effused blood on the urinary bladder, excites distressing inclinations to make water ; while the pressure, which the sigmoid flexure of the colon suffers, is the cause of obstinate consti- pation. In the mean time, as the quantity of extravasated blood increases, the peritoneum inflames. The pulse grows weaker; debility ensues ; the countenance becomes moistened with cold perspirations ; and, according to some writers, unless the surgeon practice an incision for the discharge of the fluid, the patient falls a victim to the accident. In the year 17u3, Vacher adopted this treat- ment with success. Petit afterwards tried the same plan, though it did not answer, (as Is al- leged,; in consequence of the inflammation having advanced too far, before the operation ■was performed. Long'bdbre tha lime of Va- cher and Petit, a successful instance of similar practice was recorded by Cabrole, in a work which this author published under the title of • A\<pa/3r]Tov uvaiojxiKov, id est, Anatomes elenchus accuratissimus, omnej human; corpo- ris partes ea qua solent secari methodo, deli- neans. Accessere osteologia, observationesque Medicis ac Chirurgicis perutiles. Geneva: 1604. The method, pursued by Vacher, was therefore not so new as Petit imagined. Indeed, when the symptoms leave no doubt of there being a large quantity of blood extra- vasated in the abdomen; when the patient's complaints are of a very serious nature, and are evidently owing to the irritation and pressure of the blood on the surrounding viscera ; and when a local swelling denotes the seat of the extravasation, there cannot be two opinions about the propriety of making an incision for its evacuation. Surgeons should recollect, however, that if no opening be made, a small extravasation of blood may not produce any considerable irritation. On the contrary, when the cyst including the blood, is opened, the air then has access, and that part of the fluid which cannot be discharged, putrifies and becomes so irritating, as to be a true cause of inflammation. The bad symptoms are also sometimes chiefly owing to the injury done to parts within the abdomen, and still more commonly to inflam- mation within that cavity, arising rather from the wound, than from the presence of effused blood. On the whole, I am disposed to join a late writer in the belief, that the practice of discharging extravasated blood from the abdo- men can rarelv be advisable.— (See Hennen's Mil. Surgery, p. 412, ed. 2.) 2. Chyle and Feces.—These are not so easily extravasated in the abdomen as blood, because they do not require so much resistance on the outside of the stomach and intestines, to make them continue their natural route through the alimentary canal, as blood requires to keep it in the vessels. However, when the wound is large, and the bowel distended at the moment of the injury, or when, as Mr. Travers has ex- plained, air is extravasated, or blooc effused in the abdomen, which fluids are incanab:e of making effectual resistance to the escape of the intestinal matter, the latter may be effused. (See an Inquiry int'i the Process (f Nature in repairing Injuries of the Intestines, <5fc. p. 26.) Nothing is a better proof of the difficulty with which chyle and feces are extravasated, than the operation of an emetic, when the stomach is wounded and full of aliment. In this in- stance, if the resistance to the extravasation of the contents of the stomach were not con- siderable, they would be effused in the abdo- men, instead of being vomited up. A pecu- liarity in wounds of the stomach and intestines is, that the opening, which allows their contents to escape, may also allow them to return into the wounded viscus. Extravasation of intestinal matter in the ab- domen is attended with severe febrile symp- toms ; considerable pain and swelling of the belly ; convulsive startings ; and hiccough and vomiting, with which the patients are generally attacked the day after the receipt of the](https://iiif.wellcomecollection.org/image/b21047376_1265.jp2/full/800%2C/0/default.jpg)
