A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
An incision two inches in length should be made through the linea alba,
midway between the umbilicus and pubes, and, after all bleeding is
stanched, the peritoneal cavity opened. The index finger should then be
passed in and the surface of the abscess-wall explored. It will be a
fortunate circumstance if the sac be found adherent to the peritoneal
surface, where the incision is made, for it can then be opened without
entering the peritoneal cavity. To prevent the escape of pus into this
cavity the sac should now be evacuated with great care. For this
purpose the aspirator is well adapted, but a small trocar, to which a
few feet of rubber tubing has been previously attached, through which
to conduct the pus into a convenient receptacle, will answer almost as
well. The opening in the sac should next be slightly enlarged by an
incision (not torn); it should then be included in the sutures, which
are now placed to close the abdominal wound. After the sutures have
been introduced the pus-cavity should be washed out with the bichloride
or carbolic-acid solution, and a glass drainage-tube placed in the
lower angle of the incision, when the edges can be brought together and
adjusted around it.
The after-treatment required will be the same as if the opening had
been made through the vagina.
The sac must be made to close from the bottom. It may become necessary
to stimulate the surface by the injection of a weak solution of nitrate
of silver, four to eight grains to the ounce of distilled water, or
with the tincture of iodine, one part to four of water.
Cases are sometimes met with in which the pus has burrowed and formed
sinuous tracts which are difficult to reach and drain. It may then be
necessary to make a counter-opening in the vagina after first cutting
through the abdominal wall. These are usually old, neglected, chronic
cases, in which the abscess has discharged spontaneously into the bowel
too high up to be properly emptied, or which have opened into the
bladder or somewhere on the abdominal wall, or possibly taken one of
the circuitous routes alluded to under the head of Pathology.
No fixed rule can be set down for the management of these grave cases.
Each one must be treated on its individual merits. A ripe experience
and judgment are necessary here to decide whether it is best to operate
or to pursue a course of masterly inactivity, depending upon the use of
hygienic and tonic remedies and time to bring about a cure. I have
known instances where patients have recovered spontaneously after
having been reduced to the lowest extremity. I have also known others
who have died soon after submitting to operative interference. Some of
the spontaneous recoveries, however, are only apparent, for the old
sinuses often reopen and discharge pus as before, or the pus may be
discharged at some new and remote point, the patient finally succumbing
to the ravages of a disease from which she flattered herself she had
escaped.
Public-domain text, read in full here on John Shaqi.
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