History, Modern -- 19th century; Nineteenth century
The surgery of the intestines by itself is a subject which could well
occupy the entire space allowed to this article. I can only, in a very
superficial way, outline what has been done. Hernia or rupture is a
condition in which through an opening in the abdominal wall a loop of
the bowel escapes. If it can be replaced and kept within the abdomen
by a suitable truss this was the best we could do till within the
last ten or fifteen years. The safety and the painlessness of modern
surgery which have resulted from the introduction of anæsthesia and
antisepsis are such that now no person suffering from such a hernia,
unless for some special personal reason, should be allowed to rely upon
a truss, which is always a more or less treacherous means of retaining
the hernia. We operate on all such cases now with impunity. Coley has
recently reported a series of six hundred and thirty-nine cases, all of
which recovered with the exception of one patient. Even in children,
if a truss worn for a reasonable time, a year or so, does not cure the
rupture, operation affords an admirable prospect of cure.
Every now and then a band forms inside the abdomen, stretching like
a string across the cavity. If a loop of bowel slips under such a
band, it can be easily understood that total arrest of the intestinal
contents ensues, a condition incompatible with life. There are other
causes for such “intestinal obstruction,” which are too technical to
be described in detail, but this may be taken as a type of all. It is
impossible, of course, to tell before opening the abdomen precisely
the cause of the obstruction, but the fact is quickly determined in
most cases. If we open the abdomen promptly, we can cut such a band or
remove the other causes of obstruction in the majority of cases, and
if the operation has not been too long delayed, the prospect of entire
recovery is good. The mortality which has followed such operations has
been considerable, and by that I mean, say, over twenty per cent.,
but a very large number of the fatal cases have been lost because the
operation has been delayed. In fact, it may be stated very positively
that the mere opening of the abdomen to find out precisely the nature
of any disease or injury is attended with but little danger. If further
surgical interference is required, the danger will be increased
proportionately to the extent and gravity of such interference.
But “exploratory operations,” as we call them, are now undertaken
constantly with almost uniform success.
Public-domain text, read in full here on John Shaqi.
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