A System of Operative Surgery, Volume IV (of 4)

, and so forth. In many instances the abdomen is occupied by a tumour which defies the skill of the surgeon to localize to any particular organ until it is exp

, or the removal of foreign bodies, &c. It is true that a c?liotomy performed on an uncertain diagnosis may become a colectomy, ovariotomy, hysterectomy, &c., and the preliminary step to the performance of the operations to be described in this section is an abdominal

of the patient. It is desirable that the preliminaries should occupy two days at least. During this time the patient is kept in bed

tied by a soap and water enema, care being taken to use soft soap

ent writers attribute this complication to microbic infection of the ducts of the salivary glands (see p. 99); its occurrence may be avoided by including careful cleani

nd the skin is well washed with warm soapy water and swathed in gauze compresses wrung out of a solution of perchloride of mercury, 1 in 5,000

In such cases the hair can be easily removed by a depilatory. I hav

iff paste, which is spread over the parts. After five minutes it is washed off by means of a dab of cotton-

ve skin so tender that it is easily blistered, and a crop of small pustules is a source of inconvenie

n warm flannel garments or drawers made out of Gamgee tissue. No open doors or windows should be permitted; though in summer this is comfortable to the surg

te during menstruation; experience has taught me that operations performed during this period

e table the bladder should be emptied naturall

dvantage to employ nurses who have had a

ts, instrument dishes and the like should be boiled.

boxes. Forceps and the handles of scalpels are nickelled, and this keeps them bright. The following instruments are necessary: Scalpel, twelve h?mostatic forceps, dissecting forcep

ber of instruments and dabs for all occasions, as it will save

nd silks are immersed straight from th

y boiling without impairing its strength. In abdominal surgery there are four useful sizes, No. 1, 2, 4, and 6, of the plaited variety of silk. The thread is wound on a glass spool and boiled for one hour immediately before use. If any silk is left over from the operation it may be reboiled once or t

therefore they are highly dangerous, and on this account should be banished from surgery. An excellent substitute is absorbent cotton-wool enclosed in gauze (Gamge

ture of the case. These are boiled for one hour and then immersed in steril

t the end of the operation concerning their number. The

ruments accidentally left in the peritoneal cavity after

responsibility in this matter is deter

s is objectionable because it is harsh and irritating t

sis. It is a very important matter that the surgeon, the assistant, and the nurses who help at

ptic emboli, tympanites, and the like. Care must be taken to impress upon all who take part in an operation that it is as essential to thoroughly wash and disinf

rse of it which will render it advantageous for him to remove one or both gloves to overcome it. It is with me a rule that if in the course of an operation it is necessary to rem

in the Trendelenburg position, that is, with the pelvis raised, and the head and shoulders lowered: this allows the intestines to fall towards the diaphragm and leave the pelvis unencumbered. There are many varieties of tables employed for this purpose. As these tabl

examples have happened in the course of long o

al practice in London is to render the patient unconscious with nitrous oxide gas and maintain the an?sthesia with ether. It is a method which has given me the great

steropexy have been successfully performed with the aid of intra

tres). The first cut generally exposes the aponeurotic sheath of the rectus; any vessels that bleed freely require seizing with h?mostatic forceps. The linea alba is then divided, but as it is very narrow in this situation, the sheath of the right or left rectus muscle is usually opened. Keeping in the middle line, the posterior layer of the sheath is divided and the subperitoneal fat (which sometimes resembles omentum) is reached; in thin subjects this is so small in amount that it is scarcely recogniz

es pushed upward by tumours, and lies in the subperiton

ood, or pus which may be present. Occasionally he finds that attempts to remove a tumour would be futile or end in immediate disaster to the patient; then he desists and closes the wound

; occasionally he will be surprised to find this structure, even in well-nourished women, repr

er to remove fluid, blood, or pus; the dabs and instruments

f these cases it drags the tail of the pancreas with it. The c?cum and the vermiform appendix often occupy the true pelvis; in middle-aged and elderly women the transverse colon sometimes forms a loop (the omega-loop), the extreme convexity of which often reaches to the pelvis. I have seen the right lobe of the liver extend into the pelvis, and come in contact with the unimpregnated uterus. It is important to remember that a kidney sometimes occupies the hollow of the sacrum; such a misplaced kidney has been remo

for an ovarian cyst; such a distended stomach has received a thrust from an ovarioto

large and small; it is therefore necessary for any one undertaking gyn?cological abdominal operations to be

the course of an abdominal operation. I met with it once in 3

owing is a list of materials used by surgeons for this purpose: silk, silkworm-gut, catgut, linen thread, and horsehair; silver, iron, al

r may yield. Nature in her great operation of uniting the lateral halves of the belly-wall in a median cicatrix, the lin

intervals of rather less than 2 centimetres apart. Care must be taken to include the peritoneum in these sutures. The skin is then brought together by a continuous suture of No. 2 silk. When the operation has been undertaken for a septic condition, such as pelvic peritonitis, suppuratio

e published in 1904 on The Closure of Laparotomy Wounds as practised in Germany and Austria, by Walter H. Swaffiel

ns in abdominal operations, but at the present time there is a marked tendency to return to the older and simpl

n their performance. This is true of all forms of surgical procedure. No man can become a navigator without going to sea, however thoroughly he masters the principles of seamanship from books, so no surgeon can acquire the art of operating from merely reading descriptions of surgical operations. If a surgeon can bring