1000000031

754 / 868

s u R G
two cells; iD which cafe, ir the o\'uy is gre~.t1 1 ma~ni6eJ.
lhe undul2tioo wil! be rcad">" f~h, and {he opcnaicn be ad–
vifeable.
"!h~n lhe aftitu ar.d oll.Jjarca ~lfe complicafed, ir is
ftldom pro!,~r 10 rcrfol1n the operation. Cince ,be water may
be much mure dré~u¡lIy encuatcd by feari6calioDs in the
I,ss ,h.n by tapping
U pon ,he fuppofitlon no,hine forbids ,he cxt"flion of ,he
water, the mar.ner of'opcr:uing is (his: Ha.'Vin~ placed the
patient in a chai, of a convenlt:nt height, let him jOIn his
h,ods fo " 'o prefs upon his tlomaeh ; theo dipping the
trocar in oil. you Hab it fuddenly through tbe tcgu!n(nts,
and, withdrawing Ihe pcrforator, lea"fe lhe waters to empty
by lhe canula: the abdo1!len being.. when fill cd, in the cir–
cumOanee or. bl.dder d,Hended IVi,h , flu id, would m,ke
it indlfferent ",hefe to wound; bat (he apprehenfioDofhurt–
ing lhe liver, if it be: much enlarged, has inrluc~d opera-o
tors rather (O chufe ,he Id t fide, and genc:rally in that part
whicb is aboat three inches obliqllely below the na,eI : if
the na.,el pro:uberaul, you may lnake ,¡ fmall punéture with
a laocet throulh the Ocio, and the waters \ViII t,e readily
vo!ded by that ori6ce. without ¡ny danger of a hernia fuc–
ceediog : bu, it fltOuld be earefully ",ended 'o. whether
the protuberance is formed by .he water or an rx()1tIphalol;
in which Iatter cafe, lhe iOlefiinc ,,'ould be wounrled. and nOl
witbout the grf'3terl dan~er. T he {urgeon neicher In open.
jng with Ihe lancet, nnr ped qrating \!11th lhe trOt ar, need
[ear injuring lhe inteClinco:'s, unlefs (beTe 15 but Ilule water 'in
the abdomrn. (ince (hey are too much eonrln~d by lhe me·
fent ery 10 come \Vi,hln rearh of d.lOger from lht fe ¡nluu,
ments ' bUl il rometlmes happens. rhar when lhe water ¡s·
almoO .11 emp,ied, i: i. fuddenly rtoPFed by ,he i.tefiineor
omentulII preffing 2gainn the lnd o( lhe canul.! ; io which
care you móly puJh Ihem awóly with a probe: during lhe e·
vaCUatlOn, ..ffill~nts muH krcp preOing 00 eaeh Cicle of
the ~bdo1J/rll. with a force equaJ to ,hal of ,he waters be.
fore contained lhere i (or hy nep,le:tllng lhis rule, the patient
will be apt 10 fall iCHO f;\)Otiogs, from the weigb t on the
grelot veflels of ,lie (Jbd~IIJrn bt'ing laken off, and the link·
in~ of the diaphragrn fu :-ceeding. in confequence of whlch¡
more bltiod flowing ioto rhe inferior vdfels than ufual. h:ave:s
tite fuperior ones of a fudden t OO empty. alld thus ínter
rupts .he regul.H prngrcfs of (he circulalion To obviate
Ihi, inconvenience, the comprdlion mufl nOI only be Olitde
wi 'h ,he haoos during the operAtlon. out be ~flel\Vard'S con·
tinued, by fWd ,hlOg ¡he: ab:!~1J/~n wjlh :J roHer of .fl .. ooel,
.about eit ht y:uds lon~. and Ii\'e incht5 broad. begilluin;! at
the UOUOr.l of the bell)r, fo tbítt Ihe ,"teU ioes nuy be hOlne
u-p ag'!in!l th"! di;;¡rhrar,m : fotl n¡ay ch<l.:"tr,c: Ihe ro)ler every
dily till lhe th:rd or (outth d:ty , by \\h:dl 1ime Ihe f::\'e·
ral parts will have acq ulred their du~ tonc. 'F'or thc d:-e{·
fine él píeee of dly lim anti pJ ..lltcr Cllffice; bOl bet\veen
, he ncin .nd roller i, m.y be proper 10 I.y • dcuble n.nne!
a rool fqu:ue, dipt in bnn(l y or rpirils or winl!.
This operation. thour.h lt ducli not orten abColulely cure,
yel it , ron1C.~times prcCerves Ji fe :a. gfeal m;tny )ear9, ;;¡n,. c:ven
a plear,lOt one, cfpeci",Jly ir the W;HCtS have been long col–
Icfling.
EXPLANATION or Fie. 3. Platc (,LV l!.
A, A ú ocar of Ihe mo(l convcnient f-z· .. ¡or . m~lyinS! ,~,e
Q/¡d:,l/lcIJ whcn the water ís gclatínous. lt ís h~rc re·
E R Y.
prcrented ~ilh the perror:uor in tbe CdDU!;I¡ jufi 1S il is
pl~ceJ when we pcrform th: opcr¡.ti on.
lJ, Thc ('(\oula of a larg'! trocar, recommenoed in cafc,
wher~ the W;ttcr is Ilc!íu inous
C. T he p;!rforato~ 01 rhe I~rge trocar.
"f'he h;¡n~Je 01' the tr\lc¡r is gl!neTaIJy of wood, the
canula o( hlver, and lhe p::rForator of fl\!el. G real carl!
fhou ld be tólkcn by (he makers of this icnrument. thal the
perforator fhould 611 up the cavityof lhe car¡uh j for
unlt:fs the extrernllY of the canula l¡es quile clore. and C01ooll1
on thr: perforator. the introdu8ioo of it ioto the abdomen
will be very painful. To rnake ic Aip in more eafil y, the
edgeof the exuemity of thecanula fhould Be lhi D ~nd rharpi
,nd ,h2t ,he e.nul. Ibould be of !teel; ror ,he fi l.., one be ·
ing of100 foft a metal, becomes jagged or bruit"td at 1IS ex..–
trtmitY'with very litde ufe.
0r/he FISTULA ,. A.o.
TH E jiflula in ano is an abfctfs running upon or ¡nto
the ill/eflmu1lJ t'([Jum o
The pilel, which are I¡ttle lumours forrned about Ihe
verge of (he Ill1UI , immediately withih the membrana in–
lerllll of the r~num, do lornttlmes (uppurate. and become
Ihe fore. runoers of a large abfcefs; airo eAtern~J iojuri\!s
here, as 10 ~very other píln of the body, may produce it _
but from whatever CAuCe the abfc~fs arife, the mólnoer of o:
perating upon it will be according to {he Dature and direc_
'tion of 115 eavity.
H lhe {urgeon have the (jrn maoagemcnt of lhe abCcefs,
and thef e ~ rpeu ao inAamm.ulOo upon one Cide of
the butlock onl)'; a(ter h.n·iñg waited ror \ he propc:r matu–
"¡ty. Jet him Wlth a kOl(e rnJke an Inl:ifion lhe wnole Jt ngth
of ir ; and In ~Jl probilbilit y, eveo though the bladder be
.IfF,lled , the Jargene{s of l ~le wound, and_the pr~per apphca.
tion of rloflils lighdy prdrc:d in. ",dI prevent the: pUtrtr.. ~'iono
of the in,dline, 2nd m.~e tbe e. vi,y filJ up imporlhu–
mations of other pafls.
If thejinul be conunued to the olher bUHock, almo!l fu r.
rounding the inldtine. lhe whole cou rfe of il rnult be dlla.
tcd iD lake mannerj fince. in fuch rpungy CaVItI~~, a genera.
tion of fI~fh c¡tonot be procured but by larf;c openings ;
whellce alfo, if Ihe O(ln is vny thin, Iying Joole and n",bby
over thejil1lil, it is abrolulely oecclTuy to CUI il qUHe a–
w,y, or the patlenl wdl be apt lo .fi nk under Ihe diJchílr:je,
WlllCh, in the c;rcu!lllb nce hc:re dd¡;1ihed, is [ Imelimcs ex–
clo!ni\re. By this me t!'lod, whid, ('¡nrior be too murh re.
cOlllmendc\.l, il IS am:tzl~? how h.tppy the ,,'cm is likely 10
U~ j whereas , rrom ne&lcding it, 2T,d trufbng onl)' to <1 Illr·
row op:;¡ing. if the ddch:u C: do n,)t cldlro}' the patient, :\t
11!:\(1 ,he Olottl(:r. b), bl!inf. eOllilncd, corrUrts Ihe gUt, ¡ntl
infi nuatinc ¡tCel( abnut I{, forms m;:¡ nyolher challnc:Is, which
rUllnil"lg in vclfious di rellions orten bJffic::.n opcr;nor. an,t
h " e b,en ,he e. ufe or. fi rt" l. being fo geoerdly eOren",1
ver. tidli :lllr or cure.
H-=re \Ve hílve c'·o{idered rhe impollhur.lati..,n 3S po(iI..'ITing
a cre,u pan (lf lhe buttock; but it mOre rrequ(IIt1.v h¡¡r p'!,lS,
lbt Ih:- matler p:>inu \Vi:h a Cnull t'xt::nt of infiam:lI;"iuu
on Ihe {kin. a!ld the direélion of th~Ji'ltu is C\',on with the:!
gu. : in this·caf!.!, ha\'ílig n¡ad\! a plln~1L1f'(', )'OU Ol\y wi' h a
r robc Ica rn if it h~s pcnC't rat~d ioto lhe inc~nin(' by r::J nin~
yUUf hnct:r liD iL and feclíng tht! rr;-,Jbc ir.trutl\lc~d throu(!h
tbe \\'ound lotO iu colrity ; thou:;h, for the mon pan, it Ol;:ty
b:.: