Ascites has been already treated of in the Article MEDICINE; and when diuretics and cathartics fail to remove the effused fluid, paracentesis ab dominis should be performed, and these remedies afterwards still persevered in. This operation consists in surrounding the abdomen with a belt of strong calico, which is to keep up an equable pressure during the flow of the fluid. The patient is to sit on the edge of a chair, when the operator pierces the abdomen with a trocar and canula, in the direct line of the Linea alba, midway between the umbilicus and pubes, and removes the trocar. If the patient becomes faint during the flowing of the fluid, the bandage should be tightened, and the finger applied to the mouth of the canula for a few seconds. When all the fluid has been evacuated, the canula is withdrawn, a compress of lint applied to the wound, with a larger one of calico, and the ends of the bandage brought firmly round and pinned. The greatest care must be taken that the compression prevents any further flow of the fluid, for it collects with rapidity, and would soon ex haust life if the discharge continued. The best canula is that made of steel, the size of a hen's quill in diameter, and the round is superior to the flat. After paracentesis abdominis, if any inflam mation follows, leeches, with warm fomentations to the abdomen, and, if necessary, the lancet, castor oil, low diet, and the warm bath. Many of the acute diseases affecting the abdominal cavity are detailed under MEDICINE. When knives or such foreign bodies are swallowed and lodged in the stomach, and appear to involve the life of the indi vidual, they should be extirpated by cautiously making an incision in the line of the Linea alba from the ensiform cartilage to the umbilicus, through the integuments and tendons of the muscles to the peritoneum, which is then to be carefully punctured, and one or two fingers inserted into the abdominal cavity, and this membrane divided to the same extent as the integuments. The stomach is next to be gently raised with the left hand, and opened with a transverse incision, and the foreign body taken out. The external wound is then to be stitched with broad ligatures, at the distance of an inch from each other, and the needle, Fig. 17 of Plate DXVI. passed immediately super ficial or peripheral^to the peritoneum, compresses of lint applied, and a large handkerchief rolled round like the binder after parturition. The pa tient should be nourished for three or four weeks, or even longer if his constitution can bear it, with animal jellies, soups and milk injected per anum. This operation is termed gastrotomy.
When laudanum or other narcotic poisons are swallowed, they should be discharged from the stomach by the stomach-pump delineated in Fig. 12 of Plate DXV. The surgeon puts the fore and middle fingers of his left hand into the mouth of the patient and presses gently on the tongue, while with his right hand, he glides the tube marked a over the tongue into the pharynx, oesophagus and stomach, and then proceeds to pump out of the latter viscus its contents with the syringe b. The gag of wood c, ought to be in the mouth to prevent it from injuring the tube. If the contents of the stomach are scanty, or of a thick consistence, warm water should be first injected into it, by putting the end of the syringe into a basin full of warm water, and joining the two tubes a, d, together. By alternately filling and emptying the stomach in this manner, it may be fully divested of every drop of the narcotic fluid; and when this has been ac complished, a tea-cupful of strong coffee ought to be injected, and allowed to remain; the patient kept walking about his room between two at tendants; and his bowels afterwards freely opened. In some cases, it is necessary to apply a blister to the region of the stomach.
liens, volvulus, or intususceptio, is already de scribed under MEnicniz, and if the remedies men tioned there fail to effect a cure, we should first try large enemata of a weak infusion of tobacco, press ing the caput ctecuin coli at right angles in order to overcome the valve: and if these enemata like wise fail, we seem justified in opening the abdomen and disentangling the viscus. This operation ought only to be performed in the adult, as children in the last stage of takes mesenterica have occasionally from one to seven intususceptions.
Calcareous concretions are occasionally deposited in the colon, and if our diagnosis is clear, they ought to be removed by gastrotomy. The spleen is subject to prodigious enlargement, which sooner or later destroys the individual; and if iodine, mer cury and other medicines fail to reduce it, gastro tomy may be considered. In this case, whenever the enlarged spleen is brought into view, its plexus of vessels should be secured by a ligature, both ends of which are to be cut off. Abscess of the liver is a frequent termination of hepatitis (see MEDICINE), and when clearly indicated, should be freely opened with a bistoury; and the nitro-muriatic acid pediluvium, or the alterative course of mercury continued. Biliary calculi have been proposed to be extracted by an operation.
Nephrotomy, or the removal of calculi from the kidney was proposed in 1696, but has never been performed until the calculus has produced inflam mation and suppuration with a prominent tumour. Many die before such a result takes place, from the urine diffusing itself between the peritoneum and the parietes of the abdomen. Sometimes a com
munication is established between the pelvis of the kidney and the colon. When a calculus is arrested in its progress along the ureter, it generally soon proves fatal, by exciting inflammation, suppuration and ulceration; but occasionally it advances to the external parietes of the abdomen, and is discharged near the umbilicus, or pubes, or crista of os ilium. Various kinds of tumours grow in the abdominal cavity, as the fatty pendulous, and the medullary sarcoma; the latter of which affects the kidneys, and the mesenteric glands.
Hernia or rupture is commonly applied to a pro trusion of one or more of the abdominal viscera, either at one of the natural apertures of the abdo men, or at some preternatural one; and in the ma jority of cases, there is a sac formed by the perito neum. Hernia is applied also to a protusion of the thoracic viscera. It is estimated that one-eighth or one-sixteenth of mankind are affected with rup ture, young and old, male and female indiscrimi nately, and in every condition and mode of life. It is not immediately dangerous, but the least exertion is liable to render it fatal, and it too often keeps up such a determination to the intestines, that they either become strictured, tuberculated or ulcerated, and then cause death. Hernia is divided first into the reducible and the irreducible; the former signi fying the possibility of reducing the protruded viscera into the abdominal cavity; and the latter or the irreducible, the reverse. The irreducible is subdivided into the simple irreducible, the irre ducible with obstruction, and the irreducible with strangulation or incarceration. The viscera, which are protruded, are the omentum, then named omen tal hernia or epiplocele; the intestine, named intes tinal hernia or enterocele, and these two viscera conjointly entero•epiplocele. When the stomach is the protruded viscus, gastrocele; the liver, hepato celc; the spleen, splenocele; the urinary bladder, cystocele or hernia vesicx; and besides these, the uterus or ovarium, or both, in conjunction. The omentum and the intestines are those most com monly protruded; the omentum the most frequent, next the ilium, then the jejunum, and lastly the colon. The apertures of protrusion arc, the in guinal canal, the crural or femoral aperture, the umbilicus, the great sacro-ischiadic notch, and the foramen ovalc. Sometimes one of the apertures of the diaphragm, and occasionally a gap in the mus cular parietes of the abdominal cavity. When the viscera are forced out at the inguinal canal, either in the male or female, it is named bubonocele, or incomplete hernia, and when into the labium pu dendi or into the scrotum, complete hernia; that into the scrotum is termed also scrotal hernia or oscheocele. When the viscera do not descend along the inguinal canal, hut protrude opposite the external aperture, it is named ventro-inguinal or direct or internal hernia; and when they merely enter the inguinal canal, but do not appear ex ternally, it is denominated internal hernia. Male children are occasionally born with inguinal hernia, which is then named hernia congenita, or hernia congenita infantilis; and this as they advance in life, is liable to be complicated with common inguinal hernia. When the viscera protrude at the crural foramen, it is termed crural or femoral her nia, or merocele; the protrusion at the umbilicus, umbilical hernia, exomphalos or omphalocele; and when the viscera are forced out at any muscular gap, ventral hernia, which protrusion generally occurs at the linen alba. Hernia may be said also to exist within the abdominal cavity, when a por tion of the intestine is entangled by the omentum, the latter of which in such a case commonly adheres to the muscular parietes in the region of the in guinal or femoral aperture. Two or more hernia not unfrequently exist at the same time, generally double inguinal, i. c. an inguinal rupture on each side; and there are instances where three protrusions have existed in one inguinal region. The assigned causes of hernia are exceedingly numerous, but they may be reduced to violent muscular exertion, and a more than natural size of aperture, in conse quence of a relaxation of the muscular fibre; and hence hernia is as hereditary as scrofula or phthysis pulmonalis. In scrotal hernia, the peritoneal sac has descended to the knee, in which case it becomes so remarkably thin, that the vermicular motion of the intestines has been seen through the integu ments, and a blow inflicted on the tumour has rup tured it; the omentum, jejunum, ilium, colon, and even the pyloric orifice of the stomach, have been found in it; and if the sac adhere intimately to the ring, the fundus is occasionally lacerated, forming as it were small cysts or secondary cavities, and if the neck of the sac yields and descends, a new neck is formed, and thus two or more constrictions are produced. The sac very early forms adhesions to the contiguous cellular substance, and through this means to the neighbouring organs, uniting in a mass the integuments, eremaster muscle, sac, and even the intestines in the inguinal hernia. By some the sac is said to become thickened, but this only occurs in small old hernia; in large hernia, the cel lular substance is generally thickened, but not the sac. When the caput ccecum coli, the sigmoid flexure of the colon, or the urinary bladder is pro truded, there is commonly no peritoneal sac.