The Good Old Days

Wounds of the abdomen

Penetrating wounds of the abdomen vary from simple wounds to more severe wounds with protrusion of the viscera, such as those caused by a rapid and cutting blow from a sharp sword. With oblique sliced wounds it can be difficult to tell if damage has been done to the viscera.

It has been taught that on no account should the wound be probed to determine whether the abdominal cavity had been breached. However, if antiseptic precautions are taken, it is safer to explore the wound to ascertain whether the peritoneal cavity has been opened and the gut penetrated.

There is want of agreement on the best method for closure of penetrating wounds, particularly whether to use deep interrupted sutures that either include the peritoneum, or alternatively, do not enter the peritoneal cavity.

Modern methods suggest that it may be better to close the abdominal wall in two stages, uniting the peritoneum with a continuous suture, and then using split kangaroo tendon through the skin and aponeurosis, tightening the suture so that the muscles are drawn into position.

In cleansing wounds, a solution of carbolic acid, of the strength of one part in 40 of water, is the most efficient lotion. All the crevices and irregularities must be carefully washed out, and all dirt removed.

The plan of at once using a spray, when it can be obtained, containing the carbolic acid, and covering the wound with a gauze saturated with the same material, has, since its introduction by Professor Lister, been largely adopted.

If decomposition can be prevented in a wound, its rapid union is almost secured, and this the antiseptic system effects in a wound made during an operation performed under a spray.

When much foreign material has been introduced, it is not easy to render the wound antiseptic.

The patient must always be carefully watched for the first four or five days after a serious wound because it is during this period that serious complications are most liable to arise. At the first sign of feverishness the wound must be examined, and if there be swelling, it is best at once to remove sutures and cleanse wound.

Adapted from 'Surgery, its Theory and Practice', by William Johnson Walsham, FRCS (Eng) MB and CM (Aberdeen), published in 1887 by J & A Churchill of London.

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