464 WOUNDS. 



wound, being unable to find exit on account of the smallness of 

 the opening, burrows between the abdominal fascia and muscles, 

 separates them from each other, causing pain and swelling ; at 

 the same time small abscesses form in various parts, which are 

 difficult to heal. 



2d. Deeper punctures, penetrating almost or completely 

 through the walls, the peritoneum being divided or not as the 

 case may be, are apt to become enlarged by the pressure of the 

 contained viscera, and to cause death by allowing the protrusion 

 and escape of the intestines. 



The treatment for the first form must be conducted with the 

 view to allow the free escape of pus and other discharges, and for 

 this it may be necessary to dilate the external opening. This, how- 

 ever, must be done very carefully, or the second danger may be 

 induced. Very often the burrowing of the discharges is pro- 

 moted by the drying of the surface of the wound. This is more 

 apt to prove injurious when the hair is long, as the hair and dry 

 discharge become matted together over the opening, which is thus 

 effectually plugged up. Care must be taken that this does not 

 occur, and for its prevention the hair must be clipped round the 

 orifice, and the parts carefully washed and kept clean. If it is 

 necessary to dilate the opening, the incision should be shallow, 

 and along the long axis of the belly. When abscesses form, it is 

 always necessary that they should be opened early, as the fascia, 

 being very tough and elastic, allows extensive infiltrations or 

 burrowing of the pus. 



The deeper punctures must be treated with a view to prevent 

 the escape of the intestines. The discharges from them must be 

 allowed free exit ; but whilst doing this, their extension by the 

 weight of the viscera must be prevented, and this may be done 

 very effectually by enclosing the body of the patient in a common 

 bed-sheet, sewn firmly round him. This will form a suitable 

 support to the weakened walls, and at the same time allow the 

 escape of the discharges. Should it, however, become clogged 

 up by the coagulation of these, a small hole may be made in it 

 immediately below the wound. 



When the peritoneal cavity is actually penetrated, or even 

 when it is only nearly so, the medical treatment should be con- 

 ducted with a view to lessen the danger of peritonitis. Purga- 

 tives are to be withheld, and should the pulse be at all disturbed, 



