I So Anatomy Applied to Medicine and Smgery. 



In accidental wounds of the abdomen, the important con- 

 sideration is whether penetration or opening up, of the 

 abdominal cavity has occurred or not, as on this depends 

 the gravity of the injury. 



The diagnosis of penetration will depend on the size of 

 the instrument inflicting the wound, or, on the position of 

 the wound, etc., and will be indicated by the escape of faeces 

 or gas, extreme shock, continued symptoms of hemor- 

 rhage, etc. If it be a non-penetrating wound, the ordinary 

 treatment of a wound, viz., opening it up, removing for- 

 eign bodies, etc., suffices. Should it, however, be a pene- 

 trating wound, then laparotomy, especially if seen early, 

 i.e., within six hours after the receipt of the injury, should 

 be undertaken. Contusion of the abdominal wall may cause 

 extravasation of blood either into the subcutaneous tissues 

 or between the muscles. Suppuration in the walls of the 

 abdomen may result from contusions, or, from wounds 

 involving the different muscular planes, and, when pre- 

 sent, the pus may burrow considerable distances between 

 these muscles. Rupture of the abdominal muscles, espe- 

 cially the rectus, occasionally occurs as the result of a sud- 

 den, severe strain in lifting, etc., and is accompanied by a 

 sharp pain as though from the blow of a stick. The treat- 

 ment is rest and flexion of the lower limbs over a pillow so 

 as to relax the segments of the muscle. Tumors invol- 

 ving the abdominal wall. The commonest form is fibroma 

 arising from the fibrous aponeuroses of the muscles; 

 next, in frequency, is the fibre-sarcoma. The diagnosis 

 of tumors of the abdominal walls from those of the in- 

 terior of the abdomen may be arrived at by noticing the 

 depth of the growth. In the former instance, the tumor 

 will be comparatively superficial, in the latter, it will be 

 more or less deep ; besides, if it be superficial, then when 

 the patient is asked to strain, the muscles, with the tumor, 



