EVENTRATIONS. 449 



prognosis may vary with them, according to the condition of the 

 lesion, being more or less favorable according as the bulk of the 

 protruding viscera is less or greater. The chances of recovery 

 will also vary in the ratio of the degree of the exposure of the vis- 

 ceral organs to the atmospheric au-, or to the severity of any 

 traumatic_accidents they may have encountered. 



The indications of treatment suggested in these cases is obvious. 

 The first is always, when practicable, reduction. To return the 

 intestine to the situation designed by nature for its occupancy is 

 the first step to take. If it has not been seriously wounded, and 

 is in a state of cleanliness, and has escaped contact with the earth 

 and other soils and stains, simple washing may be attended to at 

 once. But if, on the contrary, it is bruised, soiled and inflamed, 

 it must be carefully cleansed with warm water, before being re- 

 turned to its position. This reduction must be carefully per- 

 formed by the taxis, and if the opening of the abdomen is too small 

 to allow this to be accomplished with facility, it will be good prac- 

 tice to enlarge the opening with the knife, rather than to hazard 

 the too free manipulation of the tender parts which will form the 

 dangerous alternative which may become the exciting causes of 

 consecutive inflammatory, and perhaps gangrenous sequelae. If 

 instead of the intestines the eventration allows the exit of the 

 omentum, this also must be cleaned and washed, if necessary, and 

 returned, though in some instances it may be torn or cut off after 

 ligating its large blood vessels, or better yet, Ugating the whole 

 mass with animal ligature. The second step of the operation con- 

 sists in applying means of restraint to retain the returned organ 

 and prevent a second exit. The quilled suture is at this juncture 

 the means which always first suggests itself to the surgeon's mind. 

 The clamps have their advocates, but Zundel prefers the metallic 

 interrupted sutures. The entire application is to be supported, 

 reenforced and protected by a wide bandage, similar to some of 

 those recommended in umbilical hernia. 



LAPAEOTOMY. 



This operatiod; which consists in the opening of the abdominal 

 cavity through the loins or flanks, is one which, considering the 

 general indication for which it is performed in human surgery, 

 has found but little application and occupies but a small place in 



