WOUNDS. 



18 dated by Mcebius to have had occafion to try on the human 

 fubjeft a plan, on which a vaft deal has been faid and 

 written. He cut off a large part of a mortified inteftine, 

 and joined the found ends together, by inferting the upper 

 within the lower one, and fixing them in this pofition with 

 a future ; the ligature being alfo employed, to keep them 

 at the fame time near the external wound. The patient 

 recovered, and the feces afterwards paffed entirely by the 

 reftum in the natural way. See Halleri Difputat. Anat. 

 vol. vi. Obf. Med. Mifcellan. i8. 



About a year after the operation, the patient died, when 

 the anatomical preparation of the parts was fent by Ram- 

 dohr to Heifter. They were preferved in fpirits of wine, 

 and exhibited, according to this laft author, an union of the 

 two ends of the bowels together, and their confolidation 

 with a part of the abdomen. Now it has been quedioned 

 by a late writer, whether the union here fpokcn of ever 

 really happened. When the upper end of the bowel is in- 

 troduced into the lower, the external furface of the former 

 is put in contaft with the inner one of the latter ; a ferous 

 membrane is placed in contaft with a mucous one. Thefe 

 heterogeneous ftruftures, he alleges, are not difpofed to 

 unite. The mucous membrane, when inflamed, more readily 

 fecretes a kind of mucus, which muft be an invincible ob- 

 ftacle to adhefion. He thinks it, therefore, more than 

 probable, that, in the cafe related by Heifter, the invagina- 

 tion was maintained by the union of the inteftine with the 

 correfponding part of the abdominal parietes. Several ex- 

 periments on living animals have convinced him that this 

 happens, and that the mucous membrane will not unite with 

 the external peritoneal coat. This impoflibihty of pro- 

 ducing an immediate union between mucous and ferous 

 membranes may, of courfe, be urged as an objeftion to 

 Ramdohr's praftice. ( Richerand, Nofographie Chirurg. 

 torn. iii. p. 344. edit. 4.) Another equally ftrong objec- 

 tion is, that the upper end of the bowel cannot be put into 

 the lower one, unlefs it be feparated from a part of the me- 

 fentery. Here the divifion of the mefenteric arteries may 

 caufe a dangerous bleeding. In vain did Boyer tie feven or 

 eight of thefe vefiels : his patient died with an extravafation 

 in the abdomen. (Op. cit. tom. iii. p. 343.) Mcebius 

 attempted to repeat Ramdohr's operation on a dog ; but he 

 could not fucceed in infinuating the upper part of the divided 

 bowel into the lower one, on account of the contraftion of 

 the two ends of the inteftinal tube, and the fmallnefs of the 

 canal. Motbius was, therefore, obhged to be content with 

 merely bringing the ends of the bowel together with a 

 future : the animal died, however, of an extravafation of 

 the feces. 



Dr. Smith, of the Philadelphia Medical Society, alfo 

 tried to repeat Ramdohr's method ; but could not fucceed. 

 He divided the inteftine of a dog tranfverfe^j', and having 

 inferted a piece of candle into that portion of the bowel 

 which was fuppofed to be nppermoft, he endeavoured to 

 introduce the fuperior within the inferior ; but the ends 

 became fo inverted, that it was found utterly impoflible to 

 fucceed. The fcheme was, therefore, given up, and only 

 one ftitch made, the ligature being then attached to the ex- 

 ternal wound, in the manner advifed by Mr. John Bell. 

 The dog died, and on examination there was found a 

 confiderable quantity of feces and water in the abdominal 

 cavity. 



Two more trials were made of Mr. John Bell's plan by 

 Dr. Smith, on the inteftines of dogs : in both inftances the 

 animals died, the inteftines being much inflamed, and feces 

 tffufed in the abdomen. See Dr. Smith's Thefis. 



Mr. Travers likewife tried the fame experiment. " I 

 I 



divided the fmall inteftine of a dag, which had been for 

 fome hours fafting, and carried a fine ftitch through the 

 everted edges, at the point oppofite to their conneftion with 

 the mefentery. The gut was then allowed to flip back, and 

 the wound was clofed. The animal furvived only a few 

 hours — Examination. The peritoneum appeared highly in- 

 flamed. Adhefions were formed among the neighbouring 

 folds, and lymph was depofited in maffes upon the fides of 

 the wounded gut. This prefented two large circular orifices. 

 Among the vifcera were found a quantity of bilious fluid, 

 and fome extraneous fubftances, and a worm was depending 

 from one of the apertures. By the artificial conneftion of 

 the edges in a fingle point of their circumference, and their 

 natural conneftion at the mefentery, they could recede only 

 in the intervals, and here they had receded to the utmoft." 

 In another experiment, Mr. Travers increafed the number 

 of points of contaft, by placing three fingle ftitches upon a 

 divided inteftine, cutting away the threads, and returning 

 the gut. The animal died on the fecond day. — Examination. 

 Similar marks of inflammation prefented themfelves. The 

 omentum was partially wrapped about the wound ; but one 

 of the fpaces between the futures was uncovered, and 

 from this the inteftinal fluids had efcaped. On cautioufly 

 raifing the adhering omentum, the remaining ftitches came 

 into view. Here again the retraftion was confiderable, and 

 the intervening elliptical aperture proportionally large. On 

 the fide next to the peritoneum, however, the edges were 

 in contaft, and adhered, fo as to unite the feftions at an 

 angle. 



From fuch experiments, the conclufion drawn by Mr. 

 Travers is, that appofition at a point or points is, as refpefts 

 effufion, more difadvantageous than no appofition at all ; for 

 it admits of retraftion, and prevents contraftion, fo that 

 eacli ftitch becomes the extremity of an aperture, the area 

 of which is determined by the diftance of the ftitches. 

 (P. 1 16. 119.) This gentleman, therefore, maintains, that 

 the abfolute contaB of the everted furfaces of a di'uided intefiine, 

 in their entire circumference, is requifite to fecure the animal from 

 the danger of abdominal ejufion. (P. 121.) The fpecies of 

 future employed, fays Mr. Travers, is of fecondary im- 

 portance, if it fecures this contaft. (P. 134.) And, among 

 other obfervations, we find, " wounds amounting to a dire3 

 divifion of the canal are irreparable, and, therefore, invari- 

 ably fatal." P. 133. 



In the Diftionary of Praftical Surgery will be found 

 feveral reafons for not entirely agreeing with thefe conclu- 

 fions. We cannot admit that a total divifion of the intef- 

 tinal tube is certainly and invariably fatal, becaufe we muft 

 then not only difbelieve the mode of union in Ramdohr's 

 cafe, which we undoubtedly do, but we muft alfo diftieheve 

 the refult of that cafe, and of fome others which we would 

 cite, were this a publication exprefsly allotted to furgery. 

 Nor are we at all convinced of the utility of applying nu- 

 merous ftitches to a divided bowel, in order to keep the 

 edges of the wound together. Were a cafe to prefent itfelf 

 to us, in which a bowel was protruded, and partly cut 

 through, we ftiould at moft apply only a fingle future, made 

 with a common fewing-needle, and fome fine filk ; and even 

 of the fafety and utility of a fingle future we entertain 

 doubts. If the bowel were completely cut acrofs, we 

 would alfo attach its ends together merely by one ftitch of 

 the fame kind ; and we ftiould do fo without feeling at all 

 aftured that the praftice of a future would be at all right. 

 We perfeftly coincide, however, with Mr. Travers refpeft- 

 ing the advantage of cutting off the ends of the ligature, 

 inftead of leaving them in the wound, as we believe he is 

 right in regard to the little chance there is of the injured in- 

 teftine 



