VVUUJNUa. 



covering of the greater part of the vifcera. Littre relates, 

 that a hinatic dabbed himfelf with a knife in eighteen places 

 about the abdomen, eight of which wounds penetrated into 

 this cavity, and evidently injured the bowels. The man, 

 however, recovered in two months ; but in another paro- 

 xyfm of mania he threw himfelf out of the window, and was 

 killed. On opening his body, all the cicatrices of the in- 

 teftinal canal were found adherent to fome point of the 

 furface of the adjacent vifcera or parietes of the abdomen. 

 There was not a iingle one which feemed to be formed by 

 the direft contaft of the edges of the inteftinal wound with 

 each other. Acad. Roy. des Sciences de Paris, 1705. 



The peritoneum, when irritated by any caufe wuatfoever, 

 has a Angular difpofition to inflame round the point of irri- 

 tation, and to contract adhefions with the parts which are 

 contiguous to it in the fame fituation. Thus, when one 

 or feveral convolutions of intetlines have been divided by a 

 cutting inftrument, or pierced by a ball, they always be- 

 come united for a certain extent to the furrounding parts, 

 all of which are covered with the peritoneum. ( See alfo 

 Platner's Inftit. Chir. § 694.) Thefe adhefions, which are 

 the only means employed by nature for blocking up acciden- 

 tal openings in the intelHnal canal, are promoted by the pref- 

 fure which the abdominal mufcles and diaphragm alter- 

 nately make upon the vifcera in the aftions of infpiralion 

 and expiration. 



In a fubfequent part of his work, Scarpa delivers his own 

 fentiments on the different plans which have been propoCed 

 for effefting the re-union of a divided inteftine. If, fays 

 he, we compare Ramdohr's operation with the fimple and 

 effeftual procefles employed by nature for re-eftabli(hing 

 the continuity of the inteftinal canal after hernis with mor- 

 tification, we are compelled to acknowledge on this point, 

 as well as on many others, that art continues very inferior 

 to nature. 



In the firft place, fays Scarpa, the introduftion of one 

 part of the bowel into the other is imprafticable in a great 

 many cafes of mortified hernix, in confequence of the ad- 

 hefions which the found part of the inteftine has contrafted 

 with the neck of the hernial fac, during the inflammatory 

 period of the ftrangulation. Secondly, it is hardly ever 

 poffible, without inconvenience, to draw a confiderable 

 portion of the inteftinal canal out of the belly, for the pur- 

 pofe of introducing, with all the requifite precautions, the 

 upper end of the bowel into the lower. This cannot be 

 done without handling for too long a time, and more or lefs 

 roughly, the bowel, which is already irritated ; which cir- 

 cumftance, together with the pricks of the needle, and the 

 dragging of the ftitches, is more than an adequate oaufe 

 for the produftion of a fatal inflammation. The danger 

 will be ftill farther increafed, if, according to the experi- 

 ments of fome modem furgeons, the two ends of the bowel 

 are fewed together over a piece of a calPs trachea, or a fmall 

 hollow cylinder of tallow, or ifinglafs, a pafteboard tube, 

 &c. Whatever may be the foreign body put within the 

 bowel, it may, by obftruAing the courfe of the feces, 

 bring on violent inflammatory fymploms, and deftroy the 

 patient in the moll agonizing fufferings. 



Scarpa then adverts to the experiments made on dogs by 

 Dr. Thomfon of Edinburgh, and Dr. Smith of Philadel- 

 phia, which tend to prove that the two extremities of a 

 divided bowel may be united by means of a future, and then 

 returned into the carity of the belly, without endangering 

 the animal's life. (See alfo Boyer's experiments on this 

 -lubjeft, in the Mem. de la Societc de Medecine de Paris, 

 torn. i. ) It is alleged (fays Scarpa), that there is no rifle 

 of -the ligatures falling into the cavity of the abdomen after 



their detachment ; but that by one of the operations of 

 nature which cannot be explained, the threads are voided 

 with the feces after the cure. Scarpa notices that the par- 

 ticulars of the way in which thefe futures were made is 

 not given; and how (fays he) have the above gentlemen 

 fucceeded in applying the orifices of the divided bowel 

 accurately to each other, which is extremely difficult, efpe- 

 cially in dogs ? In whatever hght the fubjeft is viewed ( he 

 obferves), " I doubt whether it be poffible to re-unite, 

 by means of any future, the extremities of a divided 

 bowel after mortification in hernia, or at leaft to do it 

 with any probabihty of fuccefs. Such experiments, even 

 when they fucceed in the belt poffible manner, merely 

 prove that certain operations, which would mofl; frequently 

 be ufekfs or fatal on man, may be fuccefsfully praiSifed on 

 other animals." 



On the contrary (fays Scarpa), in the circum^ftances 

 which have been fuppofed, nature is daily obferved to fuc- 

 ceed in re-eftabliftiing the continuity of the inteftinal canal, 

 by means equally fimple and mild. She prepires herfelf (as 

 it were) for this work before gangrene aftually takes place, 

 by forming adhefions between the ftrangulated bowel and 

 the neck of the hernial fac. After the feparation of the 

 mortified parts, flie draws back into the abdomen the ex- 

 tremities of the divided bowel, and out of the remains of 

 the hernial fac, ftie forms a fort of funnel-ftiaped membrane, 

 which ferves at firft for direfting the feces outwards, and 

 afterwards for tranfmitting them from the upper orl ice of 

 the intefti.ie into the lower, by making them follow a femi- 

 circular track from before backwards. For two or three 

 inftances of the complete fuccefs of Ramdohr's operation, 

 an almoft innumerable multitude of cures effected altogether 

 by the powers of nature could now be cited. Thi s, fays 

 Scarpa, in th- prcfent ftate of our knowledge, wc fliould 

 congratulate patients who, in thefe unfortunate circum- 

 ftances, fall into the hands of furgeons either incapable of 

 undertaking an operation, or little folicitous about healing 

 up the wound. 



It may perhaps be imagined (continues Scarpa), that 

 Ramdohr's operation is better calculated for certain cafes of 

 penetrating wounds of the abdomen, as, for inftance, where 

 the inteftine has been completely divided with a cutting in- 

 ftrument, or by the effefts of gangrene arifing from long 

 expofure to the air. Scarpa here allows that it would be 

 very defirable to find out fome operation which could be 

 ufeful in thefe circumftances, which are the more unfor- 

 tunate, becaufe they do not furnifti nature with the means 

 of re-eftablifliing the continuity of the inteftinal canal, as in 

 cafes of mortified hernix. But he doubts whether in fuch 

 inftances Ramdohr's operation could be undertaken with 

 any probability of fuccefs ; for the complete divifion of the 

 inteftine is almoft always the refult of an enormous wound, 

 which having interefted feveral vifcera leaves little or no 

 hope of recovery. Suppofing the bowel fliould not hate 

 been divided with the cutting inftrument, but that it is pro- 

 truded and gangrenous from long expofure, it muft be 

 remembered, that in this cafe it will have contrafted adhe- 

 fions to the hps of the wound, even before the feparation of 

 the mortified part ; confequently, the bowel cannot be 

 drawn farther out of the belly, fo as to allow one end 

 of it being introduced into the other. To undertake fuch 

 an operation then, would be to expofe the patient to much 

 greater perils than that of an incurable artificial anus. 



According to Scarpa, it is Httle to have proved that 

 Ramdohr's operation is imprafticable when the inteftine has 

 been completely divided ; he proceeds farther, and has no 

 Iiefitation in afferting, \.)m\. in all cafes of penetrating wounds 



of 



