WOUNDS. 



the obftacles to reparation ai-e not abfolutely infurmountable. 

 Here retraftion is prevented, and the proceffes of everfion 

 and contraftion modified by the limited extent of the injury. 

 If, therefore, the adhefive inflammation unite the contiguous 

 iurfaces, effufion will be prevented, and the animal efcape 

 immediate deftruftion. But union can only take place 

 through the medium of the furrounding parts. 



According to Mr. Travers, it is the retraftion immedi- 

 ately following the wound that is a chief obftacle to the 

 reparation of the injury ; for if the divifion be performed in 

 fuch a way as to prevent retraftion, the canal will be reftored 

 in fo fliort a time, as but flightly to interrupt the digeftive 

 funftion. In confirmation of this ilatement, a ligature was 

 tightly applied round the duodenum of a dog, which be- 

 came ill, but entirely recovered, and was killed. " A liga- 

 ture, fattened around the inteftine, divides the interior coats 

 of the gut, in this efFeft refembhng the operation of a liga- 

 ture upon an artery. The peritoneal tunic alone maintains 

 its integrity. The inflammation, which the ligature induces 

 on either fide of it, is terminated by the depofition of a coat 

 of lymph, which is exterior to the ligature, and quickly 

 becomes organized. When the ligature, thus enclofed, is 

 liberated by the ulcerative procefs, it falls of neceflity into 

 the canal, and palTes off with its contents." P. 103, 104. 



It appears alfc from Mr. Travers's experiments and ob- 

 fervations, that longitudinal wounds of the bowels are more 

 eafily repaired than fuch as are tranfverfe. In a dog, a 

 longitudinal wound, of the extent of an inch and a half, was 

 repaired by the adhefive inflammation. Here the procefs 

 of everfion is very limited ; the aperture bears a fmaller 

 proportion to the cylinder of the bowel ; and the entire 

 longitudinal fibres refill the aftion of the circular, which 

 are divided, and can now only flightly leflen the area of the 

 canal. P. 108. 



When the wounded bowel lies within the cavity of tiie 

 abdomen, no furgeon of the prefent day would have the 

 raflinefs to think of attempting to cxpofe the injured in- 

 teftine, for the purpofe of fewing up the breach of continuity 

 in it. In faft, the furgeon feldom knows at firft what has 

 happened ; and when the nature of the cafe is afterwards 

 manifeiled, by the difcharge of blood per anum, an extra- 

 vafation of intellinal matter, &c. it would be impoflible to 

 get at the injured part of the bowel, not only becaufe its 

 exaft fituation is unknown, but more particularly on account 

 of the adhefions, which are always formed with furprifing 

 rapidity. But even if the furgeon knew to a certainty, in 

 the firft inftance, that one of the bowels was wounded, and 

 the precife fituation of the injury, no future could be ap- 

 plied, without confiderably enlarging the external wound, 

 drawing the wounded inteftine out of the cavity of the ab- 

 domen, and handling and difturbing all the adjacent vifcera. 

 Nothing would be more likely than fuch proceedings to 

 render the accident, which might originally be curable, un- 

 avoidably fatal. We muft agree upon this point with Mr. 

 John Bell, who fays, " When there is a wounded inteftine, 

 which we are warned of only by the pafllng out of the feces, 

 we muft not pretend to fearch for it, nor put in our finger, 

 nor expeft to few it to the wound ; but we may truft that 

 the univerfal prelTure, which prevents great effufion of blood, 

 and coUefts the blood into one place, that very preffure, which 

 always caufes the wounded bowel and no other to protrude, 

 will make the two wounds, the outward wound and the in- 

 ward wound of the inteftine, oppofe each other point to 

 point ; and if all be kept there quiet, though but for one 

 day, fo lively is the tendency to inflame, that the adhefion 

 will be begun, which is to fave the patient's life." Difcourfes 

 on Wounds, p. 361. edit. 3. 



When the extravafation and other fymptoms, a few days 

 alter the accident, evince the nature of the cafe, a future 

 can be of no ufe whatever, as the adhefive inflammation has 

 already fixed the part in its fituation, and the fpace, in which 

 the extravafation lies, is completely feparated from the 

 general cavity of the abdomen by the furrounding ad- 

 neiions. " 



When the bowel is not protruded, and the opening in it 

 IS fituated clofely behind the wound in the peritoneum, a 

 future is not requifite ; for the contents of the gut, not 

 paffing onward, will be difcharged from the outer wound, 

 and not be diffufed among the vifcera, if care be taken to' 

 keep the external wound open. There is no danger of the 

 wounded bowel changing its fituation, and becoming diftant 

 from the wound in the peritoneum ; for the fituation which 

 it now occupies is its natural one. Nothing but violent 

 motion, or exertions, could caufe fo unfavourable an occur- 

 rence, and thefe ftiould always be avoided. The adhefions, 

 which take place in the courfe of a day or two, at length 

 render it impoflible for the bowel to (hift its fituation. Sec 

 Dift. of Praft. Surgery, edit. 3. art. IVounds. 



In a penetrating wound of the abdomen, as a late author 

 remarks, whether by gun-fliot, or a cutting inftrument, if 

 no protrufion of inteftine takes place, (and this, it muft be 

 obferved, in mufl<et or piftol wounds, rarely occurs, ) the 

 lancet, with its powerful concomitants, abftinence and reft, 

 particularly in the fupine pofture, are our chief dependence. 

 Great pain and tenfion, which ufually accompany thefe 

 wounds, muft be relieved by leeches, if they can be pro- 

 cured, by the topical application of fomentations, and the 

 warm bath ; and if any internal medicine is given as a pur- 

 gative, it muft, for obvious reafons, be of the mildeft nature. 

 The removal of the ingefta, as a fource of irritation, is beft 

 effefted by frequently repeated oleaginous glyfters ; indeed, 

 on the firft infliftion of a wound of the abdomen, the con- 

 tents of the inteftinal canal and ftomach are generally evacu- 

 ated fpontaneoufly, the ftools being fometimes tinged with 

 blood. Their accumulation muft be guarded againft by a 

 rigorous diet ; for to the general ftate of fuhiefs of the 

 veffels induced by food, is added its local and mechanical 

 ftimulus in the undigefted form. By this treatment, pene- 

 trating wounds, in which feveral plicse of inteftines have 

 been neceffarily implicated, have been happily cured. 

 Authors abound with inftances of this kind, and Mr. 

 Hennen has feen feveral : among others, he was witnefs to 

 the recovery of a foldier, who had been ftiot through the 

 abdomen with a ramrod, at the fiege of Badajos in 1812, 

 which paffed in anteriorly, and aftually ftuck in the ver- 

 tebrx, from which it was not difengaged without the ap- 

 phcation of fome force. Garengeot and Lamotte alfo 

 record cures, after the paffage of fwords completely 

 through the body. See Hennen's Obf. on Mihtary Sur- 

 gery, p. 436, 437. 



In all penetrating wounds of the belly, the dreflings can- 

 not be too fimple and light. 



In fome inftances, the ball, or part of the weapon which 

 has inflifted the wound, remains within the abdominal 

 cavity, and is afterwards evacuated by the natural paffages. 



Balls, fays Mr. Hennen, frequently pafs clean through 

 the abdomen, evidently wounding the inteftines, but with- 

 out occafioning any protrufion of them at either of the 

 orifices. Thefe cafes, like all others of thofe parts, are 

 extremely dangerous, but are not neceffarily mortal. They 

 require the moft guarded attention, and the utmoft watch- 

 fulnefs of the approach of inflammation, which often comes 

 on moft infidioufly. The mildeft pofTible apphcation fhould 

 be employed to the wounds, and no plugging with tents 

 5 D 2 or 



