WOUNDS. 



or introdudion of medicated dreflings thought of. (P. 440. ) 

 At firft a common Unfeed poultice, and afterwards fimple 

 pledgets, are as eUgible dreflings as any which can be men- 

 tioned. 



Extravafation in the Mdomen.—VJomAs of the abdomen 

 may be complicated with extravafations of blood, chyle, ex- 

 crement, bile, or urine. None of thefe complications, 

 however, are half fo frequent as an unreflefting and inexpe- 

 rienced praftitioner might apprehend. The employment of 

 the phrafe cavity of the abdomen has paved the way to much 

 erroneous fuppofition upon this fubjeft, and has induced 

 many abfurd notions, which even the fenfible obfervations 

 long ago publiftied by Petit (le fils) have fcarcely yet 

 difpelled. 



As a modern writer has obferved, " there is not truly any 

 cavity in the human body, but all the hollow bowels are filled 

 with their contents, all the cavities filled with their hollow 

 bowels, and the whole is equally and fairly preffed. Thus, 

 in the abdomen all the vifcera are moved by the diaphragm 

 and the abdominal mufcles, upwards and downwards, with 

 an equable continual prefTure, which has no interval ; and one 

 would be apt to add, the inteftines have no repofe, being 

 kept thus in continual motion ; but though the adion of the 

 diaphragm, and the re-aftion of the abdominal mufcles, are 

 alternate, the preflure is continual ; the motion which it 

 produces (they produce) is like that which the bowels have 

 when we move forwards in walking, having a motion with 

 refpeft to fpace, but none with regard to each other, or to 

 the part of the belly which covers them ; the whole mafs of 

 the bowels is alternately preffed, to ufe a coarfe illuftration, 

 as if betwixt two broad boards, which keep each turn or in- 

 teftine in its right place, while the whole mafs is regularly 

 moved. When the bowels are forced down by the dia- 

 phragm, the abdominal mufcles recede : when the bowels 

 are pufhed back again, it is the re-aftion of the abdominal 

 mufcles that forces them back and follows them ; there is 

 never an inftant of interruption of this preiTure, never a 

 moment in which the bowels do not prefs againft the peri- 

 toneum ; nor is there the fmalleft reafon to doubt that the 

 fame points in each are continually oppofed. We fee that 

 the inteftines do not move, or at leaft do not need to move 

 in performing their funftions ; for in hernia, where large 

 turns of inteftines are cut off by gangrene, the remaining 

 part of the fame inteftines is clofely fixed to the groin, and 

 yet the bowels are eafy, and their funftions regular. We 

 find the bowels regular when they lie out of the belly in 

 hernia, as when a certain turn of inteftine lies in the fcrotum, 

 or thigh, or in a hernia of the navel ; and where yet they 

 are fo abfolutely fixed, that the piece of inteHine is marked 

 by the ftraightnefs of the rings. We find a perfon, after a 

 wound of the inteftine, having free ftools for many days ; 

 and what is it that prevents the feces from efcaping, but 

 merely this regular and univerfal prefTure I We find a per- 

 fon on the fourth or fifth day with feces coming from the 

 wound ! a proof, furely, that the wound of the inteftine 

 is ftill oppofite, or nearly oppofite, to the external wound. 

 We find the fame patient recovering without one bad fign ! 

 What better proof than this could we defire, that none of 

 the feces have exuded into the abdomen ? 



" If in a wound of the ftomach the food could get 

 eafily out by that wound, the ftomach would unload itfelf 

 that way, there would be no vomiting, the patient muft 

 die ; but fo regular and continual is this prefTure, that the 

 inftant a man is wounded in the ftomach he vomits, he con- 

 tinues vomiting for many days, while not one particle efcapes 

 into the cavity of the abdomen. The outward wound is 

 commonly oppofite to that of the ftomach, and by that 



paffage fome part of the food comes out ; but when any ar» 

 cident removes the inward wound of the ftomach from the 

 outward wound, the abdominal mufcles prefs upon the fto- 

 mach, and follow it fo clofely, that if there be not a mere 

 laceration extremely wide, this prefTure clofes the hole, keeps 

 the food in, enables the patient to vomit, and not a particle, 

 even of jelhes or foups, is ever loft, or goes out into the 

 cavity of the belly. 



" How ( proceeds Mr. J. Bell), without this univerfal and 

 continual prefTure, could the vifcera be fupported ? Could 

 its ligaments, as we call them, fupport the weight of the 

 liver ? Or, what could fupport the weight of the ftomach 

 •when filled ? Could the mefentery or omentum fupport the 

 inteftines ; or could its own ligaments, as we ftill name them, 

 fupport the womb ? How, without this uniform prelTure, 

 could tbefe vifcera fail to give way and burft ? How could 

 the circulation of the abdomen go on ? How could tlie 

 liver and fpleen, fo turgid as they are with blood, fail to 

 burft ? Or, what pofiibiy could fupport the loofe veins and 

 arteries of the abdomen, fince many of them, e. g. the 

 fplenic vein, is (are) two feet in length, is (are) of the 

 diameter of the thumb, and has ( have ) no other than the 

 common pellucid and delicate coats of the veins .' How 

 could the vifcera of the abdomen bear fliocks and falls, if 

 not fupported by the univerfal prefTure of furrounding 

 parts ? In fhort, the accident of hernia being forced out by 

 any blow upon the belly, or by any fudden ftrain, explains to 

 us how perfeftly full the abdomen is, and how ill it is able 

 to bear any prefTure, even from its own mufcles, without 

 fome point yielding, and fome one of its bowels being thrown 

 out. And the ficknefs and faintnefs, which immediately 

 follow the drawing off of the waters of a dropfy, explain 

 to us what are the confequences of fuch prefTure being even 

 for a moment relaxed. But perhaps one of the ftrongefl 

 proofs is this, that the principle muft be acknowledged, in 

 order to explain what happens daily in wounds ; for though 

 in theory we (hould be inclined to make this diftinftion, 

 that the hernia, or abfcefs of the inteftines, will adhere and 

 be fafe, but that wounded inteftines, not having time to 

 adhere, will become flaccid, as we fee them do in difTe£lions, 

 and fo, falling away from the external wound, will pour 

 out their feces into the abdomen, and prove fatal ; though 

 we fhould fettle this as a fair and good diftinftion in theory, 

 we find that it will never aiifwer in praftice. Soldiers re- 

 cover daily from the moft defperate wounds ; and the moft 

 likely reafons that we can affign for it are, the fulnefs of 

 the abdomen, the univerfal, equable, and gentle prefTure, 

 and the aftive difpofition of the peritoneum ready to inflame 

 with the flighteft touch. The wounded inteftine is, by the 

 univerfal prefTure, kept clofe to the external wound, and the 

 peritoneum and the inteftine are equally inclined to adhere. 

 In a few hours that adhefion is begun which is to fave the 

 patient's life, and the lips of the wounded inteftine are 

 glued to the lips of the external wound. Thus is the fide 

 of the inteftine united to the inner furface of the abdomen ; 

 and though the gut cafts out its feces while the wound is 

 open, though it often cafls them out more freely while the 

 firft inflammation lafts, yet the feces refume their regular 

 courfe whenever the wound is difpofed to clofe." John 

 Bell's Difcourfes on Wounds, p. 323 — 327, edit. 3. 



The foregoing extraft, though drawn up in the moft 

 carelefs ftyle, contains fuch obfervations as are well calcu- 

 lated to make the reader uiiderftand that the abdomen is in 

 reahty not a cavity, but a compaft mafs of containing and 

 contained parts ; that the clofe manner in which the various 

 furfaces are conftantly in contaft muft powerfully oppofe ex- 

 travafations ; and that in faft it often entirely prevents 



them. 



