WOUNDS, 



them. The paflage cited impreiTes us with the utility of 

 that quick propeniity to the adhefive inflammation which 

 prevails throughout every peritoneal furface, and which 

 not only often has the effeft of permanently hindering 

 effufion of the contents of the vifcera, by agglutinating 

 the parts together, but which, even when an extravafa- 

 tion has happened, beneficially confines the effufed fluid 

 in one mafs, and furrounds it with fuch adhefions of the 

 parts to each other as are rapid in their formation, and 

 effetlual for the purpofes of limiting the extent of the 

 effufion, and preventing the irritation of the extravafated 

 matter from affefting the reft of the abdomen. 



It is to M. Petit that we are indebted for the intro- 

 duAion of more correft modes of thinking upon the fore- 

 going fubjeft. See Mem. de I'Acad. de Chirurgie. 



But notwithftanding the influence of the reciprocal 

 preffure of the containing and contained parts againft 

 each other, and the ufeful effeft of the quickly arifing 

 adhefive inflammation in all penetrating wounds of the belly, 

 complicated with the injuries of the vifcera, we are not 

 to fuppofe that extravafation never happens, but only 

 that it is much lefs frequent than has been commonly 

 fuppofed. Mr. Travers, with much laudable induftrj-, has 

 endeavoured to trace more minutely than any preceding 

 writer the particular circumftances under which effufions in 

 the abdomen are likely or unlikely to happen. " It being 

 admitted (fays he) that there are cafes in which effufion does 

 take place, it is eafy to conceive circumftances which muft 

 confiderably influence this event. If, for example, the fto- 

 mach and bowels be in a ftate of emptinefs, the naufea 

 which follows the injury will maintain that ftate. If the 

 extent of the wound be confiderable, the matter will more 

 readily pafs through the wound than along the canal. A 

 wound of the fame dimenfions in the fmall and the large in- 

 teftines will more readily evacuate the former than the 

 latter, becaufe it bears a larger proportion to the calibre. 

 Incited and punftured wounds admit of the adhefion of the 

 cut edges, or the everfion of the internal coat of the gut, 

 fo as to be in many inftances adlually obliterated; whereas 

 lacerated or ulcerated openings do not admit of thefe falu- 

 tary procefles. Again, in a tranfverfe feftion of the bowel, 

 contraftion of the circular fibre clofes the wound, whereas 

 in a longitudinal feftion, the contraftion of this fibre en- 

 larges it. Such (fays Mr. Travers) are the circumftances 

 which, combined in a greater or lefs degree, increafe or di- 

 minifli the tendency to effufion." On Injuries of Inteftines, 

 &c. p. 13, 14. 



After the details of fome experiments and cafes, the 

 preceding author makes among other conclufions the fol- 

 lowing : 



1. That effufion is not an ordinary confequence of pene- 

 trating wounds. 



2. That if the gut be full, and the wound extenfive, the 

 furrounding preffure is overcome by the natural aftion of the 

 bowel tending to the expulfion of its contents. 



3. That if food has not recently been taken, and the 

 wound amounts to a divifion of the gut, or nearly fo, the 

 everfion and contraftion of the orifice of the tube prevent 

 effufion. 



4. That if the canal be empty at the time of the wound, 

 no fubfequent ftate of the bowel will caufe effufion, becaufe 

 the fupervening inflammation agglutinates the furrounding 

 furfaces, and torms a circumfcnbed fac ; nor can effufion 

 take place from a bowel at the moment full, provided it re- 

 tains a certain portion of its cylinder entire, the wound not 

 amounting nearly to a femi-divifion of the tube, for then the 



everfion and contraftion ate too partial to prevent an extra- 

 vafation. 



5. That when, however, air has efcaped from the bowel, 

 or blood has been extravafated in quantity within the abdo- 

 men at the time of the injury, the refiftance oppofed to 

 effufion will be lefs effeftual, although the parietal preffure 

 is the fame, as fuch fluids will yield more readily than the 

 fohds naturally in contaft. P. 25, 26. 100. 



6. That though extravafation is not common in pene- 

 trating wounds, it follows more generally in cafes where the 

 bowel is ruptured by blows, or falls upon the belly, while 

 the integuments continue unwounded. P. 36. 



7. That when the bowels are perforated by ulceration, 

 there is more tendency to effufion than in cafes of wounds. 

 P. 38, &c. 



Mr. Travers explains the reafon of the greater tendency 

 to effufion, hi cafes of inteftines burft by violence, and in 

 thofe of ulceration, " by the difference in the nature of the 

 injury which the bowel fuftains when perforated by a fword 

 or bullet, as in the one cafe, or burft or ulcerated in the 

 other. A rupture by concuffion could only take place 

 under a diftended ftate of the bowel, a condition moft 

 favourable to effufion, and from the texture of the part, a 

 rupture fo produced would feldom be of limite(f*extent. 

 The procefs of ulceration, by which an aperture is formed, 

 commences in the Internal coat of the bowel, which has 

 always incurred a more extenfive lefion than the peritoneal 

 covering. The punfture or cut is merely a folution of 

 continuity in a point or line ; the ulcerated wound is an 

 aftual lofs of fubftance. The confequence of this difference 

 is, that while the former, if fmall, is glued up by the effu- 

 fion from the cut veffels, or, if large, is nearly obhterated 

 by the full everfion of the villous coat, the latter is a perma- 

 nent orifice." P. 46. 



Blood is more frequently extravafated in the abdomen than 

 any other fluid. Extravafations of this kind, however, do 

 not invariably happen, whenever veffels of not a very confi- 

 derable fize are wounded. The compaft ftate of the ab- 

 dominal vifcera, in regard to each other, and their aftion on 

 each other, oppofe this effeft. The aftion alluded to, which 

 depends on the abdominal mufcles and diaphragm, is ren- 

 dered very manifeft by what happens in confequence of ope- 

 rations for hernise attended with alteration of the inteftines, 

 or omentum. If thefe vifcera Ihould burft or fuppurate 

 after being reduced, the matter which efcapes from them, or 

 the pus which they fecrete, is not loft in the abdomen, but 

 is propelled towards the wound of the fliin, and there makes 

 its exit. The inteftinal matter effufed from a mortified 

 bowel has been known to remain lodged the whole interval 

 between one time of drefling the wound and another, in confe- 

 quence of the furgeon ftopping up the external wound with 

 a large tent. When the above-mentioned aftion or preffure 

 of the mufcles is not fufficient to keep the blood from 

 making its efcape from the veffels, ftillit may hinder it from 

 becoming diffufed among the convolutions of the vifcera, and 

 thus the extravafation is confined in one mafs. The blood, 

 effufed and accumulated in this way, is commonly lodged at 

 the inferior and anterior part of the abdomen, above the 

 lateral part of the pubes, and by the fide of one of the refti 

 mufcles. The weight of the blood may propel it into this 

 fituation, or perhaps there may be lefs refiftance in this di- 

 reftion than in another. In opening the bodies of perfons 

 who have died with fuch extravafations, things may put on a 

 different afpeft, and the blood feem to be promifcuoufly 

 extravafated over every part of the abdomen. But when 

 fuch bodies are examined with care, it will be found that 



the 



