\A UUMU:^. 



the abdomen, and frequent vomiting. The pulfe was 

 quick, fmall, and weak, the fl<in hot and dry, the tongue 

 much furred, the urine high coloured ; and there was fome 

 difficulty of breathing, and great thirll. Eight ounces of 

 blood were taken away, the fomentations continued, and a 

 few grains of calomel were direfted to be given every four 

 hours, until the bowels were properly opened. After- 

 wards the efFervefcing mixture, with ten drops of laudanum, 

 was exhibited every four hours. 



On the following day, the patient had had fome motions, 

 and was much better ; but as his ficknefs continued, he was 

 ordered a grain of opium every four hours. About a week 

 afterwardf, he complained of a great increafe of pain, 

 which was fomewhat relieved by a blifter. He was now 

 completely jaundiced, and his ftools were white, but the 

 tenfion, pain, and ficknefs, were abated. 



Two days afterwards, a fluAuation was perceived in the 

 abdomen, which in another week became confiderably dif- 

 tended with fluid. The patient now did not complain of 

 much pain, but appeared to be finking fail ; a puniElure 

 was made in the fwelling, and thirteen pints of what appeared 

 to be pure bile were evacuated. The bowels then foon be- 

 came regular, and the appetite good. In twelve days, the 

 operation was repeated, and fifteen pints of the fame bilious 

 fluid were drawn off. Nine days afterwards, another punc- 

 ture was made, and thirteen pints more let out ; and fix 

 were difcharged in another fortnight. From this period the 

 boy went on well, and perfectly recovered under the ufe of 

 light tonic medicines. See Medico-Chirurgical Tranfac- 

 tions, vol. iv. p. 330. 



A previous accidental adhefion of the gall-bladder to the 

 peritoneum might alfo certainly prevent the extravafation of 

 bile, and its dangerous efFefts. Callifen, Syft. Chir. Ho- 

 diernjE, torn. i. p. 718. 



Mr. Hennen has never known a patient recover after a 

 wound of the gall-bladder ; and indeed, fays he, it is diffi- 

 cult to imagine a cafe where the injury could happen with- 

 out an efFufion of bile into the abdominal cavity, except a 

 previous adhefion had taken place to the parietes. A cafe, 

 however, is mentioned in the " Opufcules de Chir." of M. 

 Paroiffe, where a leaden ball had lodged in the gall-bladder 

 two years. 



4. Urine. — Urine being of a very fluid nature may, like 

 the bile, be eafily extravafated in the abdomen, when the 

 bladder is wounded at any part which is connefted with the 

 peritoneum. If the urine in this kind of cafe be not drawn 

 off with a catheter, fo as to prevent it from ifTuing by the 

 wound of the bladder, the patient foon perilhes. There are 

 many inllances recorded of the bladder being injured even 

 by gun-{hot wounds which were not mortal. ( See Larrey's 

 Mem. de Chir. Mil. efpecially tom. iv. ) Such wounds, how- 

 ever, might only have injured the fides or lower part of the 

 bladder. But in operating for the ftone above the pubes, 

 the bladder has undoubtedly been occafionally cut at the part 

 of the fundus which is covered with the peritoneum. How- 

 ever, as the accident was known in the firfl inftance, the right 

 treatment was adopted, and fuch patients have recovered. 

 Sabatier, Mcdecine Operatoire, tom. i. p. 37. 



Wounds of the bladder are particularly charaAerized by 

 a difcharge of bloody urine and difficulty of making water. 

 They mull always be regarded as dangerous cafes, both on 

 account of the rifk of the effufion of fo irritating a fluid in 

 the abdomen, and of the chance of extravafation in the cel- 

 lular membrane. Under proper treatment, however, they 

 often admit of cure. The efFufed fluid ftiould, if poflible, 

 be difcharged by a depending pofliure, or fuitable punftures 

 or incifions, and its recurrence prevented by the iutrodu£lion 



of a catheter, which is to be left in the urethra. The pa- 

 tient muft alio be allowed little drink. As for the tenfion 

 and pain of the belly, the perpetual attendants of a wounded 

 bladder, they may be greatly reheved by the ufe of the 

 warm bath. (Calhfen, tom. i. p. 719.) Bleeding and other 

 antiphlogiftic means are not to be omitted. See Di<5l. of 

 Praft. Surg. art. Wounds. 



Extraneous bodies, particularly balls, as Mr. Hennen ob- 

 ferves, are frequently carried into the bladder iifelf, either 

 as it rifes above the pubes or through the openings in the 

 pelvis, or work their way into it, and either come off by 

 the natural paflage, or are removed by a furgical operation 

 refembling hthotomy. Wounds of the bladder, he remarks, 

 are dangerous in proportion as it is full of urine at the time 

 of their receipt, or as the upper and anterior, or lower and 

 pollerior part of the vifcus may be wounded. If the intef- 

 tines are implicated in the wound, it is highly dangerous. 

 Inflammation from wounds of thefe parts runs rapidly into 

 gangrene, which is chiefly brought on by the efi^ufion of 

 urine in the cellular membrane. " If there is a free exten- 

 five paflage, much of this danger will be obviated ; and 

 after the firfl eff^ufion from the bladder has taken place, the 

 judicious ufe of the elaftic gum catheter aff^ords us an ad- 

 mirable affiftance againll this accident. " Indeed," fays Mr. 

 Hennen, " without this ufeful inftrument, our praftice in 

 vfounds of this nature, and in thofe afFefting the urethra, 

 would be merely confined to looking on and moderating 

 fymptoms, inflead of preventing them," (P. 460.) The 

 reft of the treatment confills in letting out, without delay, 

 the effufed urine by proper incifions, and employing the an- 

 tiphlogiftic plan, in the full fenfe of the expreflion, together 

 with mild fuperficial dreflings or poultices, and the utmofl 

 attention to cleanlinefs. 



A deep wound of the liver, Mr. Hennen confiders as 

 fatal as one of the heart itfelf. Shghter injuries of this 

 organ, he fets down as fometimes recovering. He fays, 

 that the ufual fymptoms which charafterize wounds of the 

 liver are, yellownefs of the fl<in and urine, derangement of 

 the ftomach and of the alimentary canal, and cutaneous 

 affeftions, particularly great and diftrefling itching. The 

 difcharge from the wound is generally yellow and glutinous ; 

 but he has feen it of a ferous nature, and fometimes very 

 nearly allied to unmixed bile. 



Wounds of the liver, fays another writer, may caufe a 

 large efFufion of blood from the outer wound, or in the 

 abdomen, a cadaverous yellovc countenance, pain in the 

 (houlder, flow pulfe, dulnefs of the eyes, great anxiety, 

 cold fweats, and finally death, which happens the more 

 quickly and certainly, the greater the wound is, and the 

 nearer it is fituated to the place where the large vefFels 

 enter this organ. But fmall wounds of the liver, particu- 

 larly of its convex furface, when it is adherent to the peri- 

 toneum, admit of cure. Callifen, tom. i. p. 718. 



The treatment is to be at firft condu£led entirely on an- 

 tiphlogiftic principles, venefeftion, and mild aperient me- 

 dicines in particular being employed. Afterwards fmall 

 dofes of the pil. hydrarg. and tonic medicines will tend to 

 re-eftabhfh the health. 



A wound of the ftomach may be known by the difcharge 

 of aliment from the external opening ; by the vomiting of 

 blood ; the pain, the anxiety, and other fymptoms of violent 

 nervous irritation. Large wounds cf this organ, efpecially 

 thofe about the cardiac orifice, or great curvature, or fuch 

 as extend through both fides of the vifcus, are for the moft 

 part fatal in a few days : but when the wound is diflTerently 

 fituated, and properly treated, it may often be cured. In 

 certain inftances, however, a fiftula remains, through which 

 2 a part 



