7’H 
anatomy, structure, relative connections, and 
functions, of the parts concerned ; for the 
sword or the bullet may, by the smallest dif- 
ference in its direction, occasion instantane- 
ous death ; give rise to tedious, intractable, 
and ultimately fatal diseases; or penetrate and 
even pass through the body, almost with im- 
punity'. 
/Founds of the breast and lungs. Extreme 
difficulty of breathing, coughing up of blood, 
a discharge of air from its exterior orifice, or 
the sudden formation of emphysema or windy 
tumour, &c. are described by authors, among 
the signs indicating a wound in the lungs’ 
substance. If, together with these symptoms, 
“ the patient is oppressed, tossing, insen- 
sible ; his face ghastly, and his extremities 
cold ; his condition is doubtful ; it looks 
much like a wound of some vessel near the 
root of the lungs, and if so, lie is surely gone. 
If the oppression comes on more slowly, the 
pulse only hurried and fluttering, and the 
•extremities not so cold, there is reason to 
hope that the wound is merely in the edges 
of the lungs ; and as it is at a distance from 
the great veins and arteries, he may escape.” 
(J. Bell on Wounds.) If, when the breast 
is wounded, there is no emphysema, no 
spitting of blood ; none of that oppression in 
breathing, which proves that the blood is 
pouring either into the proper air-cells of 
the lungs, or the cellular texture of these 
organs, it may be concluded, that the wound- 
ing instrument has not passed into the tho- 
racic cavity, but is merely in the external 
part of the chest. To ascertain whether the 
suffocative oppression just noticed, proceeds 
from extravasation of blood into the air-cells, 
or merely into the thoracic cavity, we are 
directed, that the finger be thrust into the 
wound, and some blood let out ; which ope- 
ration, if it is attended with very sensible 
relief, proves, that the air-cells or proper 
cavity of the lungs are uninjured ; and the 
danger in this last case, is much less than if 
these cells had been wounded. 
/Founds of the belly. Wounds of the belly 
are for the most part mortal; and this, when 
it does not arise from an injury to any of 
the large viscera or their great blood-vessels, 
principally depends upon the extreme suscep- 
tibility to peritomeal inflammation. “Wounds 
of the head are deadly, from the oppression 
of the brain, and there delirium or coma are 
the deadly signs. 'Wounds of the breast are 
fatal by the oppression of the kings; and 
there difficult breathing, tossing, coughing 
of blood, coldness of the extremities, and 
a faultering, pulse are the mortal signs. 
•Wounds of the abdomen are mortal by the 
inflammation and gangrene ; and thd signs of 
danger are, swelling of the abdomen, intense 
pain, vomitings, costiveness, hiccup, faint- 
ings ; then an interval of deceitful ease, 
which is merely a sign of intellectual gan- 
grene, and of the near approach of death. 
The wounding instrument, however, may 
penetrate or pass through the liver or the 
spledn, and prove mortal in another way be- 
side that of inducing peritoneal inflamma- 
tion ; viz. bv occasioning a sudden and co- 
pious extravasation of blood, and in these last 
cases the fatal symptoms present themselves 
with more rapidity. “ In wounds of the 
liver, there is great inward bleeding : the pa- 
tient immediately sinks, and faints, languishes 
in a slumbering state, insensible almost and 
SURGERY. 
without pain, lies cold and death-like for 
perhaps twenty-four hours, and then ex- 
pires.” 
When the spleen or vena cava is wounded, 
the signs and consequences of the internal 
bleeding are nearly the same as in wounds of 
the fiver. “ A wound,” says Mr. J. Beli, 
“ of the spleen, liver, or vena cava, is as deadly 
as a wound of the heart, so full are they of 
blood.” To this rule, however, there are 
some very few exceptions. 
The inward bleedings from smaller vessels, 
as of the mesentery, the kidney, the emul- 
gent veins, &c. for the most part prove 
mortal, in the secondary manner above al- 
luded to, viz. by inducing inflammation ; 
in these last instances then, the progress and 
nature of the symptoms are different. “ And 
here it may be noticed, that if there are im- 
mediate fainting on receiving the wound, 
and then coldness, accompanied with a con- 
tinued, faintness, swelling of the belly, and 
oppressed breathing, most likely there is 
blood extravasated, and in dangerous quan- 
tity, from some greater vessel ; but if the 
patient has lain easy, and there come pain, 
swelling, fever, and* other threatening signs 
on the sixth or seventh day, with a tumour 
in one part of the belly, it is most likely a 
1 bloody tumour, which has begun to excite 
inflammation. If there are pain and swelling 
on the first or second day, it is from wounded 
intestine ; if there are pain and swelling, but 
not till the sixth day, it is from blood ; if 
there is no pain nor swelling till after the 
fifteenth day, our patient is almost safe.” 
When the stomach is wounded, a burning 
sensation is experienced at the pit of this 
organ, then follow heat, thirst, an accele- 
rated pulse, and violent vomiting, which are 
succeeded by fainting, extreme prostration of 
the vital powers, an extremely rapid and 
fluttering pulse, swelling of the abdomen, 
hiccup, and death. 
If the wound is in the intestines, the fa?ces 
often escape from the orifice; fever, pain, 
irritable pulse, swelling of the belly, faintings, 
mortification, and death, ensue. 
We have hitherto spoken of peritonaeal 
inflammation, as occasioned by an extrava- 
sation of blood; frequently, however, the 
irritating cause by which it is induced, con- 
sists of the contents of the viscus or viscera, 
that may be wounded. Thus, when the gall- 
bladder is the seat of the injury, the bile is 
poured out; when" the urinary bladder is 
wounded, the urine; when the stomach, the 
food ; and when the intestines, the freces are 
discharged, and excite this fatal inflammation. 
It is scarcely necessary to add, that be- 
side the symptoms already enumerated, 
jaundice will almost invariably be attendant 
upon a wound of the gall-bladder or ducts ; 
and an incontinence or suppression of urine, 
of the urinary bladder. 
Further, a large wound penetrating the 
cavity of the belly is generally attended with 
a protrusion of some of the viscera ; and even 
when the wound does not penetrate thewab- 
dominal cavity, the peritonaeum sometimes 
protrudes and occasions hernia. Wounds 
likewise of the belly, which do not pierce 
the cavity of the abdomen, often prove dis- 
tressing, tedious, and ultimately fatal, by 
occasioning sinuous ulcers among the mus- 
cles, and caries of the bones, and hectic fever. 
This is frequently the case in gun-shot wounds, 
where, the bullet being lodged about the 
loins and in the heart of the muscles, the 
patient may have escaped the first danger, 
but will at length, after many months, be the 
victim of tedious suppuration, and lingering 
wasting hectic. 
Respecting the symptoms which succeed 
to injuries of the head, we shall defer our 
remarks till we come to notice the surgical 
operations on the skull ; and shall now go 
on to consider the treatment of wounds. 
Treatment of zvounds. It will first b ne- 
cessary to consider the management of what 
are called simple wounds, w'ithout supposing 
the injury to have extended to the internal 
organs; to state the circumstances which 
may interfere with the orderly course of 
healing of such wound : and then to notice 
the more particular treatment of wounds in 
the breast or belly. 
In conducting the cure of simple wounds, 
the surgeon will find “ his duties happily 
reduced within the narrowest bounds, viz. 
of saving the patient from immediate bleed- 
ing, and of laying the wounded parts so 
clearly, so neatly, and so evenly in contact 
with each other, that they may adhere. The 
rest we leave to nature.” “ I fear,” says the 
author from whom we have taken the above 
extract, “ that from mv announcing a rule 
of conduct so simple as this is, you will sup- 
pose, that I mean to speak only of the slighter 
and more trivial wounds ; while I do really 
mean to include, under this general view, 
the greatest and the smallest Wounds ; and to 
establish but one rule for all, from the ampu- 
tation of a limb, or the extirpation of a tu- 
mour, to the most trivial cut of the cheek or 
hand. 
“What is amputation but a wound? .the 
greatest wound, clean and fair, made care- 
fully by the hand of the surgeon, disposed to 
heal in the easiest way? and in this great 
wound, which a fortiori includes the doctrine 
of every lesser wound, what is there to at- 
tend to but the procuring of adhesion, or the 
stopping of the flow of blood ? What were 
the defects of the old operations, but that 
the surgeon knew not how to procure this 
adhesion? that he had no means by which 
he could stop the bleeding ? The haemorrhage 
was fatal to most of those who needed to 
suffer this operation ; and the few who sur- 
vived lingered through all the miseries of a 
nine-months cure, tedious and imperfect, 
with conical, ulcerated, and tender stumps. 
What indeed is the chief perfection of modern 
surgery, or the excellency of our operations ? 
but that in bleeding from great vessels we 
trust nothing to compression, cauteries, or 
astringents, but tie our arteries firmly ; and 
that we talk no longer about mundifying, . 
incarning, or cicatrizing of wounds ; that we 
never dress the cut surfaces as distinct 
wounds, but put the sides or lips in close 
contact, and keep them so. We boast no- 
thing of our own powers, but trust all to na- 
ture; whose business it is, to make those sur- 
faces adhere which will adhere; or reunite 
by the slower process of suppuration and 
granulation, those parts among which there 
lias been a loss of substance.” (J. Bell oh 
Wounds.) 
We have thus taken the liberty of copying 
the masterly and impressive language of "this 
