SURGERY. 
wonnd. To attempt to unite the edges by 
making them toucli at everj' point, would 
he obviously nugatory. The ensuing in- 
flammation agglutinates the gut to the sur- 
rounding parts, and thus the breach be- 
comes gradually closed, while the extrava- 
sated matter readily escapes through the 
wound, behind which the injured part is 
confined. If the wounded portion of the 
gut be within the cavity, we must trust to 
the powers of nature, observing only to fa- 
cilitate the discharge of the intestinal con- 
tents. Sometimes in such a case a perfect 
cure is obtained ; sometimes the feces are 
discharged for ever after through the wound ; 
and sometimes a fistulous opening remains. 
Should the return of a large piece of 
omentum be very difficult, it may be cut 
off, and any bleeding vessels secured. The 
wound should then be accurately and firmly 
closed by means of sticking plaister, aided 
by an attention to position, which is much 
better than using sutures. The introduc- 
tion of tents is a part of the old practice, 
contrary to all principle, and therefore 
universally exploded. The general treat- 
ment of the patient requires a strict ob- 
servance of the antiphlogistic plan ; perfect 
quiet, abstinence from animal food and fer- 
mented liquors, and mild purgatives should 
be employed in every case ; and where 
symptoms of inflammation exist, even al- 
. tliongh the pulse should be small, copious 
bleeding from a large orifice is absolutely 
necessary. Cupping or leeches to the ab- 
domen, followed by fomentations and blis- 
ters, will also be necessary. 
Gunshot womids of the abdomen are very 
seldom attended with protrusion of the in- 
testines. The treatment is here limited to 
the employment of general means, which 
have sometimes the happiest effect under 
very unpronjising circumstances. 
tVounds of the abdominal viscci'a are 
often attended with extravasation of vari- 
ous substances into the cavity ; these may 
consist of intestinal contents, bile, urine, or 
blood. Besides tlie swelling which they 
cause, their presence irritates the sur- 
rounding parti, producing inflammation, 
constitutional disturbance, and sometimes 
even suppuration and a manifest fluctuation. 
If bile or urine be effused, tlie symptoms 
come on very rapidly, arid are extremely 
urgent; but in other cases the symptoms are 
not so pressing. The resistance arising 
from the pressure of the respiratory muscles 
occasions the effused matters to be collected 
into one mass, and prevents them from be- 
coming generally diffused over the cavity. 
When swelling, attended with local pain, 
fluctuation, &c. and the other symptoms 
which will attend the case, clearly indicate 
a collection of this kind, it may be opened 
by the surgeon. 
Psoas abscess is a collection of matter 'be- 
hind the peritoneum, in the cellular sub- 
stance surrounding tlie psoas muscle. It 
forms in a very gradual manner, generally 
without inflammatory or febrile symptoms. 
There is a dull pain in the loins, and a 
slight weakness of the affected thigh. After 
some time, the matter -descending by its 
own weiglit, passes Poupart’s ligament, and 
forms a swelling in the groin ; or it may 
present in the back just under the last rib. 
At tills period the motions of the thigh a-re 
considerably impaired, particularly tliose, 
in which the psoas muscle is concerned. 
There is an impulse in the tumour, when 
the patient coughs, and the swelling is 
larger in the erect position. SoYnetimes 
disease of the vertebr® accompanies this 
affection. Vl hen the abscess bursts, thd 
whole cyst falls into a state of inflamma- 
tion ; violent irritative fever ensues ; and 
there is copious suppuration, under which 
the patient gradually sinks. The most 
successful plan hitherto adopted; is that of 
opening the abscess, as soon as’ it has pre- 
sented fairly, by a pretty free incision with 
the abscess lancet ; bringing the wound to- 
gether, without allowing the introduction 
of any air, and closing it accurately with 
sticking plaister. 
This is to be repeated when the matter 
has accumulated again, and thus the con- 
traction of the cyst will be promoted ; a 
third and fourth puncture may be neces- 
sary. Electricity and emetics of the me- 
tallic salts may be combined vvith this 
plan to favour the absorption of matter; 
and a blister kept open by the savine 
cerate will be an useful auxiliary means; 
Disease of the bone requires blisters or issues 
in the loins. 
Paracentesis abdominis is an operation 
performed for the discharge of dropsical 
fluid, and consisting merely in penetrating 
the parietes of the cavity by means of a 
troebar. The instrument is to be intro- 
duced three inches below the navel, in ai 
perpendicular line drawn from that spot ; 
and it should not be pushed more deeply, 
when it meets with no fiirtiier resistance. 
Pressure by a belt or the hands of as- 
sistants should be kept up during the eva- 
cuation as faintness is frequently produced 
X 2 
