370 
DEPARTMENT OF SURGERY 
ing perforations should always be adopted when gunshot 
wounds of the abdominal region require surgical interference, 
at least when the cavity is explored, for many of the perfora¬ 
tions found in this way might otherwise be overlooked, and 
even though the surgical methods were otherwise correct, not¬ 
withstanding the oversight, nevertheless the failure would be 
preferred against the antisepsis. 
Treatment. —The treatment consists of repairing the damage 
done to the bowels, stomach, uterus, kidney, bladder or other 
abdominal organs injured, adopting strict aseptic measures in 
every detail, and overlooking nothing that might cause an un¬ 
favorable termination. Perforations of the intestines should be 
sutured ( Enterorrhaphy , Fig. 5, Vol. XX!V. , No. y, p. 280 ), and 
when all visible perforations have been sutured the intestines 
should be inflated in order to ascertain if any have been over¬ 
looked ; the cavity should be irrigated ; the wound thoroughly 
cleansed and the skin surrounding the wound should be well 
disinfected ; the wound properly sutured ; surgical dressings 
carefully applied and bandages securely adjusted. 
Peristalsis must be arrested by the use of opiates, and the 
diatetic treatment as that following the treatment of other in¬ 
testinal wounds. In large domestic animals the success in 
treatment of wounds of this description depends much upon the 
ingenuity of the surgeon in improvising methods to meet the 
demands of existing conditions, while in small animals a meth¬ 
odical procedure can more easily be followed, and every detail 
carefully observed. If a part of the intestines is badly mutila¬ 
ted the part so affected must be resected and the ends approxi¬ 
mated (Rev., Vol XXIV , No. j, Figs. 2 and j>, p. 2rj, and No. 
4, Figs. 5, d, 7 and 8, p. 283). If any portion of the intestinal 
tract is to be relieved of its function or part cf it, a gastroin¬ 
testinal anastomosis (Pig. 10) ; a lateral anastomosis (Fig. 12) ; 
or the formation of an artificial anus ( enteroproctia ), are all 
operations that can be used for this purpose in their respective 
indications ; in fact, the course to be followed in such instances 
must be determined while the patient is on the table, and the sim¬ 
plest possible method adopted that will meet the demands or 
accomplish the purpose. 
When the stomach of the horse is perforated the condition 
is generally dangerous, if the opening is large enough to allow 
the contents to pass into the cavity ; small punctures however 
often terminate favorably. In ruminants perforations of the 
stomach are not so seiious as in the horse. Rumenotomy is an 
