John Thomson," " that copious blood-letting, and the use of the anti-phlogistic regimen in all its parts, are the best auxiliaries which the surgeon can employ in the case of all injuries of the viscera, contained within the cavity of the abdomen." With us in the East the state of our patients necessitated a much more cautious use of the lancet in these and in all other injuries, than is common. Opium, however, was the chief reliance in these lesions, as it allayed that pain and anxiety which might, without it, have been interpreted into a call for depletion. The the intestine, and more of the acute, the lower." It would be a matter of some moment that we could rely on this sign.
We can seldom, however, distinguish the character of the p.iin from the patient's statement, and it does not always afford us a true guide when it is recognized. AND F.LADDER. 2G3 most.1 food is certainly one of most treating penetrating wounds y the mouth will do oil, are especially occur in mili; a;y practice which demand use of the suture to the intrstine. Such cases arc 1. To those in which its employment is not distinctly indicated, Hunter's remark particularly ics: "I should suppose the very best practice would be quiet, and do nothing except bleeding, which,,ses of wounded intestine, is seldom necessary. usion of the gut is rare, unless the wound has been occ. ly a large ball, as a grape-shot.
Its can tul return is, hown the propriety of ing protiudcd onieiituin to act as a plug in the wound. It is in wounds of the abdomen that tlie treatment by st footing. The fear of he Strong lasciayr Let ween the mil.is assigned; aim it has to adaption in these wounds. Bu nee, while it has overthrown this cause of anxi>..nthata y which tirees ooze, but cannot g. in similar wounds pe; the bladder, or in cases in which a large amount of blood has been ctiu-.l into tin abdomen, it may WAR. necessary to enlarge the wound, in order to pro ulterior consequences of more gravity than those which can follow from the step itself.
If a false anus result from a penetrating wound by gun-shot, the cure will in most cases take place in tiiiK* spontaneously. Of this I observed, with much interest, two cases at Constantinople, both of which very quickly got well. A plastic operation at a late date will probably supply what is deficient in the effort of nature. Where the destruction of soft parts has been considerable, the danger of ventral protrusion will require attention during after-life, and no little trouble is often caused by the irregular action of the viscera, by pains which either wander throughout the cavity, or localise themselves at the point wounded. These uneasy sensations are increased by any distension, such as that which follows a full meal, and they continue to distress the patient during digestion.
Dupuytren dwells on the effects of that chronic inflammation which may be set up by a contusion of the gut, and which, he says, may bring about a stricture of the intestinal canal, or its cancerous degeneration. I had fewer cases of penetrating wounds of the abdomen under my notice in the East, than of almost any other serious injury. The following are given as among the most interesting of those of which I have retained notes: Cousins, a private in the 77th foot, aged 18, was admitted into the general hospital, under Mr. Rooke, on the 8th of June. When standing in one of the advanced trenches sideways to the enemy, his right-arm be i TIL' stretched out in front of his hip, he was struck by;.