A compleat discourse of wounds, both in general and particular whereunto are added the severall fractures of the skull, with their variety of figures : as also a treatise of gunshot-wounds in general / collected and reduced into a new method by John Brown ...

CHAP. LXII.

Of the Abdomen wounded with Exition of the Intestines or Omentum.

IF the case be, that the Intestines or Omentum do come out of the wound, these with all speed are to be restored. But if they have been out long, and the ori∣fice of the wound be small, and by reason of the cold air these parts are filled with flatuosity, so as that they cannot be reduced, you are in this case according to Cel∣sus's advice first to make an incarnative fomentation to disperse this wind, and then to try the reposition of the parts. The fomentation may be made of Camomile, Spick∣nard, Squinanth, Melilot, Dill, Pennyroyal, Worm∣wood, Mints, Balm, Lavender, and all the carminative seeds and berries boyled in Wine, in which is to be dipt a spunge, and so to apply it warm to the affected part. Rhasis for this purpose doth apply the Lungs of Animals hot hereto. The flations being thus dissipated, the Inte∣stines are to be reduced with your fingers. If the Omen∣tum do come forth at the wound, and by reason of cold it hath got a strange colour, and purchased an un∣natural hardness in it, so far as the part is corrupt, this is to be cut away: but if it carries its native colour, and no change do appear in it, this are we to repose into its proper place; and if the wound be so small as we cannot get it in with our fingers, we are advised by a searching candle to repose it, this being dipt in some Trauma∣tick decoction. Some there are who for this use do use a Golden wire, and hereby do cut away all the putre∣fied part. The next intention after this is to stitch the

wound up by Gastroraphia. By Aquapendens there are set down 3 forts of these stitches: the first performed by thrusting the needle through the skin and the Muscles, even to the Peritonaeum not touching it; then from with∣in outwards the Peritonaeum is to be thrust through and the Muscles of the opposite side by the needle; then within the distance of an inch the needle is to be thrust through the Muscles of the same side, leaving the Peri∣tonaeum: and thus are you to proceed until you have stitcht up the wound. The second is done by stitching the Muscles together and the sides of the Peritonaeum together. The third differeth not from the stitch which is used in other parts of the body. These being done, the next Intention is to apply agglutinative emplasters or powders, of which I have already directed sufficiently; over which may be applied Empl. Diapalma, de Beto∣nica, Barbarum Stipticum, or the like. Galen propo∣seth the fourth scope is to prevent the hurting of any no∣ble parts; and this may be occasioned either by pain, or a collection of matter or blood in the cavity of the Ab∣domen. Gal. for the first, 6. Meth. cap. 4. adviseth to embrocate all the parts from the Arm-pits to the Inguens with Olive-oyl warmed; or oyl of Camomile, Dialthaea or Roses for this use is better. And as to the second acci∣dent, matter and blood may well fall from the lips of the wound into the Abdomen, and may not only offend the Guts but also all the other contained parts, for hereby sometimes a Tumour is caused, sometimes a Dropsie gene∣rated. And these signs do certifie their being inward∣ly contained; as first, the weight shews the same with pain and tension of the part; 2. if upon depression of the belly you find the matter make its passage from one part to another: hence are we by Galen directed to order such medicines as may rarifie the parts, both dissipate and draw forth the matter.

To conclude this, I shall present you with some remark∣able

histories worthy our observation as touching this Chapter. Albucasis lib. 2. cap. 58. Meth. Med. writes of a wound happening in the belly which was made by a small Knife, it was the breadth of a hand lacerated, and the Intestines came out the breadth of two hands, the In∣testines were restored, and the wound in 24. hours conso∣lidated, and the wound in the space of 15. days was re∣covered, upon which wound was put old wooll, wash∣ing it twice a day with Aqua Mellis until it was healed.

Another shall be of the Omentum, the which falling out of a wound, the Abdomen being cut and wounded, the Patient recovered, and this is of Galen de usu part. lib. 4. cap. 9. That the Omentum was framed for warmths sake is sufficiently evident, although in those who have been wounded in their Abdomen, in which wounds this hath fallen out, being hereby made livid, this com∣pells the Chirurgeon to cut off the hurt part. All such therefore do find their stomachs cold, and do not well digest their victuals, and do furnish themselves with many outward coverings, especially when a great part of this is taken away, as it happened once to a Fencer where we were forced to cut it almost all quite off, yet this man recovered, yet he the remainder of his life was ever hurt by any outward cold, and was not able to endure a naked belly, but ever did wear a quilt well thickned with Cotton over his belly.

Notes

• History.
• Another.