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CHAP. XXXIV. The cure of wounds of the lower Belly.
THe first cogitation in curing of these wounds ought to be, Whether they pierce into the capacity of the Belly; for those which pass no further than the Peritonaeum shall be cured like simple wounds which only require union. But those which enter into the capacity must be cured after another manner. For oft-times the Kall, or Guts, or both, fall forth at them.
A Gut which is wounded must be sowed up with such a seam as Furriers or Glovers use,* 1.1 as we formerly told you; and then you must put upon it a powder made of Mastich, Myrrh, Aloes and Bole. Being sowed up, it must not be put up boysterously together and at once into its place, but by little and little, the Patient lying on the side opposite to the wound. As for example, the right side of the Guts being wounded and falling out by the wound, the Patient shall lye on his left side, for the more easie restoring of the faln-down Gut, and so on the contrary. If the lower part of the Guts being wounded slide through the wound, then the Patient shall lye with his head low down, and his buttocks raised up by putting a pillow under them; If the upper part be hurt, then must he lye quite contrary, that the Guts falling downwards, by such a site, may give way to those which are faln out through the wound. But often in this case, the Guts having taken cold by the encompassing air, swell up and are distended with wind, the which you must discuss before you put them into their place, with a fomentation of the decoction of Camomil, Mellilot, Aniseeds, and Fennel, applyed with a Spunge, or contained in a Bladder; or else with Chickens, or Whelps cut alive in the midst and laid upon the swelling; for thus, they do not only discuss the flatulency, but also comfort the afflicted part. But if the inflation cannot thus be discussed, the wound shall be dilated, that so the Guts may return the more freely to their place.
If the Kall shall fall out, it must be speedily restored to its place, for it is very subject to putre∣fie;* 1.2 for the fat, whereof for the most part it consists, being exposed to the air, easily loses its na∣tive heat, which is small and weak, whence a mortification ensues. Hence is that of Hippocrates; If the Kall fall out, it necessarily putrefies. The Chirurgeon shall know whether it putrefie, or not,* 1.3 by the blackness and the coldness you may perceive by touching it; neither must you when it pu∣trefies presently restore it to its place, for so the contagion of the putrefaction would spread to the rest of the parts: but whatsoever thereof is putrefied shall be twitched and bound hard with a string; and so cut off, and the rest restored to his proper place; but it's good after cutting of it away to leave the string still hanging thereat, that so you may pluck and draw forth whatsoever thereof may by being too strait bound fall away into the capacity of the belly. Some think it to be better to let the Kall thus bound to hang forth until that portion thereof which is putrefied fall away of it self, and not to cut it off. But they are much deceived: for it hanging thus would not cover the Guts, which is the proper place. The Guts and Kall being put up, if the wound be great and worth speaking of, it must be sowed with that suture which is termed Gastroraphia; but this kind of suture is thus made. The Needle at the first putting in must only take hold of the Peritona∣um, and then on the opposite side only of the flesh, letting the Peritonaeum alone, and so go along put∣ting the Needle from without inwards, and from within outwards, but so that you only take the musculous flesh and skin over it, and then only the Peritonaeum, until you have sowed up all the wound. He which doth otherwise shall undergo this danger, that whereas the coat Peritonaeum is of it self without bloud, it being divided, or wounded, cannot of it self be united to it self, therefore it requires an intercourse of flesh: otherwise unless it be thus united by the benefit of the flesh in∣termixed therewith, there would remain an uncurable tumor after the wound is cicatrized on the outside. But that which we said before, according to Galen's mind, that al the wounds must be sowed,* 1.4 it is not so to be taken, as if that the wound must be sowed up to the very end; for in the lower part of the wound there must be left a certain small vent by which the quitture may pass forth, which being wholly cleansed and exhausted, the wound must be quite healed up. But the wounds which shall penetrate into the substance of the liver, spleen, ventricles, and other bowels, the Chirur∣geon shall not suffer them to be without medicines, as if they were desperate, but he shall spare neither labour nor care to dress them diligently. For doubtful hope is better than certain despair. The bladder, womb, and right gut being wounded, detergent and agglutinative injections shall be put up by their proper passages. I have read nothing as yet in any Author of the wounds of the fat, for all of them refer the cure thereof to the wounds of the Muscles.* 1.5 Yet I will say this by the way, that wounds of the fat, how deep soever they be, if they be only simple, may be dressed with∣out putting in of any Tent, but only dropping in some of my Balsam, and then saying upon it a plai∣ster of Gratia Dei, or some such like; for so they will heal in a short time.