GUN-SHOT WOUNDS OF THE 
SMALL INTESTINES. 
By CHARLES T. PARKES, M. D„ 
Professor ok Anatomy in Rush Medical College, Chicago, III. 
Being the Address of the Chairman of the Section on Surgery 
and Anatomy, read at the meeting of the American Medical 
Association, held in Washington, D. C., May, 188 
CHICAGO: 
COWDREY, CLARK & CO., PRINTERS AND PUBLISHERS. 
I 884. GUN-SHOT WOUNDS OF THE 
SMALL INTESTINES. 
By CHARLES T. PARKES, M. D., 
Professor of Anatomy in Rush Medical College, Chicago, III. 
Being the Address of the Chairman of the Section on Surgery 
and Anatomy, read at the meeting of the American Medical 
Association, held in Washington, D. C., May, 188j. 
CHICAGO: 
COWDREY, CLARK & CO., PRINTERS AND PUBLISHERS. 
1884. Gun-Shot Wounds of the Small Intestines. 
Mr. President and Gentlemen of the American Medical Asso- 
ciation: The subject-matter of the remarks to be presented 
this morning was suggested to me by an article published in 
the British Medical Journal in 1882, from the pen of “that good 
man among men, and great man among doctors,’’ J. Marion 
Sims. 
The article in question was an appeal for operative interfer- 
ence in penetrating gun-shot wounds of the abdomen, in lieu of 
the “expectant treatment” so universally accepted and adopted 
by the profession, and which, in a few seemingly well authen- 
ticated instances, has led to recovery. 
The appeal was uttered in behalf of the vast majority on the 
side of fatality attending these cases, and was based upon the 
deductions to be drawn from the recoveries following opera- 
tions for diseases affecting the viscera of the abdomen and 
pelvis, during which the most terrible injuries have been in- 
flicted upon the contents of these cavities—the peritonaeum 
exposed for hours, as well as brought in contact with all kinds 
of foreign and usually irritating substances. 
It is scarcely necessary for me to affirm in your presence the 
fact that, with few exceptions, the older writers and surgeons 4 
advocate the “expectant treatment” in the management of these 
injuries, while the younger writers and surgeons favor opera- 
tions, pinning their faith upon the wonderfully favorable results 
attending the practice of Listerism, the purest of antiseptic 
surgical methods. 
During the past few months I have instituted and carried 
out, with the valuable assistance of Mr. J. McDill and Drs. 
Anthony, Freer and Bolles, a series of experiments for the pur- 
pose of ascertaining the results to be obtained by immediate 
operations after these wounds, with the hope that the relation 
of the attending circumstances and events would be interesting 
as well as useful, by adding to the data now in our possession 
other data, from which may be determined more intelligently 
the course of action to be adopted when these cases come under 
•our charge for treatment. 
No attempt will be made to review the great question of 
penetrating gun-shot wounds of the abdomen, which would 
lead me beyond the scope of the paper. Nothing but a fair 
recital of the history of the experiments, with some application 
■ of the conclusions to be drawn therefrom, will be undertaken. 
With this intent in view, there will be presented to you the 
accompanying phenomena, the manner of treatment and results 
of thirty-seven intentional gun-shot wounds of the abdomen, 
confining my attention entirely to my own observations, and 
(exhibiting to you such specimens as I have been able to pre- 
serve, taken from the animals; both of those which died, and 
of those which were sacrificed, after recovery, to obtain the 
specimen. Experiments of like nature have been made upon 
animals by very many surgeons, previous to the application of 
their convictions of the necessity of certain procedures to 
relieve disease or the effects of injury on the human body. 
No preparation of the animals selected for experiment was 5 
made, either as to choice of physical condition or surrounding 
circumstances, except that they were anaesthetized previous to 
being hurt. The wounds were produced by the ordinary Smith 
and Wesson revolver of 22, 32, 38 and 44 caliber, and by the 
22 caliber rifle. The shots were given at short range, so the 
damage done by the bullet fairly represents the injury met with, 
either in military or civil practice, as the results of shots from 
the firearms now in use. 
At first, no attempt was made to give a definite direction to 
the course of the bullet, other than that it should perforate the 
abdominal cavity. The results soon confirmed the fact so 
well known, that the larger number of patients suffering from 
such wounds never come into the hands of the surgeon, their 
injuries proving rapidly fatal. 
This ending, we can readily understand, must be a common 
one, when we bear in mind the construction and nature of the 
viscera contained in the cavity, especially their great vascular- 
ity, having vessels of imnjense size supplying them with, and 
carrying away from them, the blood necessary for their nutri- 
tion and the performance of their special functions; not to 
mention the main systemic artery and vein coursing through 
the cavity in a position rendering them readily liable to perfor- 
ation, death following speedily. 
It was also ascertained that a severe perforating and lacer- 
ated bullet wound of the viscera, such as of the kidneys, of the 
spleen, and of the pancreas, could not apparently be treated 
successfully in any other way than by an absolute removal of 
the injured organ; and notwithstanding the reported successful 
removal of almost every important organ of the abdomen by 
one surgeon or another, the conclusion was reached that some 
of these organs must be left in situ, in order that the functions 
of life may be carried on. 6 
Hence we were compelled to exert such control over the 
course of the missile as to have it produce a wound of the 
nature of those likely to come, and actually coming, under the 
care of the surgeon; so that the injuries became those confined 
to perforations and injury of the intestinal tube, with occasion- 
ally the injury of some of the larger special organs. 
It will not be amiss to recall to your minds, very briefly, some 
of the triumphs of abdominal surgery, and more especially to 
impress the fact that shot wounds of the cavity and contents 
present many questions of prime importance which are not 
met with in, and do not complicate, ordinary operations for 
disease or injury with any free, external wound. 
The removal of the spleen for acute wounds nearly always 
results in.recovery; so also one kidney has been removed suc- 
cessfully, either for disease or injury, often enough to place the 
operation of nephrectomy among the list of justifiable under- 
takings. 
Again, wounds of the intestinal tube of all degrees of sever- 
ity, up to complete division by the resection of portions of the 
entire calibre thereof, have been successfully treated by sur- 
geons, as is proved by the experimental researches of Dr. 
Traverse, the eminent Prof. S. D. Gross, Dr. Bell, and others, 
and confirmed by the experience of many surgeons during 
operations upon the human being for diseases of these cavities. 
Still, in each of the examples mentioned, the circumstances 
were entirely different from what is found present in perforat- 
ing gun-shot wounds of the abdomen. In the former, the 
peritoneal cavity was clear of blood and other extraneous sub- 
stances; the prevention of their entrance entirely under the 
control of the operator. In the latter, blood in large amounts 
was always found present; and the peritonaeum was smeared 
with the contents of the intestinal tube, necessitating prolonged 7 
efforts to secure a cavity clear of all hurtful substances. Of 
necessity, the latter cases would be least likely to escape the 
probabilities and dangers of subsequent inflammation of the 
serous membrane. 
Primary resection of portions of the intestinal tube, or entire 
removal of separate organs, are operations comparatively easy 
of performance, and are not necessarily attended with any dam- 
age to or exposure of any other portions of the abdominal 
cavity, outside of the immediate proximity of the site of the 
operation. 
Extravasation and haemorrhage should be entirely prevented 
and controlled; and the peritoneal sac can be maintained per- 
fectly clean during the time of, and after, all the procedures 
required by the operation. 
After gun-shot wounds, besides the resection or removal of 
any special organ required, there is great shock, and prolonged 
manipulation is necessary to obtain a proper cleanliness. 
The recital in detail of each experiment would be tiresome 
and occupy too much time, so that your attention will be called 
only to the more important facts and circumstances determined 
by them, 
There will be published with the paper a somewhat extended 
account of each experiment, from which individual inferences 
may be drawn. In addition, a short resume of the entire work 
will be given further along. 
First comes the question of haemorrhage and damage to 
blood-vessels, as this is primarily the most common and certain 
cause of death, and demands the surgeon’s first attention. In 
its excessive amount, occurring rapidly and suddenly, is to be 
found the explanation of the cases which are immediately fatal. 
This result will surely happen when the largest arterial trunks 
are severed by the bullet; further, its copiousness and persist- 8 
ency of flow, even when none but very small blood-vessels are 
divided, involve a matter of serious concern, if not a fatal issue,, 
either from the amount of blood lost, or in predisposing to- 
septic processes from blood decomposition. 
There is a remarkable persistency in the flow of blood fol- 
lowing the severance of vessels in the abdominal cavity, perhaps 
dependent upon the laxity of the tissues through which these 
vessels course, the absence of pressure from surrounding soft 
parts, and the lack of the peculiar influence of the atmosphere,, 
either from its weight or clot-producing power. 
When the abdomen is opened immediately after the transit 
of a bullet, its cavity is found to contain a large amount of 
blood, the quantity, of course, being in proportion to the size 
of the vessels wounded, but always a disproportionately large 
amount, no matter what their calibre; further, the flow is still 
going on from vessels of all sizes. There seems to be slight 
disposition to the formation of an obstructive clot in the mouths 
of the smaller ones, and slow retraction or contraction of the 
walls of the larger. 
Bleeding stops only when the heart ceases to beat in a faint 
from excessive loss, or when the amount of blood is so large that 
by its bulk, and weight, and distension of the abdominal walls, 
it makes pressure sufficient to occlude the open vessels. 
The conditions are very quickly altered after air is admit- 
ted through the abdominal section. Clots rapidly seal up 
the smallest vessels; the smaller arteries spurt less forcibly 
and soon cease beating; the larger ones contract and retract, 
just as occurs in the wounds of soft parts in other regions of 
the body. This is in accordance with, and corroborative of, 
the experience in haemorrhages occurring in abdominal sur- 
gery in the human being. Few of us have failed to see cases 
like this: a patient dies suddenly, with all the symptoms of 9 
acute prostrating haemorrhage; post-mortem examination shows 
the abdominal cavity filled with blood; the blood is carefully 
cleared away in the search for the source whence it came; and 
when this is found, it is a matter of astonishment that such a 
vast amount of blood could come from so small a vessel. 
Perhaps it is a small vein of the ovarian venous plexus, or a 
minute vessel in the thin-walled sac of an extra-uterine foeta- 
tion, or the partially closed vessels in the shrunken stump of a 
recently removed ovarian or other tumor, or some recently 
divided adhesions, all of them vessels which, in any other part 
of the body, would be no item of concern to the surgeon, or 
need any of his special care to prevent bleeding from them. 
The lesson taught by these facts is of imperative importance 
in all operations upon these cavities; and even if mastered, 
loses nothing by reiteration. Excessive haemorrhage being 
certainly the principal cause of speedy death in severe gun- 
shot wounds in this region of the body, where evidences of 
its presence are plainly exhibited, there can be no hope 
whatever of saving the lives of any of the wounded except by 
immediate abdominal section. This alone, by admitting air 
quickly, staunches the fast flowing current, and gives time for 
the application of the ordinary rules of surgery for the pre- 
vention of haemorrhage. 
In order to be safe from subsequent trouble, every divided 
blood-vessel must receive the surgeon’s attention, occluding 
clots must be thoroughly sponged away, and in their stead 
must be placed the ligature or the sear of the actual cautery. 
If'left without this restraint, and the abdominal opening be 
closed, the same conditions are restored as existed previous to 
the section; and as reaction comes on, bleeding will surely 
recur, and in large amount, leading to death from this cause 
alone, or furnishing a frequent source of septicaemia. This fact again is corroborative of the experience of ovariot- 
•omists, the most successful being those who take the greatest 
pains to staunch all bleeding before closing the abdomen. 
Following a resection of three or four inches of bowel and 
a ligation of two large subdivisions of the mesenteric artery 
wounded by the bullet, there occurred a mortification of several 
inches of the entire intestine above the site of resection. The 
mortified part corresponded with the distribution of the arteries 
wounded and ligated. This assuredly was an important fact to 
know, if at all likely to occur as the result of wounds of these 
arterial branches; even its accidental occurrence is a circum- 
stance to be remembered. Its occurrence would surely add 
largely to the gravity of the cases in which it happened, prob- 
ably necessitating a resection of a portion of the intestine cor- 
responding to the area of distribution of the wounded vessel. 
The great freedom of anastamosis between the mesenteric arteries 
rather argues against their wounds being followed by any such 
hazardous result; still, the case recorded above required ex- 
planation. Two experiments were performed in order to deter- 
mine whether destruction of the arteries alone was sufficient 
to lead to such mortification. 
Both demonstrated that a closure of two or three of the larg- 
est subdivisions of the main mesenteric vessel was not in itself 
sufficient to produce death of the portion of intestine supplied 
by them. The experiments were as follows: an animal was 
anaesthetized, and the abdomen opened. A sufficient length 
of bowel was drawn through the opening to allow of the liga- 
tion of two large sets of vessels adjoining each, the ligatures 
including vein and artery. The parts were returned to the 
abdomen and the latter closed. At the end of thirty-six hours 
the wound was reopened. No very noticeable change was 
found in the intestine; pulsation had returned in the ligated vessels beyond the ligature. The external wound was again 
closed. The animal recovered in a few days so as to be as 
lively as ever. 
A second animal was etherized, and a ventral section made. 
Three large vessels were ligated (veins and arteries), before 
their division into any branches. These three vessels lay par- 
allel with each other. A ligature was also thrown around the 
anastomosing branch near the intestine which connected with a 
fourth larger vessel. There followed immediately very marked 
whitening of the bowel. The parts were returned and the 
wounds closed. The animal recovered promptly from the ef- 
fects of the ether and the immediate effects of the operation. 
It remained quite well for six days, when it grew ill. The 
wounds were reopened. Pulsation had returned beyond the 
ligature. There was no sloughing or mortification of the intes- 
tine. It was congested slightly and seemed paralyzed, and was 
of wider caliber opposite the distribution of the ligated vessels; 
this was the only change. There was a great deal of very 
offensive matter in the peritoneal sac, and notwithstanding the 
high grade of inflammation, there was no adhesion of intestinal 
folds except at one point. Here there was found a perforation 
of the intestine. Out of the opening there protruded a piece 
of wood which, upon being pulled out from the cavity of the 
intestine, was found to be four inches long, and connected with 
a large mass of twine. This had evidently been swallowed by 
the animal, and had gotten along safely enough until it reached 
the inactive portion of the tube corresponding to the seat of 
operation, where it was forced through the tube by the strong 
contractions behind it. Unfortunately, the animal was killed 
by the ether during the examination. Aside from this accident, 
the animal had a good chance of recovery. 
The complication of a complete resection of the bowel, with 12 
a ligation of twocor more vessels, is the only .explanation to be 
given of the* case where mortification occurred. The experi- 
ments prove that such result does not follow simple closure of 
the vessels by ligation.' >■ r 
The second item to: be considered refers to the course of the 
bullet and the character of the damage done by it. Nothing 
can possibly be more uncertain and erratic than the track of 
the missile through the body. A contracting muscular fiber, 
an edge of fascia, the elasticity of the skin, a surface of bone, 
or a distended knuckle of intestine, each and all of these at 
times present obstructions sufficient to divert it from the direct 
line of its flight. It is certainly astonishing what very exten- 
sive and severe lacerations of the intestines are produced by 
so small a bullet as one of calibre No. 22, Fig. 1. c.; the entire 
circumference of the bowel at some points being mangled be- 
yond recognition; again, it is equally surprising how minute 
are the perforations made by the large No. 44, Fig. 2. As a 
rule, the larger the calibre of the bullet the larger the wound. 
An estimate of the direction of 
transit, based upon the points of 
entrance and exit, is purely con- 
jectural, and furnishes no standard 
whatever by which we may judge 
of any supposed injury to any or- 
gans known to lie in such course. 
In one experiment, the bullet made 
four openings through the abdo- 
minal walls, and did no damage other than contusion of two 
knuckles of the small intestine and gouging the serous mem- 
brane. 
The animal had a remarkably deep furrow along the course 
of the “ linea alba.” The bullet entered the right side of the ab- 
Figure i. 13 
domen obliquely, two inches from the mid-line,, perforated its 
walls, and coursing to the left, furrowed the peritonaeum in its 
passage; was evidently deflected outwards,.immediately before 
reaching the linea alba, by a knuckle of .intestine, which it 
contused slightly. 
Here it made its first exit through the walls, passed to the 
left side of the mid-line, again perforated the abdominal walls, 
and, furrowing the peritonaeum upon the left side, finally made 
its second exit through the abdominal walls three inches to the 
left of the linea alba. Near its place of final exit, a second 
knuckle of intestine was found badly contused. The contusion 
was so severe and extensive that it was thought best to resect 
a length of one inch. The animal recovered. 
In a second instance, the bullet entered the cavity about two 
inches to the right of the linea alba, on a line with the umbil- 
icus, with a direction upwards and to the left side. It made its 
exit nine inches, to the left of the mid-line, and just at the lower 
edges of the last rib. On opening the abdomen the stomach 
was found greatly distended, entirely concealing the other vis- 
cera from view, and presented two large perforations in its walls 
about two inches apart, from which some blood, mucus, and 
food were found running into the peritoneal sac. The wound 
to the right, in the stomach walls, was the smaller, and situ- 
ated directly opposite the entrance perforation in the abdom- 
inal wall, having the same direction. The wound to the left in 
the stomach walls (two inches to the left) was the larger, very 
ragged, and had evidently been made by the bullet deflected 
forward at its first entrance into the stomach. After leaving 
the stomach the bullet impinged upon the inside of the abdom- 
inal walls just to the left of the mid-line, and then, instead of 
perforating them at that point, was again deflected upwards 
and to the left, merely furrowing the peritonaeum along the 
remainder of its course to the point of exit mentioned. The 14 
wounds of the stomach were inverted, as it were, into the cavity 
of that organ, by bringing its peritoneal surfaces surrounding 
the wounds in contact with each other by means of the contin- 
ued catgut suture. The abdomen was carefully cleansed of 
blood, etc., and the wounds in the walls closed in the ordinary 
way. The animal speedily recovered from the injury, without 
any uncomfortable symptoms. During the recovery from the 
effects of the ether, the animal vomited considerable quantities 
of blood, giving an additional evidence of the perforation of the 
stomach. 
There were two cases in which the bullets perforated the 
abdominal walls, and in their transit did no injuries to the vis- 
cera, in which the points of entrance and exit were five and six 
inches apart. In each instance the only damage done was a 
furrowing and laceration of the peritonaeum along their entire 
courses, the blood from the track of injury falling into the 
abdominal cavity. In one experiment, the bullet failed to pen- 
etrate the abdominal walls and was subsequently dissected from 
between the muscles. On opening the cavity, quite a rent was 
found in the spleen opposite to the seat of external bullet 
wound, from which blood was freely flowing. There was neither 
abrasion nor perforation of the peritonaeum. This case may 
suggest the probable cause of death in some fatal cases from 
non-perforating wounds. The laceration was evidently caused 
by concussion alone. 
Other instances might be cited to illustrate the exceedingly 
great uncertainty as to the course taken by the bullet, and as 
to the organs probably impaired. They would also confirm 
the possibility of perforations of the walls without accompany- 
ing injury to the contents of the abdomen. Still, no instance 
was shown of failure to produce a wound thereof when the 
bullet’s course lay among the intestines. Their safety followed' 
deviation by glancing. 15 
The wounds of the intes- 
tines may be many in num- 
ber and situated very near ta 
each other (Fig. 3) so that one 
resection including all the 
openings will constitute the 
only operation that furnishes 
relief. 
Again, the openings may 
be few in number and widely removed from each other; and if 
each wound is large, and the damage to the tube extensive, 
such as is usually produced by a 32, 38 or 44 calibre bullet, 
three or four resections are necessary. The latter are the most 
difficult cases to manage and most fatal in their results. The 
position of the points of entrance of the bullet in the 
intestines is subject to immense variety, even in simple cases. 
It may involve only the top of a knuckle of intestine, merely 
opening the cavity thereof. The points may be so near each 
other that only a half inch or less of intestinal wall separates 
them from each other. (Fig. 1, a.) The bullet may merely cut off 
the mesenteric junction opening into the cavity more or less 
freely. The intestine is often perforated transversely near the 
middle, or longitudinally; in 
the latter case the bullet, enter- 
ing at one point, courses along 
in the cavity of the tube for 
some inches, and then makes 
its exit. 
All of these varieties depend 
upon the situation of the in- 
testinal folds with reference to 
each other at the time of the transit of the bullet. One case 
Figure 2. 
Figure 3. 16 
■showed io complete perforations in 18 inches of length-<yf the 
ileum, Fig. 3. 
Extravasation of the contents of th,£ tube was present in 
every instance where there existed the slightest degree of per- 
foration. These contents were forced out into the peritoneal 
cavity, or on to the surface of the intestines, if the wound was 
large, by the bullet itself, and the normal tonic contractions of 
the bowels ; and, if small, perhaps by the latter alone. This 
facility of extravasation agrees with my experience in wounds 
of the intestine in the human being. I have personal knowl- 
edge of two instances in which the medium-sized aspirator 
needle was employed to relieve tympanitic distension of 
the tube with success so far as getting rid of the gas 
was concerned, and giving great temporary comfort to the 
patient. Death ensued from the disease. Post-mortem ex- 
amination in each case demonstrated the presence of 
faecal extravasation at the seat of the needle puncture. It 
would not be an arduous task to collate instances of this 
accident in the practice of others, where this plan has been 
adopted. It is difficult to understand how any other result 
could follow a perforation, if there be contents at the seat of 
the puncture, when we remember how strong and constant is 
the action of the circular muscular fiber. It is stated that the 
protrusion or eversion of the mucous coat, which ensues very 
rapidly after complete division of the walls, acts as an imme- 
diate stopper of wounds of small size, say one-eighth of an 
inch in diameter. This may be true in incised wounds, but it 
was not shown to exist in a single one of the several hundred 
perforations coming under my inspection as made by the bul- 
let. The latter tears away and lacerates the parts through 
which it passes, and perhaps paralyzes the muscular fibers in 
its immediate neighborhood, but whatever the cause, there was 17 
no instance in which the eversion of the mucous membrane 
was sufficient to prevent extravasation. 
Recognizing the very deleterious influence of this material 
upon the peritoneal membrane, this fact of the great certainty 
of extravasation adds another point to the argument in favor 
of abdominal section in these cases, as furnishing the only 
means by which this source of trouble can be absolutely elim- 
inated. 
As part of the extravasated material from the wounds of the 
intestine, it was an exceedingly common thing to find intesti- 
nal worms of all kinds, and in large numbers protruding from 
the rents or free in the serous cavity. 
In the treatment adopted during these experimentations, it 
was found necessary to make an extensive external incision, 
freely exposing the abdominal cavity, in order that all the vis- 
cera might be thoroughly and carefully examined, and every 
wound brought within reach. In a majority of instances the me- 
dian line gave space enough, in two the bleeding vessels could 
not be reached without a lateral prolongation toward the 
flanks. 
There was no reason to suppose that the extent of the inci- 
sion added very much, if at all, to the gravity of the operation. 
After opening the abdomen, the intestines were all turned out, 
critically examined for perforation or contusion, the situation 
of these fixed, and the hamiorrhage therefrom controlled by 
means of the snap forceps, after which wounds of special organs 
were sought for. If the substance of the spleen or the kidney 
was found perforated, the organ was immediately removed af- 
ter ligating its blood-vessels, the stump being returned to the 
abdomen. If slight lacerations only at some point on the sur- 
face had been produced, these were closed by bringing perito- 
neal surfaces of the organ over the wound by means of the 
continued suture. 18 
The peritoneal sac was then carefully and thoroughly cleared 
of blood and other extraneous substances by repeated spong- 
ing or irrigation. The intestines, which during this process 
had been protected by being enveloped in towels wrung out of 
warm water, were now cleanly sponged, while all unwounded 
portions were returned to the abdomen. 
It seems to be of little consequence whether or not the in- 
testines be returned to the cavity in any definite order — in 
fact, it is doubtful whether they are ever returned precisely to 
the same positions they originally occupied before being dis- 
arranged during the operation. Still, some care must be used 
in order to avoid the accident which happened in one experi- 
ment. After the divided ends of the intestine had been united, 
it was found that during the manipulation one of the ends had 
in some way been passed through an opening in the divided 
mesentery, so as to produce a figure of eight convolution in 
the tube. It was left in this shape. The animal recovered, 
and I have the specimen with me to demonstrate the perfect- 
ness and security of the union in the intestine at the place of 
reunion. The animal was sacrificed to secure the specimen six 
weeks after the operation. The abdominal cavity was quite 
free from evidences of inflammation, except where the mis- 
placed folds lay in contact with each other. At this point 
slight peritoneal adhesion had formed between them. 
Where several wounds occurred rather close together, se- 
vere enough to destroy a considerable portion of the integrity 
of the bowel, one resection was made to include all of them, 
even when the length of intestine removed measured ten 
inches or more. Where the points of injury were widely sep- 
arated from each other and extensive damage done at each 
point, several resections of a length of the tube just sufficient 
to include the injured portions were made. 
In the former case, in which several inches of the tube were 19 
taken away, the mesentery was ligated as close as practicable 
to the intestine (Fig. 7), in sections corresponding to the num- 
ber of blood-vessels going through it to the resected portions. 
The mesentery was then divided close to the intestinal wall, 
and a “ V ” shaped portion of it removed. After this, the tube 
itself was divided, and the wounded portion removed. One 
artery, always needing ligation, was found in the divided ends 
at the point of junction of the mesentery with the intestine. 
Before the final division of the intestine, its contents were 
pushed back out of the way, compression exercised upon its 
walls by a pair of forceps or a temporary ligature, in order to 
prevent extravasation of its contents through the divided ends. 
The mark of constriction made by the forceps or ligature, used 
to close the lumen of the bowel, was to be plainly seen several 
days after the operation. The safest compression can be made 
by an assistant’s fingers. Results soon demonstrated the par- 
amount necessity of carefully selecting the place for final divi- 
sion of the intestine, in order to avoid sloughing of the edges 
approximated together, the results being best in those cases 
where the division was made close to the point at which any 
given mesenteric artery approached nearest to the intestine, as 
compared with those where the cut was made in the intervals 
between any two branches of these vessels, and this was seem- 
ingly dependent on the better supply of blood belonging to 
the former cases. Immediately after division of the intestine, 
there followed an instantaneous, regular and considerable con- 
traction of the calibre of the tube (Fig. 4, a), close up to the 
divided edge, caused by the action of the circular muscular 
fiber. The diameter was often diminished more than half by 
this contraction. This persisted for a time, but was soon fol- 
lowed by an eversion of the mucous membrane, which rolled 
out and over the constricted portion in a remarkable manner. 
(See Fig. 4, a, b and c.) 20 
This protrusion of the mu- 
cous membrane forms a se- 
rious obstacle to easy and 
close approximation of the 
ends of the bowel in the ef- 
forts to bring them together 
by sutures ; and, when turned 
into the bowel during such 
procedure, diminishes its calibre considerably, although it 
was not demonstrated that the obstruction was ever sufficient 
to prevent the passage of the intestinal contents. Several ef- 
forts were made to get rid of it, and overcome the seeming 
delay caused by its presence, but all these were finally aban- 
doned. 
It was pared away with the scissors ; it was dissected up 
from the other coats for a quarter inch from the edges, but the 
conclusion was finally reached that instead of being a harm, 
its presence was useful in giving support, protection, and per- 
haps vascularity to the freshly sutured edges ; at least, in all 
instances where it was removed, the stitches were found torn 
out and union defeated ; in no instance where it was left entire 
did there fail to be union in some part, and no sutures gave 
way when properly applied. 
In all instances where a per- 
foration was severe enough to 
require a resection of the 
wounded part, it was found 
advantageous to leave, if pos- 
sible, a strip of the bowel near 
the mesenteric junction (Fig. 
5, A), taking out the wounded 
portion by means of a “V ”- 
.shaped incision. The part left acted as a support to the wound, 
Figure 4 
Figure 5. 21 
avoided division cf the blood-vesse's at this point, opposed the 
action of the longitudinal fibers, and in no instance in which 
this plan was adopted was there any appearance of separation 
of the wound or any displacement of stitches. In perforations 
through the stomach, the wound did well after drawing the 
peritoneal surfaces some distance from the edges thereof, over 
it by means of the continued suture, thus converting it into a 
linear wound (Fig. 6 B). The same plan was adopted with 
success in abrasion and small perforations in the small intes- 
tines. (Fig. 6 A.) 
This way of treating the bul- 
let openings in the bowel is 
susceptible of much wider ap- 
plication than would appear 
possible at the first glance. I 
am quite well satisfied that itr 
will safely take the place of 
excision in not a few cases of 
quite severe injury. The torn 
edges of the wound can be turned in, and peritoneal surfaces 
fastened together, even in large wounds, with perfect confidence 
in the result of safe and secure adhesion following. 
It seems probable that by far the greater number of success- 
ful cases will follow a single resection, even if that include a 
number of perforations, and involves eight or ten inches of 
bowel, in comparison with those cases where several excisions 
are made of wounded portions widely separated. 
Perforations passing through the mesenteric surface of the 
intestine were found the most difficult to treat, and even if 
slight seemed always to require a complete excision. A par- 
tial excision of this surface of the bowel resulted in an acute- 
angled elbow which never did well. 
Figure fi. 22 
The point of attachment of the mesentery with the bowel 
will usually be found the most troublesome to manage, in ap- 
plying the sutures in restoring a complete division. (Fig. 5, 
B.) It is quite difficult to so place the sutures as to secure a 
perfect reinversion of the mucous membrane, to bring serous 
surfaces fairly in contact with each other, and to get a sound 
junction. The difficulty arises apparently from the manner in 
which the folds of peritonaeum separate from each other before 
passing on to invest the bowel, leaving a little triangular inter- 
val filled with loose connective tissues, fat and blood-vessels. 
Now, if the suture fails to include the muscular coats of the 
intestine as well as the peritonaeum at this point, the junction 
will surely give way and extravasation result. To make this 
point secure, the greatest care must be taken in placing at 
least three sutures (Fig. 5, B), this number being usually quite 
enough to include the troublesome area, and these should 
always be the first sutures applied. In placing the remaining 
sutures to complete the junction after placing the three sutures 
mentioned, at the mesenteric surface, it assists materially in 
the ease of application, saves time, and especially avoids trouble 
from the everted mucous membrane, to apply one at the most 
convex surface, and then one half way down, on each lateral 
surface. After this is done, the remainder can be introduced 
easily and rapidly. If introduced in a regular series, one after 
the other, all the way around, it is a very slow process; the 
mucous membrane is always in the way, the needle openings 
in the intestines are apt to be uneven, and it is altogether the 
poorest plan of proceeding. The advantages mentioned as 
gained by taking the course suggested, are certainly all of 
them items of importance, and have some bearing on the re- 
sult. At best, these procedures will be found very prolonged 
and tedious. The material used by me for sutures was silk 23 
and catgut—the latter for the continued, the former for the 
interrupted ligatures. No. i catgut; No. 2 silk. The needles 
were the full curved round needle, or ordinary straight sewing 
needle; the latter is the best. The sutures were introduced 
about the third of an inch, 
never less, from the divided 
made to include the 
peritoneal and muscular coats, 
and brought out just free of 
the edge on one side, and were 
then reintroduced close to the edge, and made to include about 
the same amount and kind of tissue on the other side, being 
very sure not to allow the nedle to pass into the intestinal cavity. 
(Fig. 11.) Mr. Howse,* of London, proved conclusively in his 
cases of gastrotomy, that the fact of entrance of the needle 
into the cavity of the tube, carrying the thread with it, made 
the difference between success anti failure, cases dying from 
peritonitis and extravasation when the entry occurred, and 
recovery following when the thread included only the peri- 
tonaeum and muscular coats. 
Again, the everted tissue should be turned in before intro- 
ducing the needle, so that it will pass through the rim of con- 
striction. If entered too far away from the divided edge, too 
much tissue is turned into the intestine. When the mucous 
membrane was turned in, and the suture tightened, two broad 
surfaces of peritonaeum were brought in contact. This you 
will recognize as Lembert’s suture (Fig. 6, B), with one change. 
Lembert directs that only one and one-half line in width of 
tissue should be taken up by the suture. This amount of tis- 
1. Peritoneum. 
2. Muscular Coat. 
3. Mucous Coat. 
Figure 11. 
* Mr. Howse was the first surgeon to use the double row of sutures for the 
junction of serous surfaces together. Czerney’s suture is an application of it to 
intestinal wounds. Its use is altogether too tedious, and gives no better result 
than the single suture including sufficient tissue. 24 
sue will do very well in the closure of small slits, for which it 
was intended, and to which it was applied; but complete re- 
section needs a much firmer hold to withstand the strain of 
peristaltic movements. The fact is, that it makes no difference 
whatever what kind of suture is used, so that the principle of 
positively securing the applica- 
tion of two broad surfaces of 
peritonceum in contact zvith each 
other is certainly carried out. 
Jobert's, Gely's, and Czerneys 
double rozv of sutures zvere all 
given a fair trial, but none of them resulted as well as this 
modified Lembert stitch. (Fig. 11, B.) It never failed to be 
followed by good union when properly applied, with periton- 
eal surfaces brought together around the entire circumference 
of the intestine. 
The greatest number of mishaps followed drawing the sut- 
ures too tightly, which, if done, leads to death of the applied 
edges, and, of course, to failure. They must be drawn only 
sufficiently close to bring the surfaces fairly in contact, the 
subsequent swelling from obstructed circulation will hold the 
surfaces firmly together until glued to each other by the rapidly 
forming adhesive material. 
The interval left by the incurving of the edges of the bowel, 
immediately after the completion of the operation, was found en- 
tirely obliterated, and the sutures covered up by effused lymph 
at the end of twenty-four hours. In one or two instances, 
where very small openings had been made in the bowel, they 
were occluded by passing a suture around the perforation, a 
short distance from its margin, pushing the wound into the 
cavity of the intestine, and then by tightening the suture the 
peritonaeum was drawn together over it; a very satisfactory 
Figure 11. 25 
plan of procedure where circumstances will permit its applica- 
tion. 
The question of the proper 
disposition to be made of the 
divided mesentery, after re- 
moval of some length of in- 
testine, is an important one 
to decide. No plan adopted 
proved entirely satisfactory. 
Previous to separation it was ligated in sections (see Fig. 7); 
the part beyond the ligature is apt to mortify and thus prove 
a focus for fatal inflammation. The tissue of the mesenteric 
membrane is not very vascular, and the vitality of the distal 
portion of the stump is seemingly best provided for by causing 
it to adhere to surrounding vascular parts. 
In some cases the stumps were left free in the abdominal 
cavity; these all did badly, each showing mortification. In 
others the different sections were all included in one suture 
and then stitched to the bowel at the seat of operation, making 
as nearly as possible a continuous surface of mesentery. 
These did much better, there being few instances of slough- 
ing. When sloughing occurred, it seemed to be dependent 
upon and follow a too tightly fastened ligature. This method 
above mentioned of treating the divided mesentery is useful 
in another way: it gives support to the bowel at the point of 
resection, maintains the intestine in proper position by pre- 
venting bending, and also leaves fewer raw surfaces free in the 
serous sac. This last, a condition acknowledged to be the 
frequent source of serious trouble from faulty adhesions to 
surrounding organs, and from furnishing points from which 
septic absorption takes place. 
A plan of dividing and treating the intestine and mesentery 
Figure 7 26 
has been suggested* to me as a possible improvement on 
those already noticed. It is really an application of the plan 
already recommended in 
single perforations. (Fig. 
5, A). This is to make the 
separation through the in- 
testinal walls three-eighths 
of an inch on either side of 
the mesenteric attachment 
(Fig. 8), tear away the mu- 
cous lining of the retained 
strip of bowel (Fig. 9), and 
draw the peritoneal sur- 
faces thereof together by 
the continued stitch. (Fig 
8). This would avoid division of the blood-vessels going to the 
bowel, do away with the necessity of using ligatures, and leave 
no raw surfaces free in the 
abdominal cavity. The 
opening formed by the 
folding together where the 
bowel-ends are united, 
should be closed by the 
continued suture. (Fig. 10). 
This method was adopted in one experiment with an excellent 
result. 
Bleeding from slight lacerations of the spleen, kidney, or 
liver can be controlled by actual cautery lightly applied, per- 
haps the very best method to adopt. If the wound is a com- 
plete perforation of the body of the organ, the haemorrhage is 
very great, rendering extirpation of the entire organ apparently 
the only sure way of surmounting the difficulty. 
Figure 8. 
Figure 9. 
Figure 10. 
* Dr. John Bartlett, Chicago. 27 
Quite frequently the entire mass of the greater omentum 
seemed to require removal. The bullet in the transit not only 
perforated it here and there, but passed along between its folds 
as well, leaving injured tissue and blood-clots of considerable 
size in its track. These clots disseminated themselves in the 
meshes in such a way as to entirely prevent their removal 
without tearing the tissue to shreds. When this condition was 
present in any degree the mass was amputated, after ligation, 
in sections. In a few instances these stumps gave rise to 
trouble, either from recurring h<xmorrhage or mortification of 
the distal end. 
In the after treatment it was often necessary to administer 
morphia to secure quiet. Very careful attention must be paid 
to the amount and kind of food given for some time after ap- 
parent recovery. One experiment resulted in failure after the 
lapse of three weeks from date of operation. The animal was 
lively, running about as freely as ever, all the functions normal, 
and the external wounds all healed, when it suddenly sickened 
and died, having tetanus accompanying rupture of the intes- 
tine, several inches above the seat of resection. Post-mortem 
examination showed masses of food and grit and greasy cloth, 
occluding the intestine, and distending it so enormously that 
rupture was produced; the tube at the seat of the operation 
was patulous and nearly of usual size. This animal was lost 
solely through neglect in the matter of feeding. Milk alone 
was given in all other cases for some weeks after operation. 
Certainly this is a matter of great importance, and suggestive of 
the proper care to be given after all such operations. Extreme 
emaciation occurs during the first week following the opera- 
tion, and, if there is shown any likelihood of recovery, there 
follows a voracious appetite, which should be very sparingly 
gratified. 28 
The circumstances under which these experiments were 
done, were such that it was absolutely impossible to carry out 
full antiseptic appliances. The external incision was treated 
with iodoform and oakum or absorbent cotton, and with two 
exceptions healed by first intention. 
The bullet wounds through the abdominal walls were not 
probed nor disturbed in any way. Occasionally, when large 
and much contused, iodoform was poured on them. In only 
two instances did they suppurate or give rise to any trouble 
whatever, crusting over and healing rapidly. This result clearly 
enforces the rule of not disturbing the track of a bullet through 
the soft parts unless the most urgent reasons call for interfer- 
ence. The damage of a serious nature is not in the abdominal 
walls, but in the cavity; the nature of it can be better ascer- 
tained and the most satisfactory treatment adopted, after sec- 
tion through the linea alba, rather than by enlargement of the 
wound of exit or entrance, if any surgical interference be insti- 
tuted. 
In gun-shot wounds of any part of the body, it is not the in- 
jured muscular tissue or facia that causes grave concern, but 
the torn arterial trunk, or severed nerve, or fractured bone 
made by the missile, and here, too, incisions out of the course 
of the bullet track often furnish the best exposure of the parts 
for manipulation. 
None of the wounds of entrance were perpendicular to the 
surface of the abdomen. All were more or less obliquely di- 
rected through the component tissues of the walls, so that they 
were valve-like in character and tended to close spontaneously. 
None of these cases presented any extravasation of the con- 
tents of the intestines through the external wounds, notwith- 
standing the lacerations of the tube were often very extensive, 
and considerable quantities of faecal matter were found in the 29 
peritoneal sac. The conclusion naturally follows, that the dis- 
charge of such matters, through the external openings, is not 
of frequent occurrence after the wounds under consideration. 
The absence thereof is far from being proof of the non-occur- 
rence of perforation of the intestine. 
It can scarcely be expected that extravasation through the 
wounds in the abdomen will often happen as an immediate 
occurrence. This is most likely to occur, if present at all, 
several days after the injury, following adhesion of the 
bowel to surrounding parts, and the accumulation of consid 
arable quantity of matter. 
There is no reason to suppose that interference with the 
adhesions to be met with in operations, done some time after 
the injury, would be followed by any worse consequences 
than that which follows their disruption during the perform- 
ance of operations for ovarian or other tumors. The hazard 
supposed to attend their severance is certainly exaggerated. 
With a clean cavity they will do equally well in all cases. 
These experiments have not developed any data which 
will aid in the positive diagnosis of the severity, or extent, 
or kind of injury done to the viscera, or render such diag- 
nosis less difficult than heretofore, previous to abdominal 
section. 
The\r go a step in advance of this by supporting the asser- 
tion that it is absolutely useless to expect immunity from 
perforations of the intestines when the bullet has traversed 
the cavity. It seems, and is infinitely more reasonable to 
subject a patient to the slight risk of an abdominal section, 
showing unwounded intestines, than to allow him to pass 
through the fearfully deadly peril of wounded intestines 
unrelieved, on the barren supposition that they may have 
escaped injury. 30 
Some uncertainty as to its necessity is likely to arise,, 
except in those cases showing extravasation of the contents 
of the bowels, or those where the free loss of blood, as indi- 
cated by the usual symptoms accompanying such accident, 
calls for aid. When doubt exists, and a critical condition of 
the patient argues severity of lesion, abdominal section surely 
seems to promise relief that can come in no other way. Ex- 
ploratory incision of the abdominal walls has been done so- 
often, and with so little hazard, as to entitle it to be classed 
as a procedure in itself almost destitute of danger. Such a 
conclusion is certainly supported by the results developed 
during these trials. The rule was, no trouble whatsoever 
from this incision. 
No deduction can more justly or positively follow, as the 
result of these experiments, than that an incision de novo, 
through the linea alba, is the best method of procedure in. 
the treatment of the class of wounds under consideration; a 
plan far preferable to enlarging either of the openings made 
by the bullet. It at once gives command over the entire 
cavity; therefore any lesion likely to result in harm is far 
less liable to be overlooked; it is the least vascular part of 
the walls; incisions thereof are more easily and perfectly 
co-aptated than elsewhere, heal readily and soundly, and as- 
a consequence, the oncoming cicatrix is less likely to be fol- 
lowed by ventral herniae. 
Thirty-nine (39) animals were used in these experiments,, 
exclusive of those dying from the effects of the anaesthetic. 
Two of the thirty-nine were used to demonstrate the effects 
of closure of the main branches of the mesenteric artery 
upon the nutrition of the intestines. Of the remaining 
thirty-seven (37), three cases died immediately after the shot or from the effects of profuse haemorrhage; one having a 
division of the aorta just below the mesenteric artery; the 
second had a large laceration of the kidney, with a wound 
of the renal artery; the third, a laceration of both kidney 
and spleen. One case, No. 4, had tetanus three weeks after 
operation, and is given a special position, simply owing to 
the presence of this condition as a complication in the case. 
The post-mortem examination, as already mentioned, devel- 
oped other conditions which would have caused death, and 
which were no doubt the cause of the tetanic convulsions. 
Twelve of the remaining cases died inside of twenty-four 
hours, either from severe primary or recurring haemorrhage, 
and the effects of the very extensive character of the 
wounds. Two out of this twelve (12) were cases requiring 
removal of the pregnant uterus, accompanied with many 
perforations of the bowel; death in both occurred from sec- 
ondary haemorrhage from uterine stumps—the ligature 
having slipped. Three (3) more had slight lacerations of 
the spleen and numerous perforations of the intestine. The 
spleen was removed and several inches of the tube excised 
in each case. In three (3) others, from twelve to twenty 
inches of the bowel was excised, and many arterial trunks 
severed. One of the twelve (12) had rapid mortification of 
five or six inches of the entire caliber of the bowel, appar- 
ently dependent upon the division of two large mesenteric 
arteries by the bullet, and also the resection of six inches of 
the intestine. The remaining three (3) of the number dying 
inside of twenty-four hours, are classified as having died of 
shock. On all of them the damage done by the missile was 
of excessive severity. The bullet was of large size (38 or 
44 caliber), and the fire-arms possessing great penetrating 32 
and lacerating power. There was not manifested in any 
case any recognizable evidence of shock aside from that fol- 
lowing great loss of blood. The transit of the bullet made 
no noticeable impression upon the pulse or respiration. In 
every instance where signs of severe prostration became 
manifest through change in respiration or weakening of 
pulse, there was found profuse haemorrhage to account for 
such condition. I am inclined to infer that the cases are 
exceptional indeed, in which purely nervous shock will give 
rise to symptoms severe enough to mislead one to perform 
an unnecessary ventral section; rather, when severe consti- 
tutional manifestations follow the passage of a bullet through 
the abdominal cavity, good cause for them will be found, as 
soon as the cavity is opened, in wounded viscera or blood- 
vessels, and this course will often be the only possible way 
of either actually saving life or even prolonging it. None 
of these twelve cases could possibly have lived longer than 
twenty-four hours after the injury received. Most of them 
would have died much sooner without the control of haem- 
orrhage, alone made possible by the opening. 
Two cases of the series were subjected to the expectant 
treatment. These cases were chosen because their injuries 
did not seem very severe; the haemorrhage was not great, 
and the prostration not extreme. Both died; the first in one 
day; the other lived five days. Post-mortem examination 
showed extensive extravasation of the contents of the bowel 
and septic peritonitis. 
In one case an attempt was made to establish an artificial 
anus. The wounded intestine was resected, and the ends 
fastened to the edges of the abdominal incision. The animal 
died of septic peritonitis in three days. This trial was made 33 
early in the experimentation, before any definite plan of pro- 
cedure had been settled upon. This is the only experiment 
that has given rise to any regret, for I feel satisfied that, 
with a fair junction of the bowel and a clean abdomen, the 
animal would have been saved. 
Eighteen of the thirty-seven (37) have thus far been 
accounted for; of the remaining nineteen (19), ten (10) died 
and nine (9) recovered. 
The ten fatal cases lived from three days to three weeks. 
Peritonitis from one cause or another seemed to be the pre- 
cursor of death. In six of them, mortification of the ligated 
stumps of the divided mesentery, together with mortification 
of the edges of the recently united bowel, were present. In 
the one that lived three weeks, death was the result of intes- 
tinal obstruction, caused by the adhesion of a fold of the 
intestine to the stump of mesentery left free in the cavity. 
An acute flexure was produced at the point, against which 
the contents of the bowel had accumulated in large quantity. 
A rupture was found above this mass, through which ex- 
travasation had taken place. The inflammation was so 
intense that everything was matted together, and the speci- 
men so horribly offensive it could not be preserved. There 
was no separation at the point of operation on the bowel; it 
was thicker here than elsewhere; but full distension with 
water was allowed without leaking. All of these cases 
demonstrate conclusively the necessity of great care in the 
manner of dealing with the divided mesentery, and in the 
application of the sutures which bring the separated bowel- 
ends together. The remaining four furnished evidence of 
separation of the recently united parts of the intestine at the 
mesenteric junction. In all of them the thread failed to 
3 34 
include the muscular and fibrous coat of the bowel, hold- 
ing only the peritonaeum. The result was extravasation, 
and death followed. 
It may be a matter of surprise to you that the percent- 
age of successful cases presented is so small—nine out of 
nineteen of those surviving over 24 hours—so few out of so 
many. To me, knowing well the extremely adverse cir- 
cumstances under which these experiments were performed, 
it is a matter of astonishment to have so many recoveries 
included in so few cases. It is suggestive to remember that 
all the recoveries followed the use of the modified Lembert 
method of bringing the peritoneal surfaces together, while 
in many of the failures, trials were made of other methods. 
Full six weeks have gone since the last case followed by re- 
covery was subjected to operation. The first favorable case 
was treated four months ago. None of the animals present 
evidence of being other than in their usual health. The 
longest resection of intestine among the recoveries measured 
over six (6) inches and included four (4) perforations. 
It is scarcely possible to do work of any kind under more 
disadvantageous surroundings than accompanied the per- 
formance of these experiments. The operative work was 
carried on, and the animals kept in the prosector’s room of 
a medical college during the winter season, in the midst of 
the odds and ends and bad hygienic conditions of such a 
place. No better accommodations could be secured. The 
labor has been purely one of experimental inquiry, and not 
a striving after recoveries, implying a choice selection of 
attending circumstances and special preparations to that end; 
therefore, I judge it proper and fair to claim the results as 
satisfactory. These results certainly indicate that a better 35 
showing is likely to follow where more satisfactory control 
can be had over both patients and surroundings than was 
present during these examinations. 
They clearly demonstrate that a hopeful expectation of re- 
covery may be entertained after operation, and suggest the 
nature of the injuries produced, what accident to avoid, and 
what treatment to adopt. 
My confidence in coming before you with no better record 
is assured, when I remember that all of you are well aware of 
the great mortality of these injuries, under all circumstances. 
It must be large, surely, when Dr. Otis, in the surgical history 
of the war, says the authenticated cases of recovery can be 
counted on the fingers of one hand. It cannot be said that 
operative interference in these cases has as yet an established 
position. Still, perhaps Dr. J. Marion Sims looked with pro- 
phetic eyes upon the future, when he closed the article already 
referred to with the following words: "I have the deepest con- 
viction that there is no more danger of a man’s dying of a 
gunshot or other wound of the peritoneal cavity, properly 
treated, than there is of a woman's dying of an ovariotomy 
properly performed. Ovarian tumors were invariably fatal till 
McDowel demonstrated the manner of cure, which has now 
reached such perfection that we cure from go to 97 per cent, 
of all cases. And by the application of the same rules that 
guide us in ovariotomy to the treatment of shot wounds pene- 
trating the abdominal cavity, there is every certainty of attain- 
ing the same success in these that we now boast of in ovariot- 
omy. "—British Medical Journal, March 4, 1882. 
In a rather quaintly-written but richly-laden book on surgery, 
by Herr. L. Heister, Professor, etc., written in 1739, there occurs 
this passage: 
“When the intestines are wounded but not let out of the 36 
abdomen, and therefore the wounds are out of reach, the sur- 
geon can do nothing but keep a tent in the external wound, 
according to the rules laid down at chap. V, and after this bleed 
the patient if his strength will admit of it, advising him to rest, 
eat abstemiously, and to lie upon his belly; the rest is to be 
left to Divine Providence and the strength of his constitution. 
But the question may be asked here whether a surgeon may 
not very prudently, in this case, enlarge the wound of the ab- 
domen, that he maybe able to discover the injured intestine 
and treat it in a proper manner. Truly I can see no objection 
to this practice, especially if we consider that upon the neglect 
of it certain death will follow, and that we are encouraged to 
make trial of it by the successes of others. Sacherus, in Pro- 
grammate Publico, Lipsiae, ed. 1720, mentions a surgeon who 
performed this operation successfully.” 
A period of 100 years and more has rolled away since Dr. 
Heister published his belief and reported recovery, to the time 
when Dr. Sims expresses his convictions—over a century of 
doubts, timidity, uncertainty, and gloomy misgivings, lightened 
only occasionally by some bold and resolute assertions. . The 
future asks for action, and it is not unreasonable to assert that 
careful trials will accomplish successful results. 
Avoiding any spirit of dictation, it seems proper to tabulate 
the following conclusions as an outgrowth of the experiments: 
P'irst. Haemorrhage following shot wounds of the abdomen 
and the intestines, is very often so severe that it cannot be 
safely controlled without abdominal section; it is always suffi- 
cient in amount to endanger life by secondary septic decompo- 
sition, which cannot be avoided in any other way than by the 
same treatment. 
Second. Extravasations of the contents of the bowel after 
shot injuries thereof are as certain as the existence of the 
wound. 37 
Third. No reliable inference as to the course of a bullet 
can be made from the position of the wounds of entrance and 
exit. 
Fourth. The wounds of entrance and exit of the bullet 
should not be disturbed in any manner, except to control bleed- 
ing or remove foreign bodies when present. They need only 
to be covered by the general antiseptic dressing applied to the 
abdomen. 
Fifth. Several perforations of the intestines close together 
require a single resection, including all the openings. Wounds 
destroying the mesenteric surface of the bowel always require 
resection. 
Sixth. The best means of uniting the wounded intestine 
after resection is by the use of fine silk thread after Lembert’s 
method. It must include at least one-third of an inch of bowel 
tissue, passing through only the peritoneal and muscular coats, 
never including the mucous coat. The everted mucous mem- 
brane must be carefully inverted, and needs no other treatment. 
Seventh. Wounds of the stomach, small perforations, and 
abrasions of the intestine, can be safely trusted to the continued 
catgut suture. 
Eighth. Every bleeding point must be ligated or cauterized, 
and especial care devoted to securing an absolutely clean cavity. 
Ninth. The best method of treating the stumps of divided 
mesentery is to save the mesenteric surface of the bowel as 
above indicated. 
Tenth. Primary abdominal section in the mid-line gives the 
best command over the damage done, and furnishes the most 
feasible opening through which the proper surgical treatment 
of such damage can be instituted. Further, its adoption adds 
but little, if anything, to the peril of the injury. 38 
Eleventh. Is not the moral effect of the assurance to the 
patient, that he will be placed in a condition most likely to lead 
to his recovery, a good substitute for the mental depression 
accompanying the general and popular conviction that these 
wounds mean certain death? 
Experiments on Gun-Shot Wounds of the Abdominal 
Cavity. 
[.Appended to Dr. Parke s’ Address.] 
Experiment No. i. 
Wednesday, November 14, 1883.—Long, lean and lank set- 
ter; about 30 lbs.; in rather poor condition. Etherized with 
common ether and shot through abdomen with a No. 32 cal. 
ball, which passed directly through anterior wall to the innom- 
inate bones. Upon opening abdomen found ileum perforated 
about the middle and at the ileo-cmcal valve, and slightly 
grazed at another point. Extravasation of intestinal contents 
at each perforation. Some entozoa. The two perforated re- 
gions were resected and continuity of ileum re-established by 
Lembert’s intestinal stitch. The grazed portion was closed by 
continued suture. Intestines washed with a feeble solution 
of carbolic acid, and returned to abdomen; and the external 
wound closed by two sets of sutures, one set through muscular 
walls, including peritoneum, and the other uniting the skin. 
Drainage tube inserted, and wound dressed antiseptically with 
gauze, cotton, etc. 
Entire operation lasted about one hour, and conducted anti- 
septically, abdomen being shaved, washed and irrigated with 
carbolized solution, etc. The animal waked considerably 
shocked. Gave rectal injection of alcohol and water (1-2 1-2), 
about 3 drachms, and in half an hour gave 10 drops of lauda- 39 
num. The dog seemed very bright. At 6 p. m. was consider- 
ably weakened; respiration very rapid, with much febrile ex- 
citement. About three-quarters of a pint of warm milk per 
stomach-tube, twelve drops of laudanum, and about a quarter- 
grain of morphia hypodermically. Tied him under register 
well bedded in a large comforter, and covered him with a coat. 
Thursday, November 15.—Dog died between midnight and 
morning. Post-mortem. Abdomen filled with bloody serum 
and intestines inflamed and badly smelling; kidneys a bright 
blue, and rectum filled with hardened faxes. Dog had vomited 
during the night a quantity of hair and some pieces of carti- 
lage, etc. Died of shock. Wounds of intestine well agglutin- 
ated. 
Experiment No. 2. 
Friday, November 16.—The ball (32) severed the aorta. 
Experiment No. 3. 
Saturday, November 17. — (Ball 32 cal.) Dog etherized, 
shaved and shot very near abdominal margin. Upon opening 
abdomen (incision 31/ inch), but one loop of gut was found 
perforated. This was excised, and the continuity of intestine 
restored by eighteen individual silk stitches, which brought 
serous surface to serous surface, the greatest difficult)' being 
encoumered at the mesenteric attachment to the gut on account 
of the fat which lay between the two layers of peritonaeum and 
adherent to the gut itself. Extravasation of intestinal contents. 
Tape worm. 
Wound closed with heavy silk and dressed antiseptically. 
Gave 15 gtt. laudanum at night. 
November 18.—Animal seems bright, but disposed to remain 
quiet, drinks plenty of water and urinates freely, Respiration 
hurried and febrile action high, 40 
November 19.—Seemed very well, and partook of some milk 
during morning, but began vomiting in the p. M. a sour, watery 
and greenish fluid. Gave per rectum about x/± grain morph, 
sulph. at night, and left him sleeping comfortably. 
November 20.— Seemed quite lively and comfortable, the 
dressings having been removed the day before, and a large body 
bandage applied. About 11 a. m. seemed rather tired, and vom- 
ited large quantities of the same sour fluid as before; would 
not eat meat or drink milk, but drank water freely. Gave about 
grain morph, sulph. hypodermically, and during the P. M. he 
seemed extremely sleepy and much disposed to lie down flat, 
but is nervous and easily alarmed by sudden noises, etc., etc. 
This condition lasted all day, and suppose it is the effect of the 
morph. 
November 21.—Died during night. Post-mortem showed a 
separation of the resection, which had evidently first torn out 
at the mesenteric attachment. Extensive peritonitis, intestines 
being agglutinated together and abdomen filled with fluid blood 
and faeces. 
Experiment No. 4. 
November 23.—(Ball cal. 32.) Very large dog, weight about 
seventy-five pounds. Upon opening abdomen found a section 
of intestine for about six inches perforated in several places, 
the ball apparently having skipped along inside the gut; at 
another place the free edge was shot off and other portions of 
ileum grazed three times. The middle section was resected 
entirely, and closed perfectly; the shot edge was closed by 
trimming edge or side of the tube of intestine by a “V”-shaped 
cut towards the mesenteric attachment, and that also was closed 
fairly well. This was close to the left end of the pancreas. 
Each opening showed extrusion of contents. Many worms. 
The operation lasted two hours, abdominal wound closed by two sets of sutures, one set through the muscular walls, the 
other bringing the skin in contact. Wound was covered with 
cotton, and bandage applied. Gave 20 gtt. deod. tinct. opium 
and a little water. Seemed to be doing well all p. m., and at 
night at six o’clock gave about 20 gtt. more of the opium, and 
left some water where he could get it. 
November 24.—Dog still alive and very thirsty, but vomits 
the water soon after drinking; gave another dose of opium at 
night. 
November 25.—Bandages have not been changed. 
November 26.—Changed dressings; dog seems bright. Gave 
pint of milk; also opium, which he drank readily, but soon 
vomited. Gave more milk about noon, which he retained. In 
the afternoon he seemed much weaker. Gave deod. tincture of 
opium gtt. 20 at night. 
Still lives, but is not strong. Lies in any position in which 
placed, and seems quite prostrated. Opium as before seems to 
revive him; he refuses milk, but drinks freely of water, 
which the stomach promptly rejects. In the afternoon, be- 
ing no better, removed dressings, and although wound was 
quite healed made an opening for medium-sized drainage- 
tube, and let out about a quart of bloody serum; re-dressed 
the wound after injecting a weak carbolized solution of 
warm water into abdomen through tube. Gave a rectal 
injection of alcohol and water 1-2) warm and gtt. 20 of 
opium. Is getting very poor, but respiration is regular; 
pulse very weak and rapid. 
November 28.—Gave enema of soapy water very weak. 
Washed out wound and inserted short drainage-tube and 
fresh bandages. About eleven o’clock had a passage from 
bowels of a large quantity of black, tarry, and badly smell- 
ing faeces, result of injection per rectum. At 2 p. m. was 42 
very weak. Gave enema of whisky and milk, warm, about 
2 oz., and made a stew of small bits of beef and milk in 
whisky, which he ate greedily. Gave milk and whisky per 
rectum every three hours, also Valentine’s extract of meat. 
November 29.—Seems much stronger; had a semi-liquid 
passage from bowels. Gave enema every four hours of 
Valentine’s extract, milk and whisky; and also fed pieces of 
raw meat in milk. 
November 30.—Steady improvement; another passage 
which evidently came from above seat of operation. Fed 
him on raw steak, and gave whisky per rectum every four 
hours. Sutures through integument have ulcerated their 
way out; were removed and dog allowed to lick his wound, 
as he promptly tears off all bandages. 
December 1.—Feeding as before, with steady improve- 
ment. 
December 2.—Another passage from bowels during night 
Gave meat, about one-half pound every three hours, which 
he eats greedily; marked improvement daily in strength 
and appearance. 
December 3.—Same improvement. 
December 4.—Sent dog down stairs in basement. 
December 10.—Alive and apparently in perfect health. 
External wound closed completely. 
December 11.-—Seems sick; refuses to eat; howls at 
night. 
December 12.—-Has marked symptoms of tetanus, and is 
in a state of rigidity with episthotonos. 
December 13.—Died, and post-mortem showed an ob- 
struction of intestine by a large mass of meat or a collection 
of various substances of a gritty consistency which com- 43 
pletelv obstructed and occluded bowels for some distance. 
The bowel was opened above this, and abdominal cavity 
tilled with intestinal contents, and organs all adhered, as re- 
sult of peritonitis; resection wound quite strongly united. 
Dog died from careless feeding and obstruction following 
adhesion of knuckle of intestine to omental stump. 
Experiment No. 5. 
Monday, November 26.—(Ball cal. 32.) Medium-sized, 
well-conditioned and sturdy dog. Shot passed through a 
six-inch piece of intestine, making several perforations. 
Much fecal matter free in abdomen, some opposite each 
opening. Many tapeworms. 
November 27.—Made a resection of but one piece six 
inches in length, including both wounds. In this instance 
the larger silk sutures were used. After the continuity of 
the intestine was restored there was a great deal of bleed- 
ing from the interior of the abdomen, the origin of which 
could not find, but allowing the air to reach into all parts of 
the abdominal cavity, it ceased after considerable loss of 
blood. A portion of the omentum being filled with blood, 
it was ligated and removed. In closing abdominal wound 
was obliged to tear away a certain amount of fat which was 
closely adherent to interior wall of abdomen, along the line 
of the wound, in order to introduce sutures so they would 
not include the fatty mass. Introduced two drainage-tubes, 
and applied large pad of cotton. Gave some opium, about 
gtt. 15. I*, m. dog seemed considerably shocked, but was 
quite thirsty. At night gave more opium. 
November 17.—Cotton was soaked with fluid from drain- 
tubes. Removed dressings, and, upon getting him upon his 44 
feet, a small quantity of fluid escaped. In the evening 
washed out the abdomen with a warm solution of carbolic 
acid, about i, and applied dressing of gauze. During the 
day he vomited considerable milk and water which he had 
drank, and was evidently very weak. Gave about gtt. 20 
of opium at night. Died at 8 a. m. on November 28. 
Post-mortem showed that sutures had parted at mesenteric 
edge, and death was from peritonitis. Mortification of 
edges of resection. 
Experiment No. 6. 
December 5.— (Ball cal. 32.) Died of haemorrhage, after 
being shot, from wound of renal arteries, the ball perforat- 
ing one kidney. Several perforations of the small intestines,, 
all of them showing extrusion of contents. One large, round 
worm free in cavity. 
Experiment No. 7. 
December 7.—Died under ether. 
Experiment No. 8. 
December 7.—(Ball cal. No. 32). Ball opened one of 
the mesenteric arteries, and after resecting three pieces of in- 
testine, and closing wound nicely (every perforation showed 
faecal matter, worms, etc.); she died in less than nine hours 
from the shock. Great loss of blood; died of loss. 
Experiment No. 9. 
December 10.—(Ball cal. 32.) Gave morphine hypoder- 
mically at 9 a. m. Medium-sized female dog. Anaesthe- 
tized at 9 A. M., and shot at 9.30, first shot simply going 45 
through abdominal walls; second shot higher up and per- 
forating spleen. Operation began at 10.15. Found abdo- 
men full of blood, ftecal matter, and some worms. Re- 
moved spleen and large mass of omentum; ligated and 
removed one piece; resected about three inches in length; 
perforated in two places. Much haunorrhage; operation 
concluded at twelve. Gave opium and whisky ; much 
shocked. Died. 
Experiment No. to. 
A well-nourished bull-dog (female), about twenty-five 
pounds in weight. Was anaesthetized about 9.15 a. m., and 
then shaved over the abdomen. Was shot at 9.35 by a 32- 
100 calibre revolver just posterior to the umbilicus, the bul- 
let entering on the right side about three inches from the 
median line, the point of exit being in the corresponding 
situation on the opposite side. On opening abdomen found 
animal pregnant. There was one wound through the right 
cornu of the uterus, rupturing the membranes of one fcetal 
dog, and allowing the escape of the amniotic fluid into the 
peritoneal cavity. One of the smaller mesenteric arterial 
branches was cut, and the small intestine perforated in one 
place. The abdomen contained considerable blood on open- 
ing immediately after the shot, and there was slight extrava- 
sation of fiecal matter from the gut at openings. The 
vagina and uterine ligaments were ligated by single carbo- 
lized silk ligatures, and the large gravid uterus removed. 
The haemorrhage in the mesentery having been checked, 
the wound in the intestine was resected, about two inches 
being removed. The free ends were united with the inter- 
rupted silk ligature. The peritoneal cavity was sponged 46 
out and washed with slightly carbolized warm water. The 
external wound was united with about ten silk ligatures, 
and dressed with iodoform and gauze, the whole being cov- 
ered with oakum and bandaged. About half a grain of 
morphia was administered hypodermically; and at twelve 
the dog was allowed to come from the influence of ether. 
She showed marked symptoms of shock, but rallied in the 
afternoon. She died in the night. Post-mortem revealed 
hasmorrhage from the uterine stumps, and some peritonitis 
commencing. 
Experiment No. ii. 
A full-grown, healthy-appearing dog. Etherized at 9.30 
a. m. Abdomen shaved and cleansed. Was shot at 10 a. m., 
still under the influence of ether, the bullet from a 32 S. & 
W. revolver passing transversely through the lower part of 
the abdomen. Was placed on table and kept partially 
anaesthetized until 10.45. The animal then presented signs 
of extreme loss of blood, feeble respiration and heart action, 
cold extremities, pallid gums, etc. Abdomen was opened 
by large crucial incision and found to be filled with blood. 
Bleeding was ascertained to come from a divided mesenteric 
artery, and was readily checked by ligature. Clots were 
turned out, and two wounds of small intestine found. But 
slight extravasation of contents of bowel into the cavity, 
still some matter and worms found at openings. The intes- 
tine was resected at the site of each wound, about three 
inches being removed in each place. The cut ends of each 
were then united by about twelve interrupted silk sutures, so 
placed as to bring peritoneal surfaces in apposition. Intes- 
tines were then returned to their place, the cavity sponged 47 
out, and the external wound closed tightly with silk sutures. 
This was finished at twelve o’clock, the dog appearing mor- 
ibund at its close, and remaining in a condition of collapse for 
about three hours. Reaction then took place, and he was 
able to stand and walk about. Second day, took some 
milk, which was vomited at once. This was repeated at 
intervals during second and third days. Dressings were 
changed on third day. No discharge from wound. On 
fourth day vomiting was increased, and was faecal in charac- 
ter. Dog too weak to stand. Dressings changed again 
and wound found to be discharging purulent fluid. Died at 
4 p. m. on fourth day. Post-mortem showed sero-purulent 
exudation in abdominal cavity, intestines glued together by 
adhesive lymph, wounds uniting well, and occlusion of the 
bowel in the neighborhood of one of them, from its having 
been sharply folded upon itself and bound in the position by 
the inflammatory exudate. 
Experiment No. 12. 
December 27, 1883.—The bullet, 32 cal., entered the 
abdomen on a line corresponding to the junction of the 
anterior and lateral surfaces of the abdomen, just in front of 
the hind leg, its point of exit on the other side being on the 
same line a little above the umbilicus. 
On opening the abdomen it was found that the lower part 
of the jejunum was cut in two places within two inches of 
each other, and that there was considerable blood in the 
peritoneal cavity from these cut surfaces, there being no 
mesenteric vessels cut; also faeces and worms. 
Both wounds were included in the parts excised, and the 
cut ends of the intestines were fastened together by three 48 
sutures, and then stitched to the abdominal parieties, thus 
forming an artificial anus. 
Considerable shock was experienced, and owing to a de- 
sire to hasten the operation, the peritoneal cavity was not as 
carefully sponged as it should have been. 
The dressing consisted of iodoform, protective and oakum. 
Of tinct. opii. deod. gtts. 20 were given by the mouth. The 
operation lasted two hours. On the following day he took 
a little nourishment; there was no tenderness, but some pus 
was squeezed from the point of exit of the bullet, the dog 
lying on that side. 
Next day about one-half ounce of pus was forced from 
the point of exit of the bullet, the dog lying on that side, and 
by turning him on to the other side an equal amount was 
obtained from the point of entrance, but there was no sup- 
puration from the wounds themselves. 
He took a little nourishment and seemed to be in good 
condition, respiration being normal and pulse regular. He 
had a free urination from the bladder, and soft stools were 
passed from the artificial opening. He died during the 
night. Post-mortem revealed a large amount of septic 
material in the peritoneal cavity. 
Experiment No. 13. 
Saturday, December 29.—(Ball calibre 32.) Medium-sized, 
middle-aged female dog. Gave with the anaesthetic about 
grain of morphia hypodermically after shot. Abdomen found 
full of blood; seat of haemorrhage found at one of the point ot 
perforation, of which there were two; from these issued fmcal 
matter, gas and worms; a medium-sized mesenteric artery hav- 
ing been shot off. All the intestines were drawn out of abdo- 
men for examination, and it was found necessary to resect two 49 
portions which were a considerable distance apart, both places 
closing neatly and perfectly. Abdomen washed out and external 
wound closed by one set of sutures and a large pad of oakum 
laid over and held in place by roller first, and over all a many- 
tailed bandage. Gave 25 gtt. laudanum. 
December 30.—Dog got loose during night and was running 
around very briskly; room very cold and disagreeable. (On 
the afternoon of the day of operation some person had opened 
the doors and windows and exposed the animal to a strong, 
cold draft for about two and one-half hours.) In the evening 
gave hypodermically morphine, when she vomited for first 
time and seemed very weak. 
December 31.—Seemed lively and well all day; gave milk, 
which she would drink but could not retain. About noon 
gave an enema of Valentine’s extract, and in the evening left a 
pan of milk. 
January 1, 1884.—She seems as well as ever, but the floor 
of the room was profusely decorated with vomit. The milk was 
all gone. Gave an equivalent of an ounce of whisky, of alcohol 
and water per rectum, and left a supply of water, as she seemed 
very thirst)’. Bandages changed for the first time since the 
operation. There had been but little discharge and the wound 
was in good condition. Applied a large pad of oakum and a 
wide roller as before. 
January 2.—Seems quite exhausted. Gave alcohol and water 
(1-2 1-2) per rectum about four or fixe times a day in quanti- 
ties of about 1 ounce; has a diarrhoea and vomits. 
January 3.—Diarrhoea continues, but no vomiting. Has 
some appetite, and gave raw meat (steak) chopped fine, every 
two or three hours; also fresh milk, which she drinks readily. 
January 4.—Seems quite well, and hungry; fed regularly and 
removed all dressings; wound in good condition. Removed 
4 all stitches and did not apply dressing again. Appetite good, 
January 5.—Dog is seemingly well; has a voracious appe- 
tite. Much wasted in flesh, but appears strong. 
January 6, 7,8.—Fed her upon milk; also meat chopped 
fine and raw. 
January 9.—She seemed well enough to be sent down cellar, 
where she continues gaining strength and flesh. 
January 15.—Is perfectly well. Recovery. 
Experiment No. 14. 
January 9, 1884.—This dog was allowed some milk a short 
time previous to the operation, hence his stomach was distended. 
The first bullet (32 calibre) grazed the abdomen walls, not 
entering the peritoneal cavity. 
The second entered on a line corresponding to the junction 
of the anterior and lateral surfaces of the abdomen, a short 
distance in front of the hind leg, coming out a little nearer the 
median line, and two inches nearer the front leg. 
On opening the abdomen it was found there was some 
haemorrhage, mucus and particles of food in its cavity and on 
surface of stomach, and that the lower part of the stomach was 
wounded, the point of exit being two inches from the point of 
entrance, passing through the whole thickness of the stomach. 
There was no wound of the gut. The peritoneal surfaces were 
drawn together with cat-gut, by inverting the edges and using 
the continued suture. 
Great care was taken in the toilet de peritonie. Immediately 
after closing the external wound he vomited half a pint of 
blood, mucus and milk. Time of operation was one hour and 
a half. Then he was given tincture of opii deod. gtts. xx. 
The wound was dressed with iodoform, protective and oakum. 
On the tenth was given nothing except a little water. On 
the eleventh he was given a little milk, which caused some dis- 51 
turbance. On the sixteenth the strtches were removed and no 
dressing applied, there being but slight discharge from the 
wound made by the incision and none from the bullet wounds. 
Recovered. 
Experiment No. 15. 
Small dog, female, was anaesthetized and shot at 10:30 a. m. 
(S. & W. revolver, 32 calibre.) First wound passed through 
abdominal muscles only. Shot again immediately, bullet this 
time passing transversely through middle of abdomen. Open- 
ing made at once by lineat incision. But little blood in cavity. 
All bleeding stopped upon exposure of intestines to air. Five 
wounds of small intestine found, all showing extravasation of 
contents. Two resections of five inches each were made to 
include all wounds. Cut ends were united by a continued cat- 
gut suture in each place. Intestines returned and abdominal 
incision united by silk sutures, after thoroughly washing out 
cavity by 2 per cent, solution of carbolic acid. The operation 
was finished at 10:30 a. m. Dog was laid in a warm place, 
apparently suffering but little from shock. External wound 
dressed with iodoform, covered by protective carbolized gauze, 
tow and a bandage. Animal died in about twenty hours. Was 
not given any food or medicine in that time. Post-mortem 
showed some small blood-clots about the wounds in the intes- 
tine. No serum or other fluids in cavity, and no signs of peri- 
tonitis. Death from shock. 
Experiment No. 16. 
A dog of uncertain breed, about twenty pounds in weight, 
was shaved over the abdomen and anaesthetized at 10 a. m. 
Was shot in the abdomen in front of umbilicus, the bullet en- 
tering on the right side and coming out on the same side 
about two inches nearer the median line, not entering the 
abdominal cavity or wounding the peritonaeum. Was shot 52 
again, the bullet entering on the right side, external and 
posterior to the first, and coming out on the opposite side, about 
two inches from median line. The calibre of the revolver 
was 32-100. Upon opening the abdominal cavity the periton- 
aeum was found to be plowed across between the wounds of 
entrance and exit, and the spleen to be slightly nicked, the 
bullet having skirted the abdominal walls. The only haem- 
orrhage was from the external wounds and the spleen and track 
of bullet. The spleen was removed, its peritoneal connections 
being ligated by five silk ligatures. Th: small intestine was 
resected, about four inches being removed. The abdominal 
cavity was washed with warm carbolized water. The external 
wound was sewed up by about ten sutures. The dog came 
from under the influence of ether at 11:30 A. m. The wound 
was dressed externally with iodoform and oakum, and fifteen 
drops of deodorized tr. of opium administered by the mouth. 
A curious phenomenon was observed upon cutting out the 
spleen. The stomach and intestine became distended enor- 
mously with gas, extruding from the abdominal cavity and 
covering a large area of the operating-table. They were with 
difficulty returned with steady pressure. The dog died in the 
night from shock and haemorrhages from splenic stumps. 
Experiment No. 17. 
January 23.—(Ball cal. 32.) Good-sized coach dog. Bullet 
passed through abdominal walls without wounding intestines 
and just entering the peritoneal cavity, as was found after open- 
ing abdomen, the point of entrance and exit being on either 
side of the middle line and five inches apart. Removed the 
major portion of the greater omentum and also resected about 
six inches of the ileum and closed the wound by five sutures, 
the external wound being but two inches long. 
January 24.—Seems inclined to be quiet all day; had de- 53 
fecated during the night and urinated very little; drinks but 
little water, and does not vomit it. Is by nature a very frisky 
dog, and do not think his extreme quiet very favorable. 
January 25.—Seems quiet; no bloating of abdomen; removed 
bandages; re-applied dressings. Refused milk all day; also 
water. 
January 26.—Gave small quantity of milk in the afternoon; 
re-applied the dressings which had been removed the day be- 
fore; found the bullet wounds much puffed up, and that the 
stitches had slipped in two places, leaving a hole opening into 
abdomen large enough to admit little finger. The portion 
of intestine viewed through opening in external wound looked 
red and inflamed, but not badly so; little running from the 
wound. Filled it with iodoform and applied pad of oakum. 
January 27.—Gave about one-half pound of meat and a quart 
of milk; seemed to be ready to get well. 
January 28.—Fed meat and milk during day, and he seems 
to be rapidly getting well. 
January 29.—Wound gaping, but discharged him to the cel- 
lar. Recovered. 
KxPF.RI.MENT No. 18. 
January 25, 1884.—This dog, a black and tan bitch, having 
been shaved the day before, was anesthetized and shot. 
The bullet, 32 calibre, passed directly through the .abdomen 
about its middle, piercing the gravid uterus in two places, and 
cutting the gut longitudinally. No large vessels were cut. 
The uterine attachments were ligated en masse and the uterus 
removed. Contents of bowel found at site of wound in intestine. 
During the time that an excision of the gut was being made, 
a profuse haemorrhage occurred from the uterine stumps, before 
they could again be ligated by passing a suture through and 
ligating one-half at a time, the animal was almost exhausted 
from haemorrhage. 54 
The excision of the gut was then completed, and the cut 
ends stitched together with silk. The peritoneal cavity was 
then thoroughly washed out with slightly carbolized warm 
water, and the external wound closed. The dressing consisted 
of iodoform, gauze and oakum. 
Of tinct. opii. deod., gtts. xx were given. Death occurred 
within ten hours after the operation, from effects of the haem- 
orrhage. 
Experiment No. 19. 
Dog was full-grown and apparently healthy. When the 
abdomen was exposed by shaving, two small abscesses, each 
the size of a filbert, superficially seated and non-inflammatory, 
were discovered. They were not disturbed. The animal was 
anaesthetized at 8:30 a. m., and at once shot through the middle 
of abdomen with a 44 calibre revolver. The dog was placed 
upon the table, and a linear incision of about three inches made 
in the median line. It was there found that the ball had 
glanced upon the abdominal muscles, and instead of going 
through the mass of small intestines, had been deflected so that 
it just entered the peritoneal cavity beneath the linea alba, 
traversed the cavity for about an inch, producing a contused 
wound of a fold of intestines, and then entered the abdominal 
parietes to make its exit opposite the wound of entrance, about 
two inches from the linea alba. Only a small amount of blood 
was found in cavity. Although none of the intestines were 
wounded, a resection of about two inches from the middle of 
the ileum was made. The divided ends were united by about 
a dozen interrupted silk sutures. The cavity was washed 
thoroughly with a 1 per cent. sol. of carbolic acid, the intes- 
tines returned, and stitches were being placed in external wound, 
when the abdominal cavity was found to be filling with blood. 
Source of the haemorrhage was found to be a branch of mesen- 55 
teric artery at the site of the resection, which had commenced 
to bleed as soon as circulation was restored by warmth of 
abdomen. A ligature was applied, the intestine returned and 
the cavity again thoroughly washed out. The external wound 
was now closed by silk sutures, the wound dusted with iodo- 
form, and dressed by applying a few thicknesses of carb. gauze, 
covering this with a mass of tow and a bandage over all. Ani- 
mal appeared to suffer but little from shock. On morning of 
second day was given grain morphia with i-iooth grain 
atropia by the mouth. 
On the third day appeared greatly prostrated, vomited at in- 
tervals, and a muco-purulent discharge was noticed coming 
from nostrils and eyes. Vomiting ceased on fourth day. Pros- 
tration and evidence of fever kept up to the morning of 
fifth day, when improvement began. Discharge from nostrils 
continued about ten days. On the fourth day a small quantity 
of milk was taken and retained. Loose discharge from bowels 
on fifth day slightly colored with blood. A rectal injection of 
alcohol; water was given on the sixth day. Dressings changed 
for the first time on sixth day. Wound appeared healthy and 
united in its deeper portions. Some pus from superficial part 
of wound from this time on, the dog ate milk regularly, and 
had regular and normal passages from bowels. On ninth day 
sutures were removed from external wound, which had entirely 
closed. On the thirteenth day, February io, 1884, dog is ap- 
parently perfectly well; has been eating regularly of raw beef, 
and has begun to gain in flesh. On the evening of thirteenth 
day dog was well. Recovery. 
Experiment No. 20. 
February 2.—(Ball cal. 32.) Died from ether before any in- 
cision was made. 
Experiment No. 21. 
A strong black dog, about 20 lbs., was shaved over the ab- 56 
domen and then etherized at 9.15 a. m. Was shot with a 38- 
IOO calibre revolver through the abdomen about opposite the 
umbilicus, and five inches to the right of the median line, the 
point of exit being in a corresponding situation on the oppo- 
site side. Upon opening the abdominal cavity such a large 
amount of blood was found that it was necessary to enlarge 
the incision by a cross cut. A large mesenteric artery was 
found to be cut and was ligated. Another smaller one was 
treated in the same way. There were two wounds in the small 
intestine close together, about six inches intervening between 
them. Extravasation of contents from-both. One was per- 
forating and the other nicking the gut on the mesenteric side. 
Eight inches were removed, and the free extremities of the in- 
testine united by interrupted silk sutures. There were three 
other wounds nicking the .intestine which were sewed in the 
same manner without resection. The end of the caecum, which 
is peculiarly shaped in dogs, was shot off. Stained mucus and 
some shreds at the opening. This was sewed, turning the cut 
end in. The spleen was cut in one place, which was left with 
one deeply-planted suture. A large fold of omentum was liga- 
tured and removed. The abdomen was thoroughly washed 
with carbolized water, and the external wound united with 
about fifteen sutures. It was then then dressed with iodoform 
and oakum, y2 ounce of alcohol and 15 gtts. of deodorized 
tincture of opium were administered per rectum, and at 12.15 
the dog was allowed to come from the influence of ether. 
The same amount of alcohol and opium were administered as 
before at 6 p. m. The dog died during the night. Post-mortem 
revealed no evidence of inflammation, and some slight bleeding 
from the spleen. The sutures in the intestine were in good 
condition. The piece of gut, about eight inches long, supplied 
by the mesenteric artery, which was cut by the bullet, was 
found to be completely mortified. 57 
Experiment No. 22. 
February 12, 1884.—(Ball cal. 32.) Brindle bull dog. No 
attempt to sew up the holes in the intestines, of which there 
were about twenty. Died the day following. “ Tilley’s anaesthe- 
tizer.” Every opening showed evidence of extrusion of con- 
tents. 
Experiment No. 23. 
February 28, 1884.—Tilley’s anaesthetizer. Died before 
operation from effects of ether. 
Experiment No. 24. 
February 28, 1884.—(Ball cal. 44.) A short, strong Sp'tz 
dog. Bullet wounds of entrance and exit 4 in. apart. Intes- 
tine perforated in four places and abraded in one spot. Intes- 
tinal worms free in abdomen. Tape worms protruding from 
perforations. 
Extravasation of contents of the bowel. No arteries di- 
vided by bullet. Resected one piece, (including three perfora- 
tions) 12 in. length. Removed a V-shaped piece including the 
fourth perforation, and inverted the serous surfaces by inter- 
rupted sutures, the same as in complete section. The apex of the 
V (pointed to the attached border of the bowel) controlled the 
oozing from the abraded spot by small suture passed across 
mesenteric side of abrasion, the abrasion being the size of a 
copper cent, and on the side of intestine. Washed the in- 
testines and abdomen cavity as clean as possible by stream of 
weak carbolized and pretty warm water from the irrigator; 
closed abdomen wound by five deeply-placed sutures about 
one-third inch apart; gave hypod. of one-fourth grain of mor- 
phia. Shock and little loss of blood. Omentum also removed. 
February 29.—In morning seemed very lively and bright; 
gave some water, which was immediately rejected by stomach. 
During morning vomited foul-smelling fluid and two large 58 
chunks of meat. About io a. m. gave hypod. of one-half 
grain morphia; in very few minutes he laid down and began 
to whine as though in pain, and threw up large quantity of 
offensively-smelling fluid. Died about 3 p. m. 
Post-mortem.—Abdomen showed evidence of intestinal ex- 
travasation, all organs being bound together by peritoneal in- 
flammation; extravasation of blood beneath peritoneal cover- 
ing of intestines, and small clots adherent all along the length 
of ileum. The stumps of ligated mesentery and omentum 
were black. The seat of the operation showed adhesion of 
the serous surfaces, and water could be forced through the ex- 
cised piece which was taken out by a cut six in. to each side 
of the stitches, without any leaking at seat of operation. The 
spot of abrasion was swollen and blue, and there had been a 
little haemorrhage from it. The intestines generally were con- 
tracted, glued together, and pressed into prismoidal and other 
shapes. Stomach empty. 
Experiment No. 25. 
February 28, 1884.—(Ball cal. 44.) “Tasso.” 
Bullet under skin opposite to point of entrance. Intestine 
riddled in about four places, for which a complete section 20 
in. in length was removed and was nicely adjusted; another 
hole in the ascending colon was closed on each side by the 
continuous suture; the tip of the spleen being shot off, to ar- 
rest haemorrhage a ligature was passed around proximal side 
of wound tight enough for that purpose, but yet not enough 
to cause death of the spleen tissue beyond ligature. The 
stumps of ligated mesentery being gathered upon a suture, 
were united to intestine near or about at the seat of the ap- 
proximation of the divided ends; omentum removed; gave 
rectal injection of alcohol and water /4 about. Each open- 
ing in bowel had more or less of the contents around it. 59 
February 29.—Seemed very quiet all the morning, and was 
quite indisposed to move. Towards noon, gave him, about 
11 o’clock, about 1 oz. of alcohol and water ]/2 ]/2 per rectum 
and some water to drink, which was at once vomited. Seemed 
very tired all day and disposed to lie stretched out before the 
heat of the register, and his breathing was entirely thoracic and 
by means of the cervical muscles. At 6 p. m. gave hypod. of 
morph, gr. and left water where he could drink. 
March 1.—Seemed very weak all day; gave hypod. of 
morph. ]/2 gr. twice, the last at night. About noon gave rectal 
injection of alcohol and water. 
March 2.—Still alive, but very cold; listless and indifferent; 
gave morph, in a. m., and tied him up in blanket. Returned at 
nine p. m., and poor “ Tasso ” was in rigor mortis. I think the 
exposure to cold during the day (Sunday) which was a very 
wintry day, was in great measure the cause of his death. He 
refused to drink any milk during the day, and also seemed to 
have lost his thirst for water. 
Post-mortem March 4.—Extensive peritonitis present; no 
separation of the united intestine to be found at the seat of 
operation. 
Experiment No. 26. 
March 3.—(44 cal. cartridge.) Large, fat and old bitch. 
Used Frank Gould’s revolver, 44, and upon opening the abdo- 
men, found four large rents in the intestines (every one of 
which showed extrusion of contents and some worms) at a 
considerable distance apart, and a very profuse haemorrhage 
from the wound of exit, which was not discovered until the 
resections were made, of which two included the wounds in 
the gut, which was about shot off, and much bleeding took 
place before they were found and ligated. The animal was so 
fat and boggy that it was with the greatest difficulty that 60 
haemorrhage could be controlled, and the beast was old and 
presented signs of cataract in both eyes. The bladder was 
greatly distended, and the structure of the intestines themselves 
seemed “ sleazy,” and the sutures tore out with readiness upon 
slight traction. Cleansed out abdomen as best we could by 
thorough washing, but a little bleeding was going on when 
the wound was closed in the abdomen, and the operation given 
up as a bad job of one-half hour’s duration. 
March 4.—Found dead. 
Experiment No. 27. 
March 4.—(44 cartridge.) Medium-sized dog; died from 
shock on night of 4th. 
Experiment No. 28. 
March 6.—(Ball cal. 22, revolver.) Very small, black and 
tan dog. Shot him with a 22 cartridge, and had to use three 
shots before could get a good perforation and but little bleed- 
ing. Resected a piece around the bullet-hole of inches 
long, cleaned abdomen and closed tightly; gave morph, gr. )/x. 
March 7.—Seemed very bright. 
March 8.—Gave little milk and morphia in evening. 
March 10.—Milk. 
March 11.—Sent down cellar to be fed on milk. 
March 12, 13.—Very hearty, and eats ravenously of milk 
and very little meat. 
March 14, 15.—Doing nicely. Recovery. 
Experiment No. 29. 
March 6.—(Ball cal. 44.) Large, strong dog. Used 44 
cartridge. Found the abdomen full of blood; spleen perforat- 
ed, and intestines wounded in three or four places. From 
these issued faeces, etc. Removed spleen, omentum, and 
resected about 12 in. gut, including all the holes but one,, 
which was sewed up by continuous stitch. The animal having 61 
lost nearly all his blood by this time, and as death was sure to 
ensue, one of the mesenteric arteries was ligated to ascertain 
results. 
March 7.—Found dead in morning. 
Post-mortem.—Intestine black, but the animal had evidently 
not lived long enough to get any positive mortification of liga- 
tured part, or any interesting appearance at all. 
Experiment No. 30. 
March 10.—Tilley’s Inhaler. Large chandler bitch. Killed 
by ether. 
Ex PERI M ENT No. 3 I. 
March 10.—Tilley’s Inhaler. Large Hastman dog. Killed 
by ether. 
Experiment' No. 32. 
March 10.—(Ball cal. 22, rifle.) Medium-sized bitch. Eound 
three mesenteric arteries severed, and intestines riddled in 
many places and far apart. Perforations showed faecal matter 
and tapeworms. Stopped bleeding and returned intestines 
without closing the perforations, and closed abdomen. No 
dressing but iodoform (C. T. P.) Spleen also removed, being 
perforated. 
March 1 1.—Still alive, and sent down cellar. 
March 13, a. m.—No better. 
March 14, 15, a. m.—Vomiting, and refused food. 
March iS.—Dead. Peritonitis septic. Pockets of faeces. 
Experiment No. 33. 
March 10.—Small dog (yellow). Shot with 22 cal. rifle. 
Three perforations of small intestine, showing faecal matter. 
Removed a 4-in. piece in two places, and brought ends to- 
gether very closely; stitched mesenteric stumps to attached 
border of intestine. Removed omentum, tying tightly, and 
also putting in three side stitches connecting sides of stumps 
on each side of ligation with one another. 62 
March 11.—Alive, but feverish and vomiting. 
March 12.— Died. Separation at seat of operation, and 
stumps mortified. See specimen. Faecal extravasation. 
Experiment No. 34. 
March 12.—(Ball cal. 22 rifle.) Old, mangy bitch. Died 
under ether. Tilley’s Inhaler. Perforation showed extravasa- 
tion of contents, faecal matter and worms. 
Experiment No. 35. 
March 12.—Medium-sized, short-haired, yellow cur (white 
nose). Shot with 22-ball rifle. Upon opening the abdomen, 
found blood flowing from a rent in the side of spleen. This organ 
was three times the normal size, but no holes in the intestines 
anywhere, and no hole could be found in the abdominal wall 
on either side. The bullet lay next the abdominal muscles, 
and was cut out from the wound of entrance. P'ree bleeding 
from the laceration in the spleen, which was controlled by a 
continued suture. Resected six inches of intestine and closed 
abdomen. Also omentum removed. Iodoform and oakum 
dressing; gave morphia. 
March 13.—y gr. morph, a. m.; very weak p. m. 
March 14.—Morph, a. m.; very weak p. m. Temperature 
102. 
March 15.—Re-opened, but found intestine in solid mass 
and filled with badly-smelling fluid. Washed out as best I 
could and reclosed. Seat of operation showed mortification 
on one side, and stumps mesentery also were black and soft. 
March 16.—Still alive. Morph, gr. )/x. 
March 19.—Dead. Found intestinal worms in abdominal 
cavity. 
Experiment No. 36. 
March 12.—Short, black, stumpy and very fat dog. Fired 
four 22-balls at the animal before was sure that any had entered. 63 
Found abdomen full of blood; two perforations five inches 
apart, and two mesenteric arteries shot off near the gut. Each 
perforation showed extravasation, faeces and worms. Ligated 
the arteries ; resected one piece, including both holes ; sponged 
out abdominal cavity; removed omentum, also a large quan- 
tity of fat which hung to the inner wall of the belly, and closed 
wound. Iodoform and oakum dressing; gave morphia. 
March 13.—Quite bright. Morph, a. m. and p. m. 
March 14.—Dead. Post-mortem. P'ound considerable pe- 
ritonitis and mortification of the ends of the intestines where 
they were stitched together. The stumps of mesentery and 
omentum also showed signs of mortification. 
Experiment No. 37. 
March 13.—Medium-sized brindle bitch. No. 22-ball rifle, 
Resacted one piece six inches having two holes; removed 
omentum very little ; haemorrhage ; gas and faeces from wounds ; 
temperature 98 2-5 at close of operation. 
March 14.—gr. morph, a. m. Temperature 102 2-5, 
Morph, p. m. 
March 15.—]/x gr. morph, p. m. ; temperature 102 2-5. 
March 16.—Morph, p. m. ; temperature 102. 
March 17.—Gave milk and morph, p. m. 
March 19, 20.—Gave milk and morph, p. m. ; seems well. 
April 22.—Perfectly weH ; recovery. 
Experiment No. 38. 
March 13.—Medium-sized yellow dog (with bare spot on 
tail). No. 22-ball rifle ; found one lateral hole which closed by 
continuous suture, and three holes which were included in one 
piece which was cut in half by mistake ; two arteries gave some 
bleeding, but were ultimately controlled. Contents of bowel 
found at each wound. Abdomen closed while yet there was 64 
some oozing from the wound, which ceased when bandages 
were applied; omentum removed. 
March 14.—Very weak and much prostrated. Refused to 
lie down, and can stand with difficulty on his feet. Gave mor- 
phia hypodermically, morning and evening. 
March 15.—Found dead. Post-mortem. Mortification at 
seat of operation, and escape of intestinal contents. 
Experiment No. 39. 
March 14.—(Ball 22-cal. rifle.) Medium-sized brindle dog 
(wolf face); found three ragged holes. Resected one piece 
which included all openings, the piece being seven inches 
long; closed neatly, the omentum being removed also (many 
tapeworms and considerable fmcal matter from openings), then 
washed clean by irrigator. The entire ileum was inspected and 
sponged off, and returned to abdomen. Spleen also pulled 
out and inspected; gave morphia and dressings of iodoform 
and oakum. 
March 15.—Some shock; morphia. 
March 16.—Morphia p. m. only. 
March 17.—Morphia p. m. only. 
March 19.—a. m. morphia, stercoraceous vomiting, and seems 
very sick; p. m. is evidently dying. 
March 20.—Vomiting has stopped, and seems much better. 
Died in the evening, p. m. Septic peritonitis. Post-parito- 
neal abscesses. 
Experiment No. 40. 
March 14, 4.45 p. m.—A young, black, bitch pup; anaesthe- 
tized and abdomen opened without shooting; ligated a mesen- 
teric artery and closed wound to be re-opened to-morrow p. m. 
and resect the part supplied by ligated vessel; gave morph. 
March 15.—Opened her at 3 p. m. in presence of Prof. Parkes. 
Intestine supplied by the ligated artery seemed softer than 65 
normal and its mesentery showed inflammatory exudate con- 
siderable effusion; closed wound, gave morphia at night. 
March 16.—Gave morphia, gr. 
March 17.—Sent down stairs. 
March 19.—Seems quite well. 
April 22.—Perfectly well. Recovery. 
Experiment No. 41. 
March 19.—(Ball 22-cal. rifle.) Medium-sized young bitch 
(black). Found one abrasion which closed up by continued 
suture and the intestine in another place was about shot off; 
faecal matter scattered all about, worms divided; resected the 
piece about one inch long; irrigated the abdomen cavity; 
removed omentum and then found a hole or rather the tip of 
the spleen shot off which bled some and was controlled by 
two interrupted sutures; gave morphia, gr. y^y and applied 
dressings. 
March 18, 19.—Morphia, gr. ]/2. 
March 20.—Seems bright, but very quiet. 
April 22.—Quite well. Recovery. 
Experiment No. 42. 
March 19.—Twenty-two ball rifle (brindle, white bitch). 
Found one abraded edge and one hole through free edge of 
ileum, from which contents issued. Closed one by continued 
suture and resected across the hole by cutting out a inch 
piece. Did not remove omentum. Gave morphia and ap- 
plied dressing. 
March 18 and 19.—Morphia. Seems to have a paralysis of 
left fore-leg since operation and for two days past seems to be 
salivated. 
March 20.—Better. 
April 22.—Well. Recovery. 66 
Experiment No. 43. 
March 20.—(Stub tail.) A small half-breed terrier dog. 
Twenty-two ball rifle. Found two perforations and one abra- 
sion, extravasation of gas and stained mucus and shreds of 
matter from openings going through mucous coat. Made a 
resection including all three wounds, the excised piece being 
six inches long, closed very snugly and connected the ligated 
mesenteric stumps with the attached border of intestine by a 
single ligature passing through both stumps (but two sets of 
vessels having been ligated) and both sides of the mesenteric 
borders of the united ends of the gut; removed omentum and 
irrigated abdomen cavity freely with a 1 per cent, of carbolic 
acid solution. Dressings, oakum and iodoform; gave morphia, 
y. Recovery. 
Experiment No. 44. 
March 20.—A young, shaggy, cur dog opened without 
shooting, and ligated three sets of branches from the super- 
ficial mesentery artery, close to the main artery, and also a 
good-sized anastomatic connection with an adjoining vasa in- 
testine tenuis, which ran parallel with and along the attached 
border of the bowel. The intestines supplied by the vessels 
blanched immediately. Closed abdomen; gave morphia, gr. y ; 
applied dressings. Recovered. 
Died subsequently from ether during examination as to re- 
sult of above operation six days after it. Found intestine per- 
forated by stick of wood four inches long, rolled in twine. 
Had removed it, and was about to sew up wound when ether 
killed him. 
Experiment No. 45. 
March 20.—A good-sized spaniel dog (old). Stopped breath- 
ing once from ether before shooting. Shot with a rifle twenty- 
two ball. Found the abdomen full of blood, two arteries hav- 67 
ing been shot off and the ileum perforated in four places; from 
each contents extruded, two being so near together and the 
wounds so great as to almost carry away an entire segment of 
the bowel, necessitating a removal of about twenty inches. 
Much bleeding, which took about half-an-hour to control, be- 
ing from the ligated stumps and bullet-wounds; the tissues 
were very brittle, and so loaded with fat as to make the opera- 
tion difficult. Died in one half-hour after closing abdomen 
wound. 
Pathological Specimens Shown. 
1st. Section of ileum made 24 hours after operation ;,..show- 
ing the sutures all covered with exudate. Union sufficiently 
firm to allow distention with water without leaking. 
2nd. Sections of intestines made four, six and eight weeks 
after operation—the animal having fully recovered. The union 
is firm and solid throughout entire circumference of the bowel. 
No narrowing of tube, or disposition to formation of a stric- 
ture. Two of the specimens show several of the sutures ul- 
cerating into the lumen of the bowel. 
3rd. Several specimens showing mortification of distal ends 
of stumps, and also mortification ofapplied edges of the bowel 
from tight sutures and ligatures. 
4th. Several specimens showing giving way of sutured 
bowel ends at the mesenteric junction, allowing extravasation 
causing fatal inflammation—sutures failed to include the mus- 
cular coat. 
5th. Specimens showing many varieties of wounds pro- 
duced by the bullet.