[From Yale Medical Journal of January, 1895.] 
FIVE GUNSHOT WOUNDS OF THE INTESTINE 
AND MESENTERY-LAPAROTOMY -SUTURES 
-RECOVERY. 
Professor William H. Carmalt. 
On the nth of July, 1894, at about 12:30 o'clock p. m., I was 
requested by Dr. Leonard W. Bacon, Jr., of this city, to go with 
him some six miles into the country, to a case reported to be a 
gunshot wound of the abdomen. We found the patient under the 
care of Dr. E. D. Swift, of Hamden, who had recognized the pos- 
sible gravity of the injury, and the necessity of operative inter- 
ference. The patient was a lad of between twelve and thirteen 
years of age, who had accidentally shot himself, at about 11 
a. m., with a 22-calibre revolver, held in immediate proximity to 
the abdomen. When we saw him he was undressed in bed, and 
presented no untoward symptoms. He was somewhat frightened 
in a vague way, at what had happened, had been told he would 
have to be "operated upon," so that his pulse was somewhat 
accelerated, and he was disposed to weep. There was no pain 
in his abdomen, and the only soreness he would acknowledge, 
was directly at the point of entrance of the bullet, which was 
about half an inch to the left of and a little above the umbilicus. 
The wound was about a quarter of an inch in diameter, with dis- 
colored edges, and the mother stated that his trousers and shirt 
(the only garments he wore) had perforations in them correspond- 
ing to the situation of the wound. 
Not finding any hardness about the wound, to indicate that 
the bullet had lodged in the abdominal wall, and appreciating that 
any search for it would almost surely involve entrance into the 
abdominal cavity, I prepared for it as carefully as the very unsat- 
isfactory surroundings would permit; and at this point I beg to 
acknowledge the great value of the services of Mrs. M. J. C. 
Smith, the present efficient Assistant Superintendent of Nursing at 
the New Haven Hospital, whose familiarity with the details and necessities of asepsis and antiseptic nursing saved me a great amount 
of thought and labor in the preparation of the room and surround- 
ings. To one accustomed to the operating theater of a well arranged 
hospital, the difficulties of securing asepsis in an ordinary farmer's 
house, with nothing else than the household appliances of a small 
family of very limited means, all in a state of excitement from 
anxiety, the difficulties would at first seem insurmountable; but 
boiled water was soon obtained, vessels of diverse shapes for anti- 
septic solutions were washed, towels and bed linen were baked in 
an oven, as an improvised dry sterilizer; the kitchen table, for 
operating upon, was scrubbed with a mercuric bichloride solution; 
and in the course of an hour and a half we felt ourselves suffi- 
ciently aseptic to justify operating. The care of the person of the 
patient and of the operating staff does not require any especial 
description; they were simply those of every aseptic operation. 
Ether was given by Dr. Swift, and Dr. Bacon's assistance was 
most skillful. 
The wound was now for the first time explored; it was found to 
go nearly perpendicularly to, but slightly downwards and out- 
wards, and evidently entirely through, the abdominal wall. An 
incision was carried along the track of the wound, and continued to 
and then along the median line. No blood appeared in the abdom- 
inal cavity, and at first no evidences of injury to the contained 
organs, but on drawing the intestines out, protecting them at the 
same time by keeping them wrapped in moist, warm, aseptic 
towels, and passing them gently and rapidly through the fingers, 
in search for an injury, we soon came across a double perforation 
in the upper part of the small intestine; these perforations were 
evidently the points of entrance and exit respectively of the bullet, 
and were separated by about half an inch of sound tissue. These 
were sewed up as one wound, using very fine silk, by the " Lem- 
bert " suture. Continuing the search, two other very similar 
wounds were found in the large intestine, which were treated in 
the same way, and later a single perforation of the mesentery 
directly at its junction with the intestine. In all five separate 
wounds were found. A little difficulty was experienced in sewing 
up the mesentery, by the extravasation of blood between the layers, 
due to a puncture of a small vessel with the needle, and I have 
since thought that it was a mistake to have sewn it up at all; 
no harm would have resulted in letting it alone, as no vessel was 
wounded by the bullet. No escape of the contents of the intes- 
tine had occurred, and, as mentioned, there was no hemorrhage; 
but the bullet and two small pieces of cloth were found; in the latter the patterns of the shirt and trousers were to be recognized. 
The intestines were then replaced, the abdomen thoroughly 
flushed out with warm boiled water, and the external wound closed 
with silk-worm-gut sutures. 
It was learned, singularly enough for an active country boy of 
twelve years of age, that he had eaten nothing that morning. He 
had drank some milk about an hour before the accident and was 
waiting for his dinner. This accounted for the empty condition 
of his stomach and bowels, and the absence of fecal extravasation 
through the intestinal wounds. 
The recovery from the anesthetic was followed by nausea, 
lasting for several days, but there was no complication that could 
be referred to the abdominal wounds. On the sixth day there 
was an elevation of temperature reaching to about 102° F., but I 
regarded it to be due to an irritation of the skin of the abdomen, 
caused by applications to control the vomiting. The bowels 
moved in the course of the first week. Later he had two severe 
attacks of intestinal colic, owing to indiscretions in diet, but these 
passed off happily, and he is now, five months after the operation, 
as well as he ever was, doing all the work and play incident to his 
surroundings and age. 
The case is of local interest only, being, so far as I can learn, 
the first instance in this vicinity of perforating gunshot wounds of 
the intestines successfully treated by modern aseptic methods. 
I ascribe the fortunate result to the intelligent carrying out of the 
details of the preparations and the subsequent nursing by Mrs. 
Smith; to Dr. Bacon's skillful assistance during the operation, and 
to the fact that the lad's intestines were empty at the time of the 
reception of the injuries to his intestines. 
87 Elm Street, New Haven, Conn.