Of the GASTRORAPHY.
THE Account of this Operation has engaged the Attention of many surgical Writers, and occasioned much Debate about the proper Rules for performing it; and yet, what makes the greatest Part of the Description, can hardly ever happen in Practice, and the rest, but very seldom. I have been told that Du Verney, who was the most eminent Surgeon in the French Army a great many Years, during the Wars, and Fashion of Duelling, declared he never had once an Opportunity of practising the Gastroraphy, as that Operation is generally described; for though the Word, in strictness of Etymology, signifies no more than sewing up any Wound of the Belly, yet in common Acceptation, it implies that the Wound of the Belly is complicated with another of the Intestine. Now the Symptoms laid down for distinguishing when the Intestine is wounded do not with any Certainty determine it to be wounded only in one Place, which want of Information makes it absurd to open the Abdomen in order to come at it; if so, the Operation of stitching the Bowels can only take place, where they fall out of the Abdomen, and we can see where the Wound is, or how many Wounds there are: if it happens that the Intestines fall out unwounded, the Business of the Surgeon is to return them immediately, without waiting for spirituous or emollient Fomentations; and in case they puff up so, as to prevent their Reduction by the same Orifice, you may, with a Knife or Probe-scissars, sufficiently dilate it for that Purpose, or even prick them to let out the Wind, laying it down for a Rule in this, and all Operations where the Omentum protrudes, to treat it in the Method I shall describe, in the Chapter on the Bubonocele.
Upon the Supposition of the Intestine being wounded in such a manner as to require the Operation, (for in small Punctures it is not necessary) the Method of doing it may be this: taking a straight Needle with a small Thread, you lay hold of the Bowel with your left hand, and sew up the Wound by the Glover's Stitch, that is, by passing the Needle thro' the Lips of the Wound, from within outwards all the way, so as to leave a Length of Thread, at both Ends, which are to hang out of the Incision of the Abdomen; then carefully making the interrupted Suture of the external Wound, you pull the Bowel by the small Threads into Contact with the Peritonæum, in order to procure an Adhesion, and tye them upon a small Bolster of Linen; tho' I think it would be more secure to pass the Threads with the straight Needle through the lower Edges of the Wound of the Abdomen, which would more certainly hold the Intestine in that Situation. In about six Days, it is said the Ligature of the Intestine will be loose enough to be cut and drawn away, which must be done without great Force; in the Interim, the Wound is to be treated with superficial Dressings, and the Patient to be kept very still and low.