General measures for the treatment of internal and external wounds of the viscera

When treating a suspected internal tear or split, the doctor's goal is to heal it, prevent blood from congealing inside, and prevent bleeding. Medicines that help achieve the first two goals are, for example, viper onion, if boiled in vinegar, or the patient is given one dirham of centaury to drink; printing clay also has great power in this case. Medicines that are given to stop bleeding are, for example, one and a half danaka of henbane seeds with water sweetened with honey, as well as other substances mentioned as means to stop bleeding and hemoptysis.

As for ruptures and wounds from the outside, the scientist says: If the soft walls of the abdomen are torn and some intestines come out, then you need to know well how to remove and set the intestine, and if part of the omentum has come out, then you need to know whether or not to apply a tight bandage, sutured wound or not, and how it is sutured.

Galen mentions the anatomy of the soft abdominal walls and we also mentioned this in the anatomy section. Says Galen According to what we said in anatomy, the sides are a safer place in case of rupture than the bump, and the bump is the middle of the abdomen, while the sides are a place four fingers away on either side of the bump. And this is for the reason,” he continues, “that when a rupture occurs at the site of the protuberance, more intestines fall out, and it is more difficult to return them to their place, since the only thing that holds them in place are two muscles that go down along the body and go down from the chest to the pubic bone. Therefore, if one of these muscles is torn, part of the intestines must come out and protrude through the tear. In addition, the muscles located in the sides compress the intestines, but in the middle of the body there is no strong muscle that would hold them, and if it happens that the wound is large, then a lot of intestines will come out and it will be harder and more difficult to set them back. As for small wounds, if you do not hurry and set the intestine right away, it will swell and become thicker, as winds form in it, and will not fit back into the rupture. Therefore, the safest wounds are those from ruptures of the abdominal walls, the size of which is moderate.

He says such wounds need several things: firstly, the protruded intestine should be returned to its special place, secondly, the wound should be stitched up, thirdly, a suitable medicine should be applied to the sore spot, and fourthly, try not to one of the noble organs was not in danger.

If the wound is so small that, due to its small size, it is not possible to straighten the protruding intestine, then either the winds mentioned above should be dissipated, or the gap should be widened. It will be better to dispel the winds if you can.

The cause of intestinal bloating is the coldness of the air, so you should immerse a sponge in hot water, squeeze it out and apply it as a poultice. Astringent wine, also heated, is beneficial in this case; it warms even more than water warms, and strengthens the intestines.

If this method of treatment does not dispel the swelling of the intestine, then let the doctor resort to widening the rupture. The best tool for this type of cut is a tool called a fistula lancet. As for double-edged piercing knives or knives with a pointed end, you should beware of them. The most suitable pose and position for the patient, if the wound is directed downward, is the posture and position with the wound facing upward, and if the wound is directed upward, then the position and posture is with the wound facing downwards. In both cases, your goal is to prevent the remaining intestines from falling onto the protruding intestine and aggravating it. When you do this or set such a goal for yourself, you will learn that if the wound is on the right side of the body, the patient should be turned slightly to the left, and if the wound is on the left, he should be placed with a slight tilt to the right. At the same time, they always strived to ensure that the side where the wound is located was higher than the other. This applies to all such wounds.

As for retaining the intestines after returning them to the stomach in their special places, if the wound is large, this requires a skilled servant. The fact is that he must cover the entire wounded area with his hand from the outside, bringing together and connecting the edges of the wound and exposing one area after another for the doctor who is suturing the wound. Then he moves to the already stitched area and, little by little, connects and brings together the edges of the wound, until the entire wound is sewn up with a strong suture.

I will describe to you the best way to sew up the abdomen and tell you since what you need is to connect the membrane with the soft parts of the abdomen, you should first insert a needle into the skin from the outside inwards and when the needle penetrates into the skin and into the muscle running vertically along the entire abdomen, do not touch the edge of the shell on this side and do not insert the needle there, but pass it again through the same edge of the abdominal walls from the outside inwards and do not touch the edges of the shell on this side, but pass the needle through the other edge from the inside out. Passing the needle

through the shell, pass it also through the edge of the soft walls of the abdomen, located on this side, until you go through this entire edge, then start from this very side and sew it to the edge of the shell along the outside. Then remove the needle from the skin located near the edge, insert it again into the skin and stitch the edges of the shell on the other side with the corresponding edge of the soft walls of the abdomen, then remove the needle from the skin located on that side, and do this over and over again until you have sewn up the entire wound .

As for the distance between the two punctures, you should be careful not to make it too wide or narrow; wide stitches do not hold properly, and narrow ones tear the skin. A thread, if it is sinewy, also contributes to tearing the skin, and a thread that is worn out breaks; choose the middle one between soft and hard. If you stick the needle very deeply, it tears the skin less, but then part of the thread remains in the wound, and the wound does not heal. Observe moderation in this regard.

Galen also says: When suturing the abdomen, make it your goal to connect the membrane with the soft walls, for this membrane, since it is rich in nerves, is difficult to connect and grow together with them.

Some doctors advise suturing in this way, the needle should be inserted into the outer edge of the soft walls and passed inside, without grasping either one or the other edge of the shell, then you take the needle out again and pass it through both edges of the shell, inserting it from the wrong side. started, and from the opposite side, then pass the needle through the other edge of the soft walls of the abdomen and continue to act in this way. This method is better than the generally accepted one, in which all four edges are swept with one stitch; after all, in the method that we just mentioned, it is also sometimes possible to hide the shell behind the soft walls and firmly connect it to them.

And then,” Galen says further, “apply some healing medicine to the seam.”

With such wounds, dressings are more necessary. A piece of sheep's wool is slightly moistened with hot olive oil and wrapped in a circle around the space from the armpits to the ureters. Sometimes the wool is also doused with something emollient, such as oils and mucus.

If the wound has reached the intestines and damaged them, then the method of treatment is as we said, but only the bandages should be soaked in warm, black, astringent wine, especially when the wound reaches the intestines or penetrates further. The jejunum never heals from a wound formed on it due to the thinness of its substance, the numerous vessels in it and its natural proximity to the nerves, as well as the abundant outpouring of bile in it; besides, it is very hot, since it is located closest to the liver of all the intestines. As for the lower viscera of the abdomen, since they are close in nature to meat, we are confident that they can be cured.

Says Galen in the book The Art of Healing Let it be your goal when the soft walls of the abdomen and the membrane are torn, sew them together so that the membrane adheres to the walls, for the membrane is rich in nerves and slowly grows together with other tissues. This is done using the method of stitching that we talked about above, because it connects, glues and fastens the tear in the shell.

Says Galen: If the patient's intestines have come out, then ask for strong wine, and let them warm it up, immerse a piece of wool in it and place it on the intestines; the wine dispels their swelling and makes them fall off. If you don’t have wine at hand, then use some strongly astringent waters, and if you don’t have those either, steam the intestine with hot water until it falls off. If the intestine still does not enter, then widen the gap.

Says Hippocrates If the omentum came out of the stomach through a wound, then the fallen part of it will certainly rot, even if it does not remain outside for long. In this respect, the omentum is superior to the intestines and the liver, for the intestines and edges of the liver do not rot unless they remain outside too long and do not become too cold. When they are inserted into the stomach and the wound heals, they return to their natural state. As for the omentum, if it remains outside the abdomen for a very short time, the part that falls out, when it is inserted into the abdominal cavity, will certainly rot. Therefore, doctors rush to cut it off and never insert the prolapsed part of the omentum back into the stomach, and if something opposite is discovered in relation to the omentum, it is only very rarely, and this almost never happens.

When a part of the omentum falls out, you need to determine whether it should be cut off or not, whether or not the wound should be sutured, and how exactly to suture it. If the wound is on the protuberance, that is, in the middle of the abdomen, then this is more dangerous, because the ends of the muscles covering the abdomen are located there, but if it is on the sides - and the sides are located on both sides of the abdomen, right and left, four fingers away from the protuberance - it more benign, because there are absolutely no muscle endings rich in nerves. As for the place of the bulge, it is also difficult to sew it up, because in this place the intestine most often comes out and protrudes from the rupture. It is all the more difficult to straighten it because it is compressed and held by two fleshy muscles stretched along the abdomen, which descend from the chest to the rakab, that is, to the pubic bone. And so, when the wound falls on this place, the mentioned muscles are cut and the intestine protrudes more strongly, because the muscle on the side compresses it, and in the middle there is no strong muscle that would hold it. If it happens that the wound turns out to be very large, then several intestines will necessarily come out of it, and it will be all the more difficult to insert them back.