30 SURGERY. 



shock upon the system is greater than in other wounds, and is partly 

 corporeal and partly mental. Syncope and depression of spirits are 

 very common attendants. 



The idea of injury resulting from the ivmd of a ball is erroneous. 

 Injuries may result from spent balls, which, having a rotary motion, 

 may roll over the surface without producing an open wound. 



The course of bullets is uncertain ; any obstacle, such as a button, 

 a watch, or a bone, may occasion a most devious track. A ball may 

 strike the forehead, and emerge at the occiput, or, striking the ster- 

 num, lodge in the scrotum. A bullet may be divided into two parts 

 by striking a sharp edge of bone ; or it may bury itself, and remain 

 concealed for years, being enclosed in a cyst. 



When there is but one aperture, it is probable that the ball has 

 lodged ; though it may have escaped upon the removal of the cloth- 

 inty, if a portion of the clothing should have been carried before it 

 into the wound ; or, the ball may make a complete circuit, and escape 

 by the aperture of entrance ; in this instance the track would be 

 discovered by redness and swelling. When two orifices are in a 

 straight line, it is not always to be inferred that the ball has escaped, 

 for two balls may have entered opposite each other ; the character 

 of the orifices will determine this point. A plurality of openings 

 does not always imply a plurality of balls ; the same bullet may per- 

 forate and escape, and perforate again. 



The wound partially sloughs and may produce abscess, eryvsi- 

 pelas, hemorrhage, disease of the bones, hectic, or tetanus. 



TrecUment. — The general indications are to overcome the shock, 

 remove foreign matters, adjust the parts, and place them in a com- 

 fortable and relaxed position. 



A simple wound, made by a ball passing through some fleshy part, 

 should at first be sponged clean, and after hemorrhage has ceased, 

 dressed with dry lint, secured by strips of plaster. A little wine 

 and laudanum may he given if the patient is disposed to faint, or 

 suflTers much with anxiety and fear. In a few days there is inflam- 

 mation ana suppuration. The primary dressings are to be removed 

 with warm water, and a poultice or the water dressing substituted. 

 Care must be taken that the sloughs are readily thrown ofl?", and that 

 no sinuses are formed. The constitutional treatment should be 

 moderately antiphlogistic ; consisting of purging, low diet, leeches, 

 and perhaps bleeding ; an opiate at bedtime will allay pain and 

 twitching. 



The presence of bullets and other foreign bodies can be detected 

 by a probe, and they are to be removed by a forceps, the wound 

 having been dilated, if necessary. If they are superficially lodged, 

 they are to be cut down upon, extracted by a counter opening ; if 

 they are deep-seated and impacted, wait for the suppurative stage. 

 When lodged in bone, they are to be removed by a chisel or tre- 



