112 WOUNDS AND BEUISES. 



gerous, if not fatal, extension into the chest. Wounds which pene- 

 trate into this cavity are so grave (in human practice the mortality 

 is about 80 per cent.), and admit of such a slight employment of 

 remedial measures, that I have little to say about them from a 

 practical point of view. Any splinters, dirt, or other foreign bodies 

 which may be in the wound should be removed and the wound 

 freely washed with an antiseptic lotion (p. 67), of which the 

 best, in this case, is probably peroxide of hydrogen. In our 

 endeavour to keep the wound free from contamination, we 

 should not touch it with either probe or finger before tho- 

 roughly disinfecting (p. 70) our exploring instrument. We 

 may then freely dust tannoform over the wound, cover it with 

 five or six layers of antiseptic cotton wool (p. 608), and apply a 

 bandage to keep the dressing in place, unless there be continued 

 bleeding, in which case the wound should be left more or less open, 

 and should be kept clean by being bathed or gently syringed over 

 with an antiseptic solution. As a rule, slings should be employed, 

 and the patient kept on gruel, mashes, green food, and carrots, 

 with plenty of fresh water to drink. No local treatment will be 

 practicable for internal injuries of the chest unaccompanied by an 

 external wound. 



COMPLICATIONS.— The following are the chief complications 

 resulting from these wounds : — 



(1.) Bleeding. A frothy discharge of blood from the nose, in 

 greater or less quantity, is a usual though not invariable symptom 

 of the lung being wounded. The blood, instead of issuing from 

 the wound, may be discharged into the cavity (the pleural sac) 

 between the lung and the wall of the chest, thus constituting the 

 condition known as liceniotliorax, which cannot fail to take place 

 in the event of the surface of the lung or the inside of the wall 

 of the chest being wounded, when there is no external outlet for 

 the fluid. The symptoms of this internal bleeding, besides the 

 frothy discharge of blood from the nostrils, will be paleness of the 

 mucous membranes, weakness of pulse and depression of the vital 

 forces from loss of blood, and more or less difficulty of breathing 

 from the pressure of the blood in the pleural sac on the lung, which 

 will suffer collapse proportionate in amount to that of the escaped 

 fluid. The presence of this blood in the pleural sac is very dan- 

 gerous, especially in conjunction with an external wound; for the 

 escaped blood is apt to putrefy or at least to form adhesions be- 

 tween the wall of the chest and the lung^. 



(2.) Emphysema or accumulation of air in the loose connective 

 tissue is found underneath the skin, between the muscles and other 

 structures near the surface of the body. This is generally first 



