WOUNDS FROM FIRE-ARMS. 139 
bo Noes cn rea tie) aie mortal accidents (perforation 
: g, of the heart, or of the brain.) Let us 
again say that a projectile that breaks up upon a bone may make three 
openings on the skin; and that the existence of two openings is no 
proof that the region has been run through, as the two openings may be 
those of entrance of two balls which have not made their exit. 
The projectile has penetrated the tissues in making a blind tract with 
one opening only: it remains in the region: what is the treatment? 
Of yore, extraction, whenever possible, was recommended ; but numer- 
ous facts have shown that the balls, which are almost always aseptic, 
are tolerated in the great majority of cases. Then systematic absten- 
tion is the rule of conduct adopted now by most surgeons. The wound 
and its surroundings is carefully examined: sometimes palpation re- 
veals a hard spot, a slight projection formed by the ball; with a stroke 
-of the bistoury those are brought out that are arrested just under the 
skin; those that are lost in the depth of the tissues or have penetrated 
the viscera are left alone. Wounds of the lung are relatively harmless 
compared with those of the encephalon, spinal cord, or heart, which 
are nearly always fatal. The penetration of a ball into abdominal or 
thoracic cavities is not necessarily followed by complications; and the 
rule is, not to attempt the extraction. The question in human surgery 
as to the course to take with abdominal wounds is yet undecided. 
Reclus, who is a great admirer of abstention, admits interference 
“not for the extraction of the projectile, but to repair the mischief it 
has done by its passage: such as, the opening of an artery or a large 
vein; the section of a nerve or of a tendon; laceration of a viscus, 
the stomach, an intestine, or the bladder.”’ We do not interfere for like 
occurrences among our large domestic animals. For the others, one 
must be guided by rules laid down in human surgery. We will return 
to this subject in the chapter on Traumatic Lesions of the Intes- 
tines. 
When the projectile is arrested in a musculo-aponeurotic region and 
produces in it violent inflammatory phenomena, it must be looked for 
by exploration of the tract of the wound. Sometimes the size of the 
‘canal permits the introduction of the index finger, but ordinarily it has 
to be enlarged by incision: an aseptic grooved director is intro- 
duced into the tract, and a straight bistoury passed along the groove 
carries the incision on to the necessary extent. When the projectile is 
exposed, it is made loose with the extremity of the probe and extracted 
with the denticulated jaws of long forceps. One should avoid violent 
manipulations, which might result in injuring the tissues more or in 
pushing the ball farther inwards: this recommendation is specially im- 
portant for projectiles arrested in the neighborhood of serous mem- 
branes. Bony lesions are always serious complications, with, however, 
