112 WOUNDS AND BRUISES. 



Tlie only wounds requiring consideration here are those which 

 penetrate the wall of the chest, or injure its contents, as the end 

 uf a broken rib might do. Wounds of the exterior of the chest 

 wall require no special treatment beyond the observance of pre- 

 cautions against their dangerous, if not fatal, extension into the, 

 chest. Wounds which penetrate 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 little can be 

 done for them. Any splinters, dirt, or other foreign bodies 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. The wound should be kept free from 

 contamination, and the exploring probe or finger should be 

 thoroughly disinfected (p. 70). Dust tannoform freely over the 

 wound, cover with five or six layers of antiseptic cotton-wool 

 (p. 636), and apply a bandage to keep the dressing in place, unless 

 there be continued bleeding. In this case the wound should be 

 left more or less open, and 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.) Bleedrng. 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) 

 bet.veen the lung and the wall of the chest, thus constituting the 

 condition known as hcemothora-x. This 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 

 tlie 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 sufi'er 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 



