WOUNDS. 



Gun-(hot wounds of the neck fometimes occafion an im- 

 mediate lofs of the ufe of the arm on the affefted fide ; a 

 circumftance which may in general be accounted for by the 

 injury of fome of the cervical nerves, in their defcent to and 

 from the axillary plexus. See Hennen's Military Sur- 

 gery, p- 378, and Thomfon's Report of Obfervations made 

 in the Mihtary Hofpitals in Belgium, p. 75, 76. 



IVounds of the Thorax, or Chejl — Some of thefe injuries 

 penetrate the cavity of the thorax ; others arc more fuper- 

 ficial, only affefting the fl<in and mufcles, and not extending 

 through the pleura coftalis. When the latter cafes are 

 produced by (harp-cutting inftruments, and the only indi- 

 cation is to accomphlh an union of the divided parts, as 

 happens in incifed wounds of the ikin, latifTimus dorfi, peAo- 

 ralis major, &c. fuch injuries are not materially different 

 from any fimple wounds of other parts of the body, and 

 require a fimUar mode of treatment. 



But where much violence has been applied to the pa- 

 rietes of the cheil, and the concuffion has operated fo for- 

 cibly as to affeft the heart, lungs, and other important 

 organs, the wound, although fimple in appearance and not 

 penetrating the cheft, may neverthelefs be followed by 

 alarming fymptoms, either at firft or confecutively ; fuch as 

 inflammation of the lungs, fpitting of blood, and difficulty 

 of breathing, as is frequently obferved in contufed and gun- 

 fliot wounds of the parietes of the cheft. A violent blow 

 on the dorfal vertebrae is alfo faid to have given rife to a 

 dilatation of the heart, and an aneurifm of the aorta. 

 Laffus, Pathologic Chir. tom. ii. p. 305. 



Thus profeffor Thomfon, in his account of the wounded 

 whom he obferved after the battle of Waterloo, remarks, 

 " We faw more inftances than one in which a ball, in palling 

 acrofs a portion of the parietes of the thorax, without pene- 

 trating that cavity, had excited an alarming and dangerous 

 degree of inflammation of the pleura. In one of thefe, the 

 ball had taken an oblique direftion along the lower part of 

 one of the fides of the cheft. In another it had ftruck 

 againll a ftrong leathern belt that was fufpended over the 

 right ftioulder, made a deep indentation in this belt without 

 penetrating it, and produced a feverely contufed wound at 

 the inner extremities of the firft and fecond ribs of the right 

 fide. This patient fuffered much from inflammation. The 

 injured portions of the ribs had exfohated and come out, 

 and the motion of the lungs in infpiration and expiration 

 was perceptible from the finking and rifing of that part of 

 the parietes which had been deprived of its bony fupport. 

 In another remarkable cafe, the ball entered above the 

 middle of the clavicle, and paffed out at a point direftly 

 behind. Neither at the firft, nor at the time we faw this 

 cafe, was there any reafon to believe that the ball had 

 wounded the pleura. Inflammation, however, of this mem- 

 brane came on, which terminated in fuppuration. The 

 operation for empyema was performed, and about four 

 pints of pus evacuated." Reports of Obf. in the Mil. 

 Hofpitals in Belgium, p. 82. 



In wounds of the cheft, it is often difficult to pronounce 

 with certainty wliether they peaetrate into the fac of the 

 pleura ; but all doubts with regard to this point are re- 

 moved the moment we obferve air coming out of the wound 

 upon coughing. That the lungs have been wounded may 

 be inferred with nearly equal correftnefs in every cafe, in 

 which a perfon fpits blood immediately or foon after re- 

 ceiving a wound of the cheft. 



It rarely happens that a wound penetrates the cavity of 

 the thorax without producing more or lefs injury of the 

 lungs, and the danger of the latter accident is in proportion 

 to its depth, its fituation, and the fize of the weapon with 



10 



which it was inflifted. A wound of the lungs with a fmall 

 fword feldom gives rife to much effufion of blood in the 

 cheft, unlefs fome of the large veffels of thofe organs 

 happen to be hurt. Putting this circumftance out of pre- 

 fent confideration, the ufual fymptoms which the puient 

 fuffers are, a fpitting of blood, cough, and difficulty of 

 breathing, fucceeded by a good deal of fymptomatic 

 fever. 



" To difcover whether the wound has injured the lungs 

 or not, ( fays a late writer, } is a point which has given to the 

 older furgeons great room for employment of their inge- 

 nuity in devifing poffible cafes, and has occafioned no fmall 

 wafte of time and wax-tapers in afcertaining the exit of air 

 through the paffage. A praftical furgeon will require but 

 little inveftigation ; bloody expeftoration immediately on re- 

 ceiving the wound, and the terrible fymptoms of dyfpnoea, 

 fenfe of ftrifture and fuffocation, infupportable anxiety and 

 faintnefs which fucceed, foon enough difcover the faft ; and 

 if by good fortune no intimation is given in this way, happy 

 is the furgeon, and thrice fortunate the patient. 



" The immediate danger in wounds of the lungs is either 

 from debility from hemorrhage, or fuffocation from the 

 blood flowing into the air-cells and cavity of the thorax. 

 The effufion of air forming emphyfema is alfo a trouble- 

 fome, but (as Mr. Hennen believes), taking it abftraftedly, 

 is not a dangerous fymptom of thofe injuries ; neither (fays 

 he) is it by any means fo frequent as has been fuppofed. 

 The fymptoms that I have now enumerated, whether fingle 

 or in combination, may be deemed the primary effefts of 

 wounds of the thorax. Violent inflammatory affeftions of 

 the lungs and the membranes ever fubjeA to relapfe ; long 

 and tedious fuppurations and exfoUations of the bones are 

 the fecondary, and though not fo rapidly fatal are often as 

 certainly fo as the others. Difeafes which, although we 

 cannot ftriftly call them pulmonary confumption, agree 

 with it in many points, particularly in cough, emaciation, 

 debihty, and heftic, are often the confequences." Obf. on 

 Mihtary Surgery, p. 395. 



When the weapon is broad, and it has entered the fubftance 

 of the lung, the hemorrhage is confiderable ; blood is im- 

 mediately extravafated in the cavity of the thorax, and alfo 

 flows out of the external wound ; the patient has a violent 

 paroxyfm of coughing, in which fome of the blood is ejefted 

 from the mouth ; the air comes out of the cheft with a 

 hiffing noife ; and if the outer wound be not parallel to that 

 of the lungs, emphyfema takes place. As we have already 

 ftated, the danger of fuch an injury depends upon the depth 

 of the wound, and the fize of the veffels which are opened. 

 Some patients recover, while others die inftantly, or in a 

 very (hort fpace of time. 



As an interefting author remarks, it is a thing really 

 wonderful, " that the thorax, containing the heart, lungs, 

 and great veffels, ftiould be fo often wounded with fo little 

 danger. Many no doubt die, but numbers efcape ; for a 

 wound of the fubftance of the lungs is far from being 

 mortal. The blood may fuffocate the patient ; the fever 

 and pain may wafte him ; he may die of the inflammation, 

 or of the oppreffion of the lungs ; or there may be time for 

 a large fuppuration, or a fingering heftic to cut him off; 

 but ftill, if his wound be only in the edges of the lungs, he 

 is in fome degree fafe. He is only in danger when the 

 thick fubftance of the lungs is perforated, and falls into 

 abfcefs, or when the root of the lungs is wounded ; for 

 there the large veffels of the lungs being opened, the great 

 effufion of blood, hke that from a wound of the heart itfelf, 

 muft kill, even by the quantity of blood loft to the general 

 fyftem. But befides, this blood, being thrown into the 



trachea , 



