WOUNDS. 



furgeon, and leads Wm to fuppofe that the cafe is a pene- 

 trating wound of the thorax when it is not fo. We allude 

 to the occafional examples in which a muflcet-ball pierces 

 the llcin and mufcles on the outfide of the cheft, runs round 

 the ribs, and makes its exit nearly oppofite the point of 

 entrance. Here the abfence of bloody expeftoration and 

 other fymptoms of injured lungs, together with the direftion 

 of the commencement of the track of the ball, will fome- 

 times convey ufeful information to the difcerning prac- 

 titioner. 



There is alfo another fource of deception as to the aftual 

 penetration of balls into the cavities of the body : this is 

 when they ftrike againft a handkerchief, linen, cloth, &c. 

 and are drawn out of the wound unperceived in a fold 

 or pouch of thofe materials. M. Larrey, Mr. Hennen, &c. 

 have publilhed examples of the occurrence. 



Wounds of the cheft are fometimes compUcated with the 

 lodgment of extraneous fubftances in that cavity, and this 

 fometimes without occafioning fatal confequences, either 

 immediately or fubfequently. Thus Mr. Hennen informs 

 us, that in examining the bodies of foldiers who have died 

 from thofe injuries, he has frequently found pieces of wad- 

 ding, of clothes, fpiculje of bone, and balls, and, in one cafe, 

 feme charpie ufed as a dreffing, either loofe in various parts 

 of the lungs, or lying in facs, formed by a depofition of 

 coagulating lymph. In fome more fortunate patients who 

 recovered, fuch matters were difcharged or extracted from 

 the wounds ; and in certain other lucky examples they were 

 ejefted by the convulfive efforts to cough, which their irri- 

 tation had excited. {Obf. on Military Surgery, p. 390.) 

 The fame author relates the following interefting cafe, to 

 prove that a much larger mafs than a bullet may pafs 

 even through the lungs, without doing away all chance of 

 recovery. 



A foldier of the guards was wounded through the thorax 

 at Waterloo, between the third and fourth ribs of the right 

 fide. On his arrival at Bruflels, he was placed in an hofpital 

 and dreffed. Nothing remarkable occurred for the firft five 

 days ; and the only fingularity in the appearance of the 

 wound was its large fize, capable of admitting three fingers 

 conically placed. Blood and air were freely difcharged from 

 it. On turning the man to examine him, and renew the 

 drefllngs, a tumour was difcovered on the fcapula, from which 

 was extrafted his breaft-plate, about two-thirds of which 

 were rolled up by the force of the blow into a figure fome- 

 what refembUnga candle-extingui{her,with the mulket-buUet 

 contained within it. The other third was broken off ; but 

 it had alfo paffed through the wound, and was extrafted. 

 The man furvived the injury three weeks, and afforded great 

 hopes of his perfeft recovery ; but in a guft of paffion, he 

 one night tore the dreflings off his wound, and was found 

 dead the next morning. The body was not examined. Op. 

 cit. p. 392. 



Balls have been found in the fubftance of the lungs twenty 

 years after their entrance, the patient being all that time in 

 perfeft health, without any fymptom charafterizing the pe- 

 cuhar fituation of fuch foreign bodies. There are alfo on 

 record inftances in which a ball has rolled about in the 

 cavity of the thorax on every motion of the body. ( See 

 Baron Percy's Manuel du Chirurgien d'Armee, p. 25 ; 

 Magatus's Bibhotheca Chirurgica ; and Hennen's Military 

 Surgery.) In general, however, balls lodged in the thorax 

 become as it were encyfted and fixed by the depofition of 

 coagulable lymph around them, and the formation of a fort 

 of fac. 



Several authors have noticed, that when a penetrating 

 M/ound of the chelt is of a certain fize, a portion of the lungs 



fometimes forms a protrufion between the ribs. In the 

 majority of fuch cafes, there can be no doubt of the pro- 

 priety of immediately reducing this fort of hernia, and keeping 

 it fo replaced by means of a fuitable apparatus. We learn, 

 however, from the obfervations which have been collefted on 

 this fubjeft, that the protruded part of the lung has fome- 

 times been tied, or cut away, without any ill confequences. 

 Fabricius Hildanus records the cafe of a man who was 

 wounded with a fword between the fifth and fixth ribs, near 

 the fternum, and in whom a piece of lung protruded. On 

 examination it prefented a livid appearance, and the difco- 

 loured part was therefore cut away with a heated knife. 

 The reft was reduced, after feparating the two ribs, from 

 each other, as far as poffible, by a wooden wedge. Not- 

 withftanding this extraordinary method of treatment, the 

 patient foon recovered, and lived without experiencing 

 any oppreffion in refpiration. See Centur. 2. Obf. 32. 

 p. 108. 



The livid appearance of the lung, as M. Laffus obferves, 

 arifes from its expofure to the air, and the manner in which 

 it is ftrangulated between the two ribs. It affords no proof 

 either that the protruded part is gangrenous, or that it ought 

 to be cut away. (Pathol. Chir. torn. ii. p. 309.) A writer 

 (fays he) who is very little known, and whofe cafe we fhall 

 relate, confeffes his having miftaken this livid difcolouration 

 for a fign of mortification. A man received a ftab between 

 the third and fourth ribs, on the right fide of the cheft, and 

 by the way in which the fword had been withdrawn, the 

 wound was rendered very large. A portion of the lungs pro- 

 truded, fwelled confiderably, and remained in this ftate three 

 or four days without any attempt being made to reduce it. 

 The part then became ftirunk and quite dry, when the whole 

 of what was exterior to the ribs was cut off. On dipping the 

 piece of lung in water, however, it immediately refumed its 

 natural colour, which, no doubt, it would alfo have done 

 had it been reduced inftead of being amputated. The patient 

 neverthelefs got quite well, and fuffered afterwards no diffi- 

 culty, notwithftanding the hard laborious life which he was 

 obliged to lead. Obf. Medicinales et Chirurgicales par 

 Loyfeau, p. 25. 



A Cmilar miftake was made on a patient who had received 

 a wound which penetrated the anterior and inferior part of 

 the cheft. A fmall bit of the lungs protruded, which was 

 fuppofed to be a piece of omentum, and was immediately 

 included in a ligature. Ruyfch being confulted, perceived 

 the miftake, and he recommended drefling the wound, and 

 leaving things as they were, until the tied portion of lung 

 had become detached. No bad fymptoms followed, and 

 the patient perfeftly recovered. (Obf. Anat. Chir. 

 obf. 53. ) We met with a protrufion of a long piece of the 

 lungs in a foldier, who had been wounded with a lance at 

 the battle of Waterloo. The part was at leaft four inches 

 in length, and (haped like a tongue. As it was confiderably 

 contufed and torn, we doubted the prudence of returning 

 it in that ftate into the cheft. We thought, therefore, of 

 cutting it off, but fearful that it might bleed freely, we 

 firft made a fmall incifion into it, in order to afcertain the 

 faft ; and as a good deal of blood began to flow from this 

 little incifion, we firft tied the protruded part clofe to the 

 ribs, and then removed all that was exterior to the ligature. 

 The patient was fo well on the day of the operation, and 

 alfo the next morning, that he would not remain in bed ; 

 but we were informed that he did not ultimately recover. 



A wound of one of the intercoftal arteries immediately 

 produces a degree of hemorrhage, which is manifeft ex- 

 ternally, and often confiderable. The blood flows out of 

 the wound, and alfo ioto the cavity of the cheft. It iffues 



per 



