WOUNDS. 



tual moaor:, ( fays Mr. J. Bell, ) I do not know how we fliould 

 expedl a cure ; for the air would be continually flreaming 

 through the wound, and the wound itfelf alternately dilating 

 and contrafting, like tliat in an artery, could not heal. But 

 as the wounded lung lies in a coUapfed ftate, the edges of the 

 wound are in contact with each other. P. 269. 



That, the lung of one fide, which remains unhurt, is fuf- 

 ficient to fupport the fyftem, we learn from various acci- 

 dents ; from thofe cafes in which, either owing to the inci- 

 fions made by the furgeon, or to the nature of the wound, the 

 cheft has been freely opened, the lungs of one fide have 

 collapfed, and yet the patient has lived with tolerable eafc, 

 and ultimately recovered. We learn it alfo from cafes of 

 emphyfema, where the lungs are oppreffed with air, and 

 from cafes of empyema, or pus, within the cavity of the 

 cheft, obftru£ling the expanfion of the lungs. (See Em- 

 pyema.) And efpecially, (fays Mr. J. Bell,) we are fure 

 of it from the very gradual decay of thofe who die with large 

 fuppurations vfithin the cheft, in whom we find after death, 

 that on one fide there remains nothing but one fmall knob 

 or tubercle of the lungs. Koelpen de Empyemate Obf. 



P- 135- 



That the breathing fliould be eafier in a free and open 

 wound of the cheft than in a punftured wound, or that in 

 the cafe of a punAured wound the patient ftiould be relieved 

 by a free incifion, no one need wonder ; for in a punftured 

 wound there is no way for the blood or air to efcape from the 

 thorax, while yet at every ftroke of refpiration, more and 

 more blood and air is drawn out from the lungs, till at laft 

 the blood, and efpecially the air, are fo condenfed, that 

 they not onlyopprefs that fide of the lungs, but by hinder- 

 ing the free play of the diaphragm, and loading the mediaf- 

 tinnm, they opprefs alfo the other lung, the difficulty 

 of breathing increafes, the extremities grow cold, and the 

 patient dies. 



Whatever danger then depends altogether upon emphyfema 

 itfelf depends upon the manner in which the confinement of 

 air in the cheft oppreffes not only the wounded, but alfo the 

 oppofite lung, the diaphragm, &c. The extenfive infla- 

 tion of the cellular membrane in other parts of the body 

 is a circumftance which creates a terrible disfigurement, 

 but perhaps very little peril in itfelf. Sometimes, however, 

 it proceeds to fuch a pitch, that eve<i the interftitial cellular 

 fubftance of the lungs themfelves becomes inflated, and then 

 fuffocation is inevitable. 



On the treatment of emphyfema we Ihall merely remark 

 at prefent, that the chief means, both of relieving the or- 

 gans of refpiration from compreffion, and of hindering the 

 further increafe of the dift^ufion of air in the cellular mem- 

 brane, confifts in praftifing an incifion in the thorax at the 

 part where the air firft efcapes from that cavity. For other 

 praftical obfervations we refer to the article Emphysema. 



The exiftence of adhefions between the pleura coftalis and 

 pleura pulmonalis, previoufly to the receipt of a wound of 

 the cheft, muft make an important difference with regard to 

 the fubfequent ftate of the lungs, and particularly with re- 

 gard to their condition in the cafe of emphyfema. Such ad- 

 hefions muft of cpurfe render a collapfe of thefe organs im- 

 poflible, and alfo prevent the air from infinuating itfelf be- 

 tween the furface of the lungs and the infide of the cheft. 

 Whether thefe occurrences can be perfectly prevented will 

 of courfe depend upon the extent of the adhefions. They 

 would, however, be certainly averted altogether, were the 

 wound to happen juft at a part of the cheft wliere the pleura 

 coftalis and pleura pulmonalis happened to be adherent. 



From fome remarks which have been delivered, the reader 

 willfee, that wounds opening both cavities of the cheft, unlefs 



Vol. XXXVIII. 



fuch adhefions exift, muft produce immediate fuffocation, in 

 confequence of both lungs becoming collapfed. That this 

 would really happen is the belief of the majority of the beft 

 modern writers, and there arc feveral faft, reported which tend 

 to confirm the accuracy of the opinion. A late author, how- 

 ever, conceives, that the finking of the lung is not an uni- 

 form confequence of a penetrating wound of the thorax. 

 He obferves, that we have fomctimes ocular proof of this, 

 not only by the clofe contaft in which the lungs lie to the' 

 wound difcoverable at firft fight, but by protrufions which 

 occafionally happen. From experiments on brutes, favs he, 

 we derive no fatisfadory elucidat''in ; for in fome, where in- 

 cifions on each fide have been made through the intercoftel 

 niufcles, much greater than the natural paifage of the air, 

 the lungs, fo far from coUapfing, have expanctd ?.g,.;r,, the 

 animal has lived, and in ten days run about as weil as ever. 

 And in our own fpecies, the recoveries from wounds of the 

 thorax on both fides, larger :han the orifice of the glottie, 

 dangerous as they are, are not few. Hennen's Obf. on Mi- 

 litary Surgery, p. 404, 405. 



Wounds of the heart generally prove immediately fatal, 

 though It is true there are to be found in the records of fur- 

 gery many curious exceptions to this obfervation. A foldier 

 received the thruft of a fword, which entered one of the ca- 

 vities of that organ, as was afcertained after death ; yet he 

 lived nine days after the accident. ( Rhodius, Obf. Medic, 

 centur. ii. obf. 39.) A young man, twenty-fix years of 

 age, was ftabbed with a fword in the right fide, between the 

 third and fourth true ribs. He became exceedingly weak, 

 had great difficulty of breathing, and died in four or five 

 days. On opening the body, it was difcovered that the 

 heart had been completely transfixed, the weapon having 

 pafTed from the right into the left ventricle, through the 

 feptum. The cavity of the cheft was full of blood, and it 

 was thought that the prolongation of life had been owing to 

 the clofure of the wound with coagula. (Saviard, obf. 

 113.) Haller, as Mr. Hennen obferves, has recorded in 

 his Bibliotheca Chirurgica, vol. ii. p. 378. an example in 

 which a needle was found in the heart of an ox ; and through 

 the kindnefs of Mr. Hammick, furgeon of the royal naval 

 hofpital at Plymouth, Mr. Hennen was lately fliewn a pre- 

 paration, in which a pin was lodged in the human heart, 

 but without any trace of the mode in which it got there. 

 The patient had complained of a pain in his cheft, about three 

 months previoully to his death, and died of carditis. (Obf. 

 on Mil. Surgery, p. 429. ) Ploucquet gives inftances in 

 which a ball was lodged in the heart of a flag, in the heart 

 of a healthy dog, and in the anterior ventricle of the human 

 heart, where it is ftated to have remained for years. An- 

 other inftance has alfo been recently publiflied, in which a 

 ball was found lodged in the right ventricle of the heart, 

 near its apex, included in a great meafure in the pericardium, 

 and refting upon the feptum. See the article Cat Rarts, 

 Di(ft. des Sciences Medicales. 



Guattani mentions a cafe in which a patient lived eight 

 years after a wound of the aorta (De Aneurifmatibus) ; 

 and in the Medical Records and Refearches, 1798, is the 

 extraordinary cafe of a penetrating wound, in which a 

 bayonet pafled through the colon, ftomach, diaphragm, part 

 of the lungs, and the right ventricle of the heart, and yet 

 the patient furvived the accident for upwards of nine hours. 

 Mr. Hennen alfo refers to another inftance, related by 

 M. Chaftenet, of a wound of the right ventricle, which did 

 not prove fatal till the 15th day after the injury. (See 

 Journ. de Med. Militaire, Paris, 1782, torn. ii. p. 359.) 

 For additional obfervations on this fubjedl, however, we muft 

 be content with referring to Mr. Hcmien's publication. 



5 C A» 



