SURGERY, 
Ifhe fingers are to be used more than the 
forceps ; these when the ball is found are to 
fbe introduced, and made to grasp it. Some- 
times the ball will have been stopped by a 
Lone and flattened, without breaking or 
[splintering such bone; at other times, how- 
lever, the bone by the force with which the 
pall has struck it will be shivered : in this case 
k ie splinters of bone are to be all carefully 
taken out, and the limb treated as in other 
rases of fracture. If the ball has entered 
and sticks in the bone, so that it cannot be ex- 
tracted in the common way, then a more free 
incision must be made, and the trepan ap- 
plied ; “ or if it is a narrow and firm bone, 
M. de la Faye orders us to cut the bone both 
aboye and below, so as to cut away that 
pie e in which the bail is fixed.” 
But it is principally on account of fractured 
bones, wounded art l ies, or pieces of cloth, 
that these dilatations of a wound are called for. 
“ It is only the openness of the wound, and 
the nearness of the ball, that tempts us to 
6earch for it; for a ball sometimes works its 
way outward through the cellular substance, 
and comes to the surface with little pain, or 
often it lies without danger buried in the 
flesh for years, or for. life. If there was mo 
other occasion for opening the wound, we 
tehold never give the patient pain on account 
of the ball, since it seldom itself gives him 
pain.” It must, however, be carefully kept 
in mind, that wounds, even though fair and 
promising for a short time, will never heal 
kindly while the foreign matters above-men- 
tioned are suffered to remain. 
When there is much blood spouting from 
a gun-shot wound, it will he concluded that 
a great artery is injured: in this case the sur- 
geon, guided by his knowledge of the ana- 
tomy of the limb, will make free dilatations 
from the mouth of the wound, until he finds 
the vessel, which he will tie up or secure. 
He must not, however, if the bleeding artery 
is of a large size, trust to compress or 
bandage. A piece of lint dry, or with some 
simple ointment, is then to be laid over the 
orifice of the wound, its sides are to he 
brought as close together as possible, without 
occasioning much irritation, and adhesive 
plaster or bandage to be placed over the 
whole. But there is another kind of hemor- 
rhage from gun-shot wounds still more dan- 
.gerous, which may be called the secondary 
'haemorrhage. This often occurs eight or 
pine days after the injury was first received, 
and the patient has often fallen a victim to it, 
even when at the first the wound was 
scarcely stained with blood.” This haemor- 
rhage is occasioned by the loosening of the 
eschar of the mortified and bruised parts, 
.leaving a breach in the sides of a great artery. 
In the course then of healing a wound, the 
proximity of which to a considerably artery 
is known, the patient ought to be attentively 
and incessantly watched : and in some cases 
it is necessary to keep constantly a tourniquet 
round the limb. 
We conclude this part of our subject by 
repeating the motives for scarifying and for 
dilating gun-shot wounds. The first is, for 
the purpose “ of opening the vessels that they 
may bleed,” and in order thus to reduce the 
wound as nearly as may be to one made by a 
cutting instrument. The dilatation of a wound 
is for the purpose of enabling usto secure any 
VOL. II. 
great artery that may have been divided, and 
to extract splinters of hone, or any other 
foreign material, the ball itself being that 
about which, on account of its shape and 
smooth surface, we are the least solicitous. 
Of tubular or penetrating wou nd'). 
But there is further another kind of wound 
which is different in its nature and treatment 
from that made by a plain and fair division 
of parts, viz. a penetrating or tubular wound, 
such as is made by the bayonet or sword ; 
and in this last case it is the surgeon’s duty 
to bring it as much as possible into that con- 
d.tion in which its sides may, by being applied 
to each other, adhere. “ Suppose,” savs 
Mr. J. Bell, “ a young man in lighting a duel 
with the sword, is wounded in the sword 
arm, his antagonist’s weapon goes in at the 
wrist, and out at the elbow. If in such case 
any great artery is wounded, then indeed it 
injects the arm with blood, forming a proper 
aneurism, so that we are forced to cut up 
the fore arm, and tie the wounded artery ; 
but if it is merely a flesh wound, it is no 
doubt somewhat dangerous from being deep 
and penetrating; but still it is so little dif- 
ferent from a common and open wound, that 
could we bring the sides of this tube-like 
wound fairly in contact with each other, it 
would close in a day ; and the reason that it 
does not happen so is plainly this, that the 
blood which exudes from the very small 
arteries is sufficient to fill the tube of the 
wound: it not only fills it, but the bleeding 
going on withinside, while it is prevented by 
a compress and close bandage from getting 
out, the tube of the wound is not only filled 
but dilated with blood, and therefore cannot 
adhere, just for the same reason as the heal- 
ing of an ill-amputated stump is delayed 
where the arteries, not being fairly tied, have 
hied after the dressing so as to fill the bason 
of the stump, and separate the flaps from each 
other. This not only prevents adhesion and 
brings on suppuration, but produces a gan- 
grenous stump filled with foul and stinking 
matter, partly purulent, and partly filled 
with blood.” 
The obvious inference from all this is, that 
the healing of those kinds of wounds of which 
we are now speaking, is principally to be fa- 
cilitated, nay, is alone to be effected, by 
Cleansing it of this blood (when no important 
artery is divided), by closing the mouth of 
the wound with a slight compress, and “ lay- 
ing its sides together with a slight bandage.” 
It was in thus cleansing these wounds of 
blood previously to closing them, that the re- 
markable success attended what was deno- 
minated some time since in France, the secret 
dressing. This used to be performed by men 
who w : ere denominated suckers, one of 
whom was present at every sword-duel. 
“ The rencounter ended the instant that one 
of the combatants received a wound ; the 
sucker immediately applied himself to suck 
the wound, and continued sucking and dis- 
charging the blood till the wound ceased to 
bleed; and then, the wound being clean, he 
applied a piece of chewed paper on the 
mouth of the wound, tied up the limb with a 
tight bandage, and then the patient walked 
home.” 
This mode of treatment has proved suc- 
cessful even in wounds which have pierced, 
or passed through, one of the cavities, when 
5 A 
7*7 
' there. have been no veins, nor any great blood- 
vessel, (wounded. 
In a deep and penetrating wound, there- 
fore, the method of cure consists in purging 
it of its extravasaled blood, and causing its 
sides to adhere. We do not here need to 
make incisions or scarifications', as in gun- 
shot wounds, unless for the purpose ot se- 
curing some great artery that may have been 
1 divided. 
j Having thus gone over the surgical treat- 
ment of wounds, fair, angular, bruised, lace- 
rated, and penetrating, we now proceed to 
lay down some rules respecting the medical 
management of patients under these injuries, 
and which is still more important than the 
surgery itself ot wounds; “ for if the con- 
nection is not understood betwixt the par- 
ticular wound ijind the genera! health ; if the 
army or hospital surgeon (and the same re- 
mark applies with modifications to private 
practice) does not know with a glance the 
constitution of a patient, or the true state of 
his sore ; if he is not careful to retain some 
general principle, which, like a mystic clue, 
may lead him through this labyrinth, he will 
see thousands dying around him without 
knowing the cause, like the fable of the Gre- 
cian camp falling under the invisible shafts 
of Apollo.” 
Among the very many mistakes and un- 
meaning prejudices which have crept into 
the practice of both medicine and surgerv, 
that of indiscriminate blood-letting has, per- 
haps, proved the most pernicious. Than this 
practice followed up, as it has been, nothing 
can possibly be more preposterous, or more 
dangerous. The writer of this article not 
many days since heard of an instance (an ex- 
treme case it must he confessed, yet, as such, 
more especially illustrative of the injudicio*u3 
conduct now 7 referred to) of a superannuated 
lady, by some accident having been literally 
scorched to death : the surgeon who was 
summoned found himself preceded by another 
“ practitioner,” who was actually, while the 
writer’s friend entered the room, unsheathing 
his lancet in order “ to take some blood.’* 
In like manner, with more colour of pro* 
priety, it must be admitted, when a wounded 
patient is first brought to a surgeon, it is by 
numbers, even to this day, deemed a neces- 
sary preliminary to further proceedings, to 
bleed the patient. “ The sovereign cordial 
of the landlady” is often more appropriate ; 
and many lives have, perhaps, been saved 
by the absence of the village surgeon. 
Let the follow ing invaluable rules be trea- 
sured in the mind of the young practitioner, 
not as dogmas to force, but as principles to 
regulate, his practice. They are more direct- 
ly drawn up for the use of army and navy 
surgeons, but will be found highly important 
to surgeons in general, 
1st. “ When your wounded patient is first 
brought to you, he is in great confusion; there 
is a tremor, a tonic stiffness, or almost a con- 
vulsion of the whole frame ; there are cold- 
ness, fainting, and nervous affection; but it is 
merely a nervous affection, and it must be 
treated as such. You may expect it to sub- 
side in time, and therefore should give some 
good warm cordial, and large opiates to 
quiet the commotion. This is no time for 
bleeding, whatever the nature of the wound 
may be. If the stupor continues, you should 
give cordial draughts and wine. 
