SINGULAR CASE OF FATAL EMPHYSJ:MA. 
425 
On examination, I found a small wound on the inside of the el¬ 
bow, barely penetrating through the skin; no blood had escaped, 
but there was a small quantity of frothy fluid about the lips of the 
wound. I immediately pinned up the orifice, and walked him 
gently home. 
On my road thither it occurred to me that, in getting away from 
the wood, I had ridden him over a ditch with a staked hedge on 
the farther side; and it was then plain that some unlucky stake, 
higher than the rest, had penetrated the loose cellular substance 
about the elbow, and, every time the horse extended his fore legs 
in the act of galloping, the air entered the wound. 
The emphysema gradually extended over the shoulder and 
along the neck, which, when struck with the stick, gave a drum¬ 
like sound. On reaching home, every thing that we could suggest 
was done for him. We attempted to evacuate the air by means 
of numerous lancet punctures. Friction was employed. Fomen¬ 
tation with warm water was had recourse to; but all in vain. 
Towards night febrile symptoms began to develop themselves. 
He was bled, but still the irritability increased. The knees and 
hocks, and every part except the head, presented a bloated ap¬ 
pearance, with a disagreeable crepitating feel. 
During the night repeated doses of opium were given. 
On the next morning he appeared to be better, but had passed 
no faeces. He continued to discharge small quantities of urine, 
apparently with great effort: aloes in solution was given, 
and enemata administered frequently. Towards evening a very 
small quantity of liquid faeces was voided; but the appearances 
of recovery proved fallacious, and he became gradually worse 
throughout the day. We inserted a rowel in the chest, and another 
in the thigh, both of which soon discharged well. 
About 6 P.M. he first shewed symptoms of acute pain. He 
would stand for some time with his fore legs wide apart, and a 
countenance expressive of suffering, and then paw his litter vio¬ 
lently for five minutes together. We sat up with him during the 
night: he was again bled, and more opium administered; but he 
became rapidly worse. The flatus was extending to his intestines, 
so that we could scarce introduce the enema pipe. He would now 
get into a corner and stand with his nostrils distended; his respi¬ 
ration much hurried ; pulse 120, and scarcely perceptible. 
He continued in this state throughout the following day, and 
was evidently sinking. About eleven at night he fell, and died 
after a few struggles. 
On the post-mortem examination next morning, the wound was 
found to be exceedingly small, and had scarcely penetrated through 
♦he skin; but the whole of the sub-integumental cellular subslaiico 
