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brave men who have suffered; what even the influence of all the
“ In a short time after the infliction of the wound, if the ball has taken a course under the skin, we may perceive the course it has taken by a red stripe on the skin, like a blush of the cutaneous vessels. By attending to this circumstance, I have discovered the ball in a remote and unexpected place. The passage which a ball makes is very seldom direct; a very slight degree of lateral resistance changes its course. The most frequent place of its lodgment not a solitary instance; in the fourth figure of the succeeding plate, the ball has passed through the body of the vertebraa, but has not been able to burst up the posterior longitudinal ligament. I have in my collection, a ball lodged in the hip joint, where the ball has broken and penetrated the neck of the thigh-bone, but has not had force to pass out of the capsular ligament. A young gentleman consulted me within these few days, with a ball in his foot ; the ball had penetrated the tarsus, but was prevented making its exit by the plantar aponeurosis.”
is just under the integuments of the opposite side of the limb to
to where it entered. For we find that a ball pierces the resisting solids more easily than it does the elastic skin. For example, a ball after breaking the bone, and passing clear through the muscular substance, being met by the elastic resistance of the skin, has its force subdued, and it remains under the skin, where a touch witha lancet will give it exit. “If a ball strikes perpendicular to the surface of a spongy bone, it will enter and lodge in the bone, as in the vertebrae, or in the head of the thigh-bone. In fig. 1. plate II., the ball A is seen sunk into the condyle of the femur; but this situation of the ball is not so frequent as that exhibited in the second figure, where A is the hole where the ball enterd, and B is the ball itself, lodged not in the bone properly, but on the posterior surface, where, although it had force to penetrate the bone, had not force to overcome the resistance of the elastic ligament, This is
The question of the scarifying or rather enlarging of gun-shot wounds is put we think in its true light, and this increase of pain is shown to be useless severity. The importance of this will be understood by those who have attended to the indecisive expressions of our late English writers.
We are happy to find our author expressing himself, when treating upon general weakness, in favour of cold spirituous applications to gun-shot wounds during their period of inflammation. We wish that we could see this practice adopted instead of the slovenly and hurtful method of covering the wound with cataplasms, which confine the heat and increase the inflammatory action.
“ To apply fomentations to the wounded limb, and poultices to the orifice, what is this but to confine and generate heat, and promote a high inflammatory action? o “It is a good remark of Mr. Hunter, that bleeding must be had recourse to with great caution where inflammātion and fever run high, for to reduce the patient in a degree equal to what the action at the time requires will often be reducing him too much for the constitution to bear after the excitement to action has
ceased. - -
extensive open wound which has suppurated, and the edges of the
We are next presented with some very useful remarks on the secret influence of a diseased state of the system upon the wound. This, as the author remarks, we shall not be able to detect, without looking around to the prevailing disease of the camp or the season; or to cure, without applying those remedies to the wounded patient which are found effectual in the more marked examples of disease. Upon the subject of gun-shot fracture of the bones, there are some striking observations, in the course of which the distinguishing peculiarities of gun-shot fracture are pointed out and illustrated. The author observes, that, if the bone be broken by a ball striking it and gliding off, the wound is not so bad as when the ball perforates the bone. In the one case the fracture may do well with common treatment; in the other the marrow of the bone is injured, the centre of the bone destroyed, and the disease called Necrosis is engendered. This is a formidable disease which exhausts the patient with frequent returns of swelling, suppuration and fever, even for many years. During this time a new bone is forming which surrounds the old one, enclosing it as in a case. The old bone is decaying, but its discharge is slow and accomplished only in the course of years. - The remedy which our author proposes is, to make a decided incision down to the fracture at the time the wound is received; to pick away the small pieces of bone from the bottom of the wound and to keep the incision open, so that there may be no lodgement of matter in the marrow of the bone. After shewing that gun-shot wounds of the fleshy, parts though distinguishable by some peculiarities are not dangerous, our author proceeds to explain that the injurious consequences are proportioned to the resistance which the ball meets with. It is the fractured bone, he observes, which gives occasion to the extensive suppurations in the fleshy substance of the limb. And proceeding to take this subject as illustrative of the necessity of an incision at the shoulder, he proceeds thus:
“. In plate VII., I have given a sketch of a man wounded in the shoulder; and in plate IV. fig. 1. and 2. I have - represented represented the shattered head of the humerus, which I dissected out after amputation. I have already described the appearance and the feel of the shoulder when that head of the bone is fractured by a musketball in this manner. We have now to notice the effects: high inflammation, enormous swelling of the arm and shoulder, deep and extensive suppuration, large sinuses, dead bones discharging, and the patient dying hectic. Such are the consequences; and these considerations presented to the surgeon's mind, he at once condemns the arm to be amputated at the shoulder joint, when he feels the bones crushed, and like a bag of sand under the deltoid muscle.
“Such is the rule of practice in both army and navy, and I have seen the surgeons of both departments united in consultation, and in operation upon such subjects. Yet I am confident, this is not the right rule of practice: for, let us observe, that a ball through the deltoides is nothing. I have seen a man wounded by a ball passing betwixt the acromion scapulae and the head of the humerus, where there was no necessity of doing any thing but giving him a bed to lie on. It is the fractured bone which creates the great inflammation, the suppuration, and sinuses. Now Suppose, that instead of performing that very serious operation, the amputation at the shoulder joint, a decided and long incision be made through the deltoid muscle, the loose bones picked away, and the broken extremities of the humerus taken off with a small saw, what will the situation of the patient be? The operation is easy, not severe to the patient, and the cause of high inflammation and protracted suffering is removed. The arm is undoubtedly shortened, but it remains a useful member. When I see so many fine fellows mutilated by this too favourite operation at the shoulder joint, I feel that I cannot express myself too decidedly on this subject. This comes of want of principles. The surgeon sees the terrible effects of gun shot wounds, without contrasting sufficiently the case of a wound of a fleshy part with a wound of the bone, without therefore seeing that it is the bone that occations all the mischief, without therefore thinking of removing the bone, and reducing the wound to a state comparatively simple.”
Our author proceeds next to consider wounds of the joints— and afterwards to make some remarks on the necessity of amputation, and on the time at which the operation ought to be per
formed in order best to ensure success. We have thus mentioned in a cursory manner some of the principal subjects of this dissertation, without troubling ourselves to follow out regularly the analysis of the work, or being able to find a plan for minute criticism, or enquiry when every question might admit of so much discussion. Of the whole we do not scruple to say of this dissertation, in the way of generar character, that the questions discussed are fairly placed before the reader, and the difficulties forcibly represented; that * all
and useful hints in practice are delivered clearly, and enforced by reasoning from principles and by examples appropriate and interesting; and that the neglect of the rules of military surgery and the evils of such neglect are pointed out with candour, but: with force, and in a manner that cannot fail to be of the greatest service. The book extends only to 65 pages, but the reader will find that it is full of matter very interesting to the military surgeon and to the public. We must, however, repeat our wish that Mr. Bell will in a second edition extend its magnitude far beyond its present limits, and present to us a more perfect manual of military surgery; as there is no one who from a laborious investigation of causes, and a practical experience of effects, added to much ingenuity and skill, is possessed of more ample resources for the performance of such a task.
ART. IV. Opere di Scultura, e di Plastrea de Antonio Canova descritte da Isabella Albrozzi. Nata Testochi Firenze.
IT was one of the disadvantages and mortifications which the
and bringing many of them to our own shores.