It is somewhat remarkable, that in the wounded who came under my own care, two died of tetanus, in the very small number of instances four or five at most in which I could not find the ball. If this was a mere coincidence, it is the more curious. Gravitation and muscular action may so change the position of a ball, that from a harmless site it may be removed to one of much danger. It may thus work its way into a cavity, and cause fatal results. But suppose the ball to become encysted in the first instance, what security have we that some very trivial AND TKT.ATM KNT. it may be a blow or even a deterioration in tinhealth of tin- patient), may not set up irritation, inflammation, and suppuration in the cyst, and so come to set tin- ball free again to work harm in the economy?
In anv case its continued pressure gives rise to much uneasiness. Tin- constant weight and weakness felt in the limb. ndering pains, ascribed to rheumatism from their a. n by cold ami damp, which attack even distant parts of the extremity, and the ever-present dread by the patient, it' the ball le in close neighbourhood to any vital organ, all unite to give much The aversion which patients who have long carried nnextracted balls express to have them removed, is not, as some would try to show, any proof of the slight annoyanee they occasion, but simply indicates that they choose to suffer the discomfort rather than undergo what appears to them an uncertain and dangerous proceeding to free themselves of a bearable inconvenience.
It seems, then, the teaching of experience, as it is of common sense, that whether the ipiestinn be viewed as immediately or remotely on the result on of tinpatient, in the proper acceptation of the term then we should, as sooi lieable, ascertain the position of the ball, remove it along with any other body which may have been introduced with it, always supposing that by such a proceeding we do nut cause more serious mischief than experience shows tinpresence and produce. To is in 'jvnenvl not difficult It is of much con! accomplishment inflammation and Celling have come on, so as to close the The great point to attend to undoubtedly is, the fulfilment of the rule, which is as old as Hippocrates, to place the patient as nearly as possible in the same position as that he occupied at the moment of injury to put the same muscles into action, and the angle which the parts form to one another in the same relation; also, to place ourselves relatively to him in a position to correspond as nearly as possible with the direction from which the ball came.
By considering the effect which bones or strong tendinous expansions may have had in deflecting the ball, or by paying attention to what Guthrie calls the general " anatomy of the whole circle of injury," and consulting the patient's own ideas, which often convey to us most useful hints, we shall in general succeed without much difficulty in discovering the ball. An examination of the patient's clothes will show us whether any part of them has been carried into and left in the wound whether the two holes seen in the limb have been caused by the same ball whicli has thus passed out, or by two balls which are still in; as well as whether the ball may not have carried in a cul-de-sac of the clothes, and been withdrawn with it.