If this be not attended to, very awkward mistakes may be made; as the mere correspondence in the direction of the two apertures, any more than their seeming want of relationship, cannot be taken as decisive in settling the matter. This point is well illustrated in the following instance related by an Indian surgeon. A Percy adds another reason to encourage us in the early removal of balls, when he says that men submit the more readily soon after the receipt of the wound to the necessary incisions, before their courage has been broken by pain and suppuration. WOUNDS AND THEIR TREATMENT. wound was found below, and another above, the patella of a WOUnded man. Tin.' former had all the signs of the wound of entrance, and the latter those usually found at tin- place of i-xit >f a hall.
The opening of an abscess, which formed in the thigh a fortnight after, gave exit to a id it was found that the external condyle i injured, and that each opening had been caused In another instance, which occurred in the case of a soldier of the 40th regiment in the ball appeared to have passed through the elbow-joint, and to have fractured the radius. There were two openings, having all the appearance of being those of entrance and exit; yet the ball was found and removed from the limb three kfl utter. Such a mistake is most apt to arise when have been fired together from the same gun, whieli happens not uncommonly in civil commotions, or iised as the "espignole " of the Danwhich a number of balls are tired in rapid succession, or when a cartridge, similar to that used dur11 war, is employed, in which two balls and a piece of lead are bound up together.
One. ball, too, it should be remembered, may make several open in ITS. Tims I have seen two in the leg, and two in nd also two in either thigh, occasioned in each case hall. Dupuytren relates a case in which, it< splitting, one hall made live h"les; and the yotlii at AntwOClfioei caused in Sir Stephen Ilammick mentions a case in which an aperture was found on either side of the published Report chest of an officer shot in a duel. These corresponded both in position and character to those which would be occasioned by a ball that had traversed the chest; yet after death two balls were found in the body. As showing the necessity of an early and careful search, as well as that we should never rely too much on the patient's statement, I may mention the following case: A soldier, wounded on the 18th June, came under my care in the general hospital.
His right arm, which had been fractured compoundly, was greatly swollen at the time of admission. I was told, and accepted the story, that the accident had been caused by a piece of shell, to which species of injury the wound bore every resemblance, and that it had been removed by a surgeon in one of the trenches. At the earnest solicitation of the patient, I contented myself with applying the apparatus necessary to save the limb without minutely examining the wound. The injury turned out to be much masked, and to be greatly more severe than it at first appeared, the shaft of the humerus having been split into the joint. When removing the limb at the shoulder, some days after, to my great astonishment a large grape shot dropped from among the muscles.* I before alluded to another case in which a piece of shell, weighing nearly three pounds, had remained concealed for two months without suspicion, from a like neglect of a proper examination.
It is well to remember also, in searching for balls, that they may have dropped out by the same aperture by which they entered, before we come to examine the case. I may, however, remark that this splitting upwards of the head from the shaft is very rare. In general, the splitting ceases at the epiphysis. TIIKIII TKKATMHNT. Stromeyrr has put us upon our guard against very ciiri;ich In- says In- has Been made in cutting on the head of thf tiluila, and.n a metatarsal bone for balls. Charles Bell has shown how tlie nerves may inus tluposition of the ball. In one case he found it by pressing on the radial nerve, and so discoverthat the ball lay behind it.
" So when a ball has i its course through the pelvis or across the shoulder, the defect of feeling in the extremity, being studied anatomically, will inform you of its course that it has cut - pressing on a certain trunk of nerve." From all this, then, it is at the least very evident, that we should not be too hasty in concluding that no ball ins in the limb, even although all the si-Mis usually indicative of its having escaped arc present; and also. that immediately before proceeding to take any steps for val ot' a ball, we should make certain <f its posi. remembering the rule laid down by Ihipuytren ipon information regarding the site ot' a hall im-d the day before, from the rapid manner inwhich n shift from one spot to another.