The only other remark make on this subject is, that the "commotion" succeeding gun-shot wounds is greater when the lower extremities are injured, than when the arms suffer; and tli is is more especially seen, if the person be in an erect position when the injury is inflicted; which observation is consistent with the remark made by Chevalier, that the shock is always greater when the ball strikes a muscle in action, than when it impinges against one which is relaxed. The destruction inflicted by a ball depends on the distance at which it is tired, the direction of its flight, its shape and velocity, as well as on the nature of the part struck. If fragments of metal are fired, as sometimes happened during the sieges of the Peninsula, as well as in the civil emeutes of Paris, and of which we had some experience in the Crimea also, a very lacerated, irregular, and dangerous wound may be A ball passing at great speed over the surface of a limb, may occasion a wound similar to that made by a knife.
But this action of a ball is rare.j" The great velocity, peculiar shape, and motion of the Hutin relates a case which occurred at the siege of Constantina, where a nail was found fairly driven into the femoral artery; and in the Burmese war, links of iron cable were fired by the enemy from their cannon. Bullets united together by wire, so as to resemble " bar shot," were at tunes used by the Russians in the Crimea, and caused very irregular wounds. f This, which is, I believe, the true state of the question, is opposed, however, to Hunter's remark: "In this case (a ball passing with velocity) a slough will be produced, but if it should pass with little velocity, then there will be less sloughing, and the parts will, in some degree, heal by the first intention, similar to those made by a cutting instrument." Hunter's Works by Palmer, vol. p.
55'J. &UN-8H TKRATMF.NT. conical ball, give to its wounds a character considerably ditfcrcnt t'nun those which is present in wounds caused mini. I musket liall. It' tirc<l at short range, and if it strike a fleshy part, the conical ball produces, I think, laceration of the soft parts than the old hall: hut if the ran ire be great, and the part struck bony, with little covering of flesh, as in the case of the hand or foot, then the tearing, especially at the place of exit, is greatly more marked. I have not been able to myself in all cases, so clearly as the description of authors would lead me to suppose I could, as to the characteristics which distinguish the wound of entrance from that of e That the former is more regular and less discoloured than the latter, is true in many cases, hut that the lips of one wound are inverted, while those of the other are everted, has seldom been clearly marked to my obsern.
If the speed of the ball be great, and no bone been struck, then there is little difference in either the size or discoloration of the wounds; hut if the flight lit as to lie retarded by contact with the body, especially if it have encountered a bone or a stmnir aponeurosis, so that its speed is eondiininished be fopit passes out of the body, then the wound of er/it will considerably exceed in size of mtrance. This is especially true of conical balls. If, on the contrary, the ball be fiivd close at hand, so that its speed is not sensibly diminished passage through a limb, then the difference of size will be very small, and may even be in favour of the wound of entrance, as I had twice an opportunity of in.u r. e UMial action of a ball in proportioning the size of the two orifices is easily understood, when we consider that the part of entrance is supported by the wholethickness of the limb, while that of escape is quite unsustaincd, and therefore the more liable to be torn.
lias shown that the loss of substance which occurs at the place of entrance, and the flap-like tearing which takes place at the orifice of exit, form the best marks of recognition we possess, and that these characters can always be made out by examination of tluclothes or accoutrements traversed in cases in which the supervention of inflammation has effaced them from the wound itself. The introduction, but non-escape of a foreign body, as a piece of the breastplate, belt, buckle, or part of the musket, along with the ball, which alone passes out; or the flattening of the ball against a bone within, and its diameter being thus increased before it escapes, will all contribute to vary the relative characters of the orifices of the To the military surgeon, it is often of consequence to be able to conclude whether the two apertures in his patient's limb have been occasioned by one ball, which is thus seen to have passed out, or by two balls still imbedded in the limb, and to the medico-legal jurist, In Arncl's experiments given in the Journal Univer. de Med. for 1830, it is shown that a ball, fired against a number of planks firmly bound together, causes a series of holes progressively increasing in size, so that a cone is formed by their union, whose base is represented by the last exit hole.
M. Devergie's experiments on the same point, given in his communication to the Academy, go to prove this also. Velpeau and others have objected, but without good grounds, to the deductions drawn from the experiments being applied to the question. >r wnrxhs TII: tinkiiowh-dire nt' tin- nnrks which characterize tljc two wound-. n >t' a ball -lies of tho. in a LIT nvd from a <>t' tin- shape of the projectile, and the nature of the jiart.-truck. Jt carries Bflll efore remarked. a piece of tinskin at the place of entrance, and rendit where it.nail plug of integument which is carried into the wmid, lluguier tells uvered there.t iision whii-h a ball causes in traversm;: to one niarkeil char;icteristic of gunwi.unds their healing only by suppuration and granuhition.
Occasionally an exception occurs to this rule. Thus. 1 have seen a case in which a superficial wound of the ii-astroi;. -miiis was said to h;t healed without suppuration by tiniifth day, and in the records of a Sepnt in India, 1 find nn licl.l l>y I'landin and Duj.i M of military Mirgcons and nifdi.-.-il jnri.-ts liavi- oscillat Devergie, who has him.1 i-ast- j.n.v. tli.a tinwound of entrance may be tl i> lircd at a distance.
Begin has given us tin- valuable observation, with regard to the resulting cicatrices. I whin. depressed, and often parts, wh. only a sort of irregular spot which does not adh.-rt.. ai: is sometimes so indistinct as to be conn th. -Mi,. difference he explains by the loss of substance sustained at the p. ntran.. t ' r speaks also cf this piece of detached integument. TIIE CRIMEAN WAR. deeper gun-shot wound of the deltoid healing in the same way by first intention. Dr. Stewart, staff assistant surgeon, a case of a similar union, as having been observed by him during the Caffre war. A Fingo received a pretty severe gunshot wound of the muscles of the back, and union without suppuration took place.
Two things are necessary to produce such a happy result: 1st, a most healthy and temperate patient, and 2nd, the rapid flight of the ball. It is curious to notice how large a body may enter through a muscle, and hide itself without producing any great wound. Thus, I saw a case at Scutari, in which a piece of shell, weighing nearly three pounds, was extracted from the hip of a man wounded at the Alma, which had been overlooked for a couple of months, and to which but a small opening led. Larrey gives a case in which a ball, weighing five pounds, was extracted by him from the thigh of a soldier. The presence of so large a body had not been detected by the surgeon in charge, and the patient suffered no inconvenience from it beyond a feeling of weight in the limb.