III tlipatients; and when wo have reason from t'i from the instrument which inflicted tli!' tintract are of that such bodies an- retained and concealed in the substance of the brain, we should make the necessary examinations f>r the discovery." It' tinball has penetrated deeply into the brain, it is a matter nt'littlr moment what steps are taken. IVrhaps tlif best line <>t' conduct is to let the man die in I have never known a case of perforating gun-shot wound of the head recover. Some such are, however, on record. -es in which pieces of loose bone remain on the dura mater, do not always require to be interfered with.
Many surgeons of large experience in the Crimea, pn them to be thrown out by the natural fcj and were not particular even about keeping the wound open. However, I believe this practice to be dangerous, and that loose portions of bone should always be cautiously The evil ft' rts of leaving them, as well as the injurious influence of too early a recurn ulant diet, were well marked in the following case. M'Louchlin, a private in the (Vnnaiurht rangers, aged wu admitted into the -vneral hospital on the mber. Hhad been knocked by a blow from a pirrr of shell in the final assault on the Redan. A scalp wound two and a half inches l<m, was found extending from ln-for. ba<-kward8 over the vertex of the head, and a small piece one was observed to be depressed at its anterior mity.
The patient did not become for tuv: vr admission. and diet comprised his treatment. Cold dressing, and nothing else, was applied to the wound. He remained perfectly well, complaining only of slight headache and giddiness, for three months; small pieces of bone being discharged in the meantime from the wound, which had almost closed. After being about a month in hospital, he was allowed full diet, and a gill of grog daily. On the 8th of December, three months after receiving his wound, he complained of a sort of transient paralysis of the left arm, which, although it continued only for a second or two at a time, recurred frequently. His sense of smell, too, suddenly left him.
There was no other symptom. On being questioned, he said he had had a rigor, and several " fainting fits " during the days immediately preceding that on which he first complained of the paralysis. Next day he had a more prolonged fit of paralysis during the night than he ever had had before, the attack being preceded by pain in the left side. I first saw him during an attack on the 9th of December, which was more severe and more prolonged than any preceding one. His left arm hung powerless, and there was complete anaesthesia of the left arm and side, from the clavicle to the false ribs, and from the line of the nipple to the spine.
The left side of the neck behind the sterno-mastoid was also without sensation. His face was unaffected. The integuments around the wound were puffy, and very sensitive. He said that his uneasy feelings had gradually increased as the wound closed. His bowels were opened freely, and a light poultice was applied to the wound, which was incised. The fit he had on the 9th passed off, leaving the arm weak. The sensibility of the left side slowly returned during the succeeding days. OF Tin: in fits is came and went, his arm recovering its power, in a great measuiv, between them. A sharp bit lying on the dura ni. the untoward symptoms disared. Short i thia he raine under my f par ahlishcd passed over the left ED when air. of lx)ne became loose, and lay on tin dura niatrr. and, so soon as this was removed, these feelings left.
If his bowels became costive, even for a very short time, not only did the headache and giddiness lint the numbness in the side returned. AYhen ft for Knuland no bits of bone could be discovered, and the wound was nearly closed; and he is now, I understand, doini: duty witli his regiment. Many of the symptoms in this case were those set down as calling for trephine; but the cautious removal of the fragments when I.M.S.-, tin- local bleeding, and the purging, did all that was rc-ijuired. - us particularly against attempting too soon to remove pieces of necrosed bone, as he thinks they do little harm if allwcd to remain. In this my own observation leads n means to a-ree.