Larrey says he constantly observed this fact, as do many other practitioners, such as Louis, David, &c. However, after the observations collected by Degranges, Chaussier, Callisen, Saucerotte, and others, we cannot look upon this phenomenon as a certain sign of hicmo-thorax; because, in many circumstances where the effusion really exists, it has not been observed, and it has followed non-penetrating wounds." f " Au reste cette indication n'est que d'une importance tout-a-fait sivonilaire quand on la compare a celle qui prescrit d'arreter a tout prix riiseinorrhagie; aussi avant de pratiquer une nouvelle ouverture ou d'agrundir cello i mi existait deja, convient-il de s'assurer si 1'ecoulement du sang li <>r TIM: CB i } -J Thenis n> <p; with wounds of the iillieult to solve, as that which has reference to -lana-emriit ot' internal lia-morrha-e.
The embarfcate ot' the demands the evacuation of the tlui.l. v,e it e8Cpe, the l.h-e.lin-- from the liinir is renewed, and death results. So it was in the tollov.: Ilannihan, a private in the Koyal Irish regiment, was admitted into my wards in the general hospital on the of June. While on the --round, with his head towards the enemy, he was struek above the left elavirle l.y a rifle hall, which traversed his Inn-' troi: summit to its and was found lyin-' <jiiite si; fieially in the left lumbar re-ion, from which position it was removed. Tindyspnoea, on admission, great, and the ha-moptysis most profuse. The sur!ewed with cold perspiration. The I weak and tremulous, and the deeuliitus was on the wounded illegible in the scan of the first
These measures appeared to afford him some relief. Next day he had rallied considerably. His pulse was better, and his look was less distressed. By the afternoon of that day, the dyspnoea became so urgent that I allowed a considerable quantity of the collected blood to escape. This gave him, for a time, decided relief. The severe exhaustion which, however, soon followed this step, and the return of the dullness on percussion to its former level, seemed to intimate a renewal of the haemorrhage; hence I did not reopen the wound, but determined to abstain from all interference till the bleeding vessel had had time to close. The patient was so completely prostrated by the haemorrhage which had evidently taken place internally, that I could not have recourse to any further depletive measures.
The stethoscopic examination of the chest discovered amphoric breathing over the upper part of the left lung, while over the whole surface of the right chest the respiration was harsh and loud. Dullness existed on the left side from the base of the lung up to an inch and a quarter above the level of the nipple. There was suppression of urine for thirty hours after admission. This patient died on the fifth day, without any change in his symptoms from those noted above. The left side of the thorax was found more than half full of blood, for the most part fluid. The lung was half solidified and compressed against the spine. Lymph was effused to a limited extent on its surface.
The ball had traversed the lung in a direction from above downwards and backwards. EOT, 1 with lymph. Tin- three and tinthree lower ril s were fractured. The it's l>ack, on the wounded side,,:ymosed ith.and irave him much pain. This to that ecchyniosis dcseriln d dentin; only it appeared at too early a period, and was not pronounced to accord with hi;s deion. in not in a position to determine whether the the Mood in the eavity c;in really rxert so me mi the wound in as to an the hut such was the opinion of Valentin,. and Dnpuytren. I am disposed to think that, in such cases as the foregoing, it would Le better practice to open the cavity freely ly cnla;. so as to allow t. and favour the contraction of the htiuj; and the cl of the vessel; hut in Ilannihan's case sucli a step would have been attended with much illegible in the scan of the first
In the evening the dyspnoea was more marked, and the pulse had increased in frequency. The decubitus was dorsal throughout. Emphysema appeared.over the surface of the right side of the chest. He was largely bled. Next day the above symptoms were notably exaggerated, and dullness was added on percussion on the right side, posteriorly and laterally. The respiration was puerile over the anterior superior half of the right, and over the whole of the left lung. The bleeding was repeated, digitalis ordered, and nothing allowed in the way of food but milk and cold tea. On the 29th, the dullness had invaded the inferior and lateral aspect of the left lung. The dyspnoea became very urgent, and was not relieved by any treatment, depletory or otherwise, and he died on the 30th.