Fluid blood, seemingly the product of oozing, was found in both pleural cavities, and some air also existed on the right side. Both lungs were much diminished in volume, and floated towards the upper part of the cavities. The ball had passed through the second rib, near the posterior superior angle of the scapula, and perforated the apex of the left lung with a transit of one and a half inches. It had there pierced the body of the second dorsal vertebra, fracturing and partially displacing INDS OF Till: <! rd< it-' anterior half. It had thru entered tinri.Lfht pleural cavi; of tli ri-hf lunu', struck ami fractured the second rib on the right side and finally fell spent within the plenral cavity.
The lungs were gorged with blood, and their coated with If only had been wounded, the ball and the don miirht have l>een both rid of by operation; but when both lungs were implicated, such interferences would only have hast.-ned death. The emphysema which was present in this case, was probably due to the oblique direction of the wound. It was a very rare occurrence in the chest wounds which J had an opportunity nf witnessing. The inflammation which follows gun-shot wounds of the! jiiires the same treatment as that which to inflammation from any other cause. AYhcn only a small part.f the Innir has been penetrated, then the pneumonia maybe at first localised; l.ut it will soon;d it' not promptly snbdiu-d. nee, the Lfivat point which demands attention is to pianl - of ivlapse. as inflammation is very apt to be re-established, and if it does P-appear, the danger nf itto purulent effusion is very considerable.
Serous effusions often eansr mm h annoyance in cases of wounds of the chest. According to (iuthrie,. MI general, from the third to the ninth day, and. if' larire, imperat ivel v demand early evacuation. fear this rule was not al ways attended to durii is diflicult to know wh;ii is the k)d of tin- disease to put it in prae!: r 'ii should be maintaincfl for ten OF THE CRIMKAN days or a fortnight after the infliction of a gun-shot wound of the lung. Any irregularity in diet, or indulc in ardent spirits during convalescence, is most apt to cause dangerous, if not fatal relapses. Not a few were lost in the East from such carelessness.
Opium is of much use in allaying the troublesome cough, which often continues for a long time. Hennen speaks of "a sense of stricture and considerable pain in raising the body to an erect posture, with great anxiety on walking up an ascent," as being frequent consequences of gunshot wounds of the chest; and at another place he says, "diseases which, although we cannot call them pulmonary consumption, agree with it in many points, particularly in cough, emaciation, debility, and hectic, are often the consequences." Veritable phthisis has, however, as is well known, been cured by the rough medication of a gun-shot wound. We had no opportunity of watching the remote results of these wounds, as the patients passed from under our care too soon for their development.
Of wounds perforating both sides of the chest, I met with four examples only. In all these the wound was inflicted by grape, and all died in a very short time. Balls are well known, occasionally, to become sacculated in the lung. This circumstance, as well as the very small amount of irritation which the presence of such a body may give rise to, was illustrated in the following case. The case was first related to me by my friend Deputy-Inspector-General Gordon, C.B., and I afterwards found the particulars of the early symptoms in the medical reports of the regiments serving in India: A soldier of the 53rd, serving in the Punjab, received or Tin: CHEST. i und the neck, entered the apex of the right d it to near its l,-ise, and lodged.
Violent dyspn.ea. urgent cough, and bloody sputa followed. from the tear of suffocation, could not lie down for several days. These symptoms were allayed by treatment, and in two months the man was discharged, feeling no inconvenience from his wound. This patient died six months afterwards of a contagious fever, when the kill was found closely sacculated in the lower lobe of the luiiir. at the apex of which a small puckering was. lint no trace could be discovered of the ball's track from tin- apex to its place of sacculation. The lung was free of disease. In the following case the position of the ball was not discovered: A soldier of the Buffs, wounded ie 8th September, received a hall on a level with, but slightly external to, his right nipple.