Dupuytren has drawn attention to the long period which ball wounds of the soft parietes of the chest take to heal, especially when they are " en gouttiere." This he accounts for by the constant motion imparted to the walls by the movements of respiration. If the blow from a ball be forcible, or strike directly on the chest without the intervention of any strong substance, then fracture of one or more of the ribs will probably be caused, and possibly pleura! or visceral inflammation, as well, from the effects of the blow, or the presence of spiculas driven inwards. These fragments are at times Unpublished records of the Medical department. CJIKST. nay IKtotally detached from rib. ami carried deeply into the
The cartilage of a rib. although torn by a hall, is seldom driven into the parcnchymatous tissue, but remains so can be easily restored to their proper position. It >ee.tsionally happens that a ball is arrested between two ribs. This happened in the following case. Cassay, a private in the 38th regiment, was admitted under my into ihi- p-neral hospital, on the 18th of June. sutieriiu: a gun-shot wound of the left side of the thorax. Tin- ball, a large conical one with abroad base, much spent when it struck him. It did not force itself into the cavity, but lay wedged between the cartieond and third ribs, on the left side, about an inch from the sternum.
On withdrawing the ball, the cavity of the chest was found to be fairly opened, and the lung was visible as it expanded and contracted. nt had a severe attack of pleurisy a few < afterwards, for which he was repeatedly bled. JO i fusion, limited cxtmt. followed, and his were touched with mercury. For five weeks the wound continued to sup; v ely. The lung became adherent to the pari.!-. This patient had suliscfjuently a short attack. but ultimately made a Lrood recovery. He wen? 'and in at which time he still complained of a severe pain in the left clavicle and shoulder, which, down to his hand, and was attended umlnios;n,d want of p, Tinp;i i n was increased by touch' i-m, and Inuedsincehe was wounded.
Iii this case the cavity was opened, but the The non-col: the IUHL; was well seen in this, as in some other instances which toll under my notice. The natural mode of repair, by adhesion between the lung and the walls of the and the troublesome affection arising from injury to the nerves of the arm, were both illustrated in the above case. Pieces of shell, not unfrequently, open the cavity, but spare the lung, while sometimes the reverse happens, and the lung may be injured without the pleural sac being opened. The following was a curious instance of this latter accident, without the thorax being opened. The case occurred under the charge of my friend Mr. J.
H. Hulke, assistant-surgeon to King's College hospital, to whom I am indebted for the details. Private Jeremiah O'Brien was admitted into the general hospital on the 15th November, 1855, having been wounded by a piece of shell when the right siege train exploded. His left arm and fore-arm were extensively shattered, and he had two small irregular wounds on the left side of his chest, one just below the lower angle of the shoulder blade, and the other on the same level, but about two inches nearer the sternum. His breathing was quick and laboured, and bright florid blood was bubbling from his mouth. His face was pale, his pulse flickering, and very feeble. He spoke with a firm voice, and begged his ami to be cut off.