No communication could be detected between the wounds on the chest and the cavity within, but two ribs were found to The advantage of this adhesion of the pleura), and the part which it, plays in the repair of chest wounds, is well brought out by IIoux in his Melanges de Chirurgie. ST. '. His wounds were dressed simply, and nothing was clone to the. as lie was not in a condition to undergo any operation. 1' breathing was easier, and he uht up less blood. Next morning his pulse fuller. but intermittent. His spit still contained blood. 1 1 is - naturally resonant as low as the fourth rib, but below this, by percussion and auscultation, dullness ami trietion sounds were discovered.
He was cheerful, but. as he had not slept, half a grain of morphia was administer, 'illy rallied somewhat, but died suddenly next afternoon, without any return of the ling. n examination after death, the sixth and seventh ribs were found fractured without displacement The pleura e.stalls was entire. The part of the lung f the fracture was entirely adherent to ind diaphragm, while, in the upper part of the pleural B 11 of bloody senim wa< found. Opposite of lured ribs, the lung.ensively lacerated. A large rein nls from the external surface towards the root, downwardi the base, and upwards towards the i of the pulmonary artery was with torn mouth in the rent, while many other.
The ridit or uninjured lung t numerous spots on it- surface, and in niatous. Ecchymosed pointwere seen ie surface of the In-art and pericardium. The mitral valves, and endocardium of the left ventricle, were The se-ments of th trieuspid valve bo,md to-ether by a librinous which passage to t: small Blood was 2,30 found in the small intestines, but not in the stomach Mr. Hulke remarks the arrestment of the bleeding by the mode in which the chief vessel was torn, as well as the conservative act of shutting off the rent in the lung, and the torn bronchi from the pleural sac by the formation of adhesions. It is seldom that a conical ball will be found to lodge in a rib, as a round one has been seen to do, or yet to run round under the integuments, or at all to lodge within the chest.
In fact, it very rarely fails to penetrate deeply, or pass quite through the entire cavity. Non-penetrating wounds are more dangerous at some points of the thorax than at others. Thus, when a ball strikes a large bone. like the scapula or the spine, or in those places where the large blood-vessels and nerves are situated, as in the axilla and upper part of the chest, the danger is greatly increased. The gravity of penetrating wounds depends very much on their direction and their point of entrance, as when, with an incidence very oblique to the surface, they enter at some parts of the chest, they may traverse a portion of the cavity without touching the contents. So it happened in the following case.
Fontaine, a private in the 90th, wounded on the 8th September, was admitted into the general hospital on the same day. The ball, after passing through the flesh of his left arm, which was at the moment in advance of his body, had entered the thorax in the axilla, and escaped at the inferior angle of the scapula, fracturing it, along with two of the ribs, at the place of exit. No immediate disturbance followed, but in twenty-four hours signs of acute pleurisy appeared, and required decided treatment. The ball had entered Til: LV,1 tj lint the substance of the y tin 1 wound of piirate long after that of had closed. No l,ad '.u arose alter th i k of pleurisy above referred to was subdued.