I have seen this man lately in perfect health. Tin- tinu'-T is the only probe permissible in examining It' we thereby discover the proii inwards of fragments of a rib, or portions of it I in the lung, we should take immediate steps ieir removal, even though the wound has to be enin order to allw of its accomplishment. The ribs are wound left free, by means of strips uf from the spine to the sternum, and from above downwards, so plaeed a! side on D wounded in tinall the breathing spaee we can u'ive them, '.y liavin.ir the sound side It is a singular -d with won of the intereos;;d art. seldom opened. 1 neither saw nor heard of sueh a case lie war, so that we were spared the adoption of any of those operative pr, f.r its r! liich, num. -roils than the authentie cases of i rencc of i Bsi' ':' llie ehrst from -ide may cause very to the j-arietes, avithout absolui-'ly w.-iu: or lun.Lrs.
This ease: in the t, WM M enemy. Tlic ball escaped below the left breast. The sternum was fractured and comminuted by the ball in its transit. Severe dyspnoea followed, together with a slight attack of hemoptysis. Repeated attacks of inflammation occurred over parts of both lungs, and the subsequent supervention of pericarditis necessitated bleeding and the use of tartar emetic, and subsequently of mercury, so as to touch the gums. The soft parts between the wounds of entrance and exit sloughed, and the sternum to the extent of about one and a half inches, together with the cartilaginous ends of the ribs thereto attached, came away in fragments, or were absorbed; so that by the 12th of July, a profusely suppurating wound had formed, 6 inches long by 2 broad, across the front of the* chest, laying open the anterior mediastinum, together with the right thoracic cavity, the opening into which was, however, sealed by the adhesion of the lung to the parietes.
At the left extremity of the wound, and at its lower part, the heart was plainly felt only covered by the pericardium. A to-and-fro sound accompanied the motions of the heart, but these were not sufficiently pronounced to prevent the recognition of the two natural notes. Hectic fever, harassing cough, and emaciation supervened. By the middle of July the wound had begun to granulate, and the patient seemed to improve. An attack of diarrhasa, however, prostrated his little remaining strength, and ultimately proved fatal. Before death, the pus with which the wound was filled receded on inspiration, and welled up when the lungs were emptied, as if it sank between the lungs when they expanded. On the morning of the day on which he died, a new sound was heard to proceed from the region of tlic heart. t> which we m-ver before lu-ard any similar.