CNDS or Tin: KACE AND CHEST. the or pericardium were injured (as I understood they were) primarily. Wli'-n a ball fairly enters the chest, and either penes or traverses the lung, the danger is most imminent, i juries, however, are not so fatal, mi the whole, as similar wounds of the head or the abdomen. The younger Larrey and Meniere both record the circumstanee, that the majority of tinkilled in the civil commotions of 1830 in Paris, succumbed from penetrating wounds of the thorax. The immediate danger will depend upon the depth of penetration, and the part implirat'-d. It' the heart or great vessels are wounded, hath will in general be instantaneous/)" When the superficially wounded, then the vessels whieh are injured must lie of small calibre; but the deeper the ball penetrates, the larger are those encoun1, and, consequently, the more mortal is the wound. may be suffocated at once by the blood, or it may escape in such quantity death, within a short i exhaustion.
If the wound be at all severe, the shock is very great, and blood generally passes from both the mouth and the wound. That from tin- mouth is t'rothy, while that from the wound is. darkercoloun-d in. The wound being high in tinwalls of the thorax, will make the escape of blood by the orifice less in piantiiy than it it be situated low down, and such a situation will render the evacuation K latin irurgicale des <Svc-nementa de Juillet, 1880, a 1'hopital mill f In the New t., there is a very interesting paper, by '. on wounds of the heart. He makes reference to several caict in which balls have remained long cmbodd< <1 in th.it organ. i.MKAN WAI I. of the effused blood, or serum, more difficult afterwards.
Air, as well as blood, will generally escape by the wund, and thus the presence of these two signs blood by the mouth, and blood and air by the wound are unequivocal proofs that the lungs have been injured, although their absence does not prove the opposite.* The dangers which attend a penetrating wound of the lung, are thus, primarily, haemorrhage and collapse, as well as those from suffocation, if the bleeding be profuse. The haemorrhage and the fainting are, by a sort of paradox, both the patient's danger and his safety. Secondarily, the danger of such wounds proceeds from inflammation and its products, the exhaustion which attends prolonged exfoliations and suppuration, together with that which arises from the organic diseases that are thereby so apt to be engendered.
A short, tickling, harassing cough, attended by bloody expectoration; a cold and bedewed surface; a pale anxious face; a weak trembling pulse; palpitations of the heart; oppressed breathing, arising in the first instance, according to Hunter, from the pain occasioned by the action of the wounded lung and muscles, and afterwards from the inflammation and effusion these are the usual symptoms which attend penetrating wounds of the lungs. At a later date, if the bleeding cease a circumstance which will be evidenced by the disappearance of the collapse, the return of the heat to the surface, and of strength to the pulse, as well as by the length of time which has elapsed since the infliction of the wound then those * In the accounts given us of the spear wound which so nearly deprived Alexander the Great of his life, in the battle with the Malli, we are told that he blew both air and blood from his wound.
Til. CHI. svmptoms which result tnun inflammation appear. We have thus two stages or periods which demand separate lion in our treatment tliat during which there is internal with collapse, and that which follows and is accompanied by reaction and inflammatory M; to these 1 also add that of convalescence. The collapse which follows penetrating wounds of the lung, though dangerous, is yet, if not very profound or prolonged, the best guarantee for the patient's safety. - uc h cases the observation of Ilewson is peculiarly applicable: " Languor and faintness being favourable to the congelation of the blood, and to the contraction of lin;c orifices, should not be counteracted by stimulating medicines, but, on the contrary, shoul-i d." With our modern notions on bleeding, it is often difficult to reconcile the net,uii experience shov is, for energetic depletion when reaction sets illegible in the scan of the first