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T T and lower jaws have been! larire p f them ivnio-. with ' a recovery has followed, when no assisted to bring abmit an of the lower in.ixiila-, lias lieeii carried nway, and in ease which came under in, which ended B The upper jaw has been completely destroyed, and in one case which occurred in the 31st regiment, a grape shot, seventeen oz. in weight, was impacted in the superior maxilla, and necessitated the removal of most of the bone. Haemorrhage is undoubtedly the great source of annoyance and danger in gun-shot wounds of the face. The difficulty of commanding it is at times so great as to place the patient in imminent danger.
It frequently appears early, but stops spontaneously. Men who have received a severe face wound, seldom leave the field without sustaining a considerable loss of blood, and secondary haemorrhage is common when the bones have been fractured. The depth, irregularity, and extreme * In a very interesting paper read to the Imperial Academy of Medicine, by M. Hutin, in April, 1857, there is an account given of an inmate of the Invalides (to which M. Hutin is surgeon in chief), who had the lower jaw carried away by a cannon ball at the battle of Wagram, forty-eight years ago. He recounts the changes which the parts have undergone since. It seems that the haemorrhage was very severe at the moment of injury, but that it ceased spontaneously.
The tongue hung down in front of the neck, and was never drawn into the throat an accident which did not occur in four other cases, in which M. Hutin has known a like injury produced by a like cause. The patient referred to by M. Hutin has worn a silver mask since his accident, which protects his tongue hanging out, and adherent as it is to the neck. By means of this mask the variations of temperature do not affect the wide void which exists in the floor of the mouth. The most remarkable change which the progress of time has brought about in the parts is, that the upper jaw, in place of preserving its horse-shoe shape, has become so contracted at its middle as to assume the figure of an hour-glass.
This change began to take place three years after he was wounded, and has gone on increasing up to within a short time. The secretion and loss of saliva is great, but the patient enjoj's perfect health. There is an interesting question raised by this case, whether an analogous change n: looked for in those instances of late years pretty numerous in which the lower jaw has been excised. WOUNDfl <>r ularity of tinthe application of a Li to the bleeding points difficult, and to be effectual, presses must be applied with much niceness. It is in wounds of the deep branches of the face, in which secondary haemorrhage has tal. from a sloughing 1's operation, performed on the main lay be said to supersede, from necessity, Bell's '1 delineation.
of the facial nerve are sometimes so much injured in wounds of the face, either by the ball, tured bone, that temporary and even permanent paralysis may ensue; but there is one source these cases which does not always obtain the tion its importance demands. I refer to the swalig of the secretion from the wound. If great > be not taken to remove all the morbid secretion which its from injury of the bones of the face, if any amount LCets into the stomach, much constitutional irritation will., er of a low typhoid, and very fatal; will In- caused. believe have seen this result very clearly follow the cause referred to in some cases, ne case, where a sergeant of the Buffs died in the ts of a severe face injury, 'i the ant'-rior part of the lower jaw, and a: of the upper, were fractmvd by a round.
I suspect i result was at least accelei; iuse mentioned, although the utmost taken to prevent its occurrence. lie was a v healt had JU from his tal a few days previous to the accident. was of a nervous, irritable disposition. He was side by a small round shot, which '2'2'2 BUBOEBI OK TIII-: CKI.MKAN WAR. previously struck the parapet of the trench. The symphysis. ami part of the body of the lower inaxill; well as a small portion of the upper jaw, were destroyed. The soft parts, especially at the chin, were much toni and bruised, and ultimately sloughed. When cxaminhis chest, on account of a cough which troubled him on admission, a cavity was discovered in on; his lungs.