If, tin 1 paries in slough, so that the gut is laid hare or opened, the injury is one of great gravity. It is sometimes very difficult to say whether a hall lias perforated the abdomen or not. The relative position, and even the peculiar characters of the two orifices, will not guarantee a decided opinion. Far less can we say, from the apparent direction of the wound, that any of the viscera have been injured. It is neither allowable nor desirable that we should make such a search as will determine the question; for if the ball be not easily found, we never " amuse ourselves," as Le Drau expresses it, " by seeking for it," and the treatment ought to be such as will provide for all contingencies.
In the following case, the ball appeared not only to have perforated both the abdomen and the chest, but also the diaphragm; yet probably it ran merely under the integuments, possibly traversing the diaphragm close to its anterior border, and wounding none of the abdominal or thoracic viscera. A ball struck a French soldier just above the crest of the ileum, and about four inches from the spine. It escaped close below the inner end of the clavicle on the same side. At the time he was struck this man was on his knees, as he was in the act of rising from the ground on which he had been lying. He had hiccough and considerable prostration for three days, and also an attack of pleurisy, all of which he had recovered from a fortnight after injury, when I first saw him.
The fatality of penetrating wounds of the belly will depend much on the point of their infliction. 1 Jails entering the liver, kidneys, or spleen, are well known to T1IK AHDOMKX be usually n.though exceptional eases are not KK also always recog- formidable than those which iinpli IL Thomson saw only two eases of wounds of the small gir. Waterloo, in t <>f recovery; ivy reports several. edingly fatal. Baudens records f uarkable case of recovery, although compile; i severe head injuries. The syncope which followed for ten hours, doubtless assisted, along with the empty state of the ieh at the moment of injury, in preventing a fatal issue. aordinary manner in which, not only 1 tails, id ramrods, may traverse the abdominal vet not wound any viscus, has been often t upon by military surgeons.
The escape of tinviscera in the following case, which occurred in India. was mos cable. A soldier of the 28th regiment endeavouring to C 'inmit suicide, leant over his musket. and drew the trigger with his toe. The ball p.i abdomen, on a level, but a little to the left, of the umbilicus, and escaped through the centre of the crest of i< urn behind. He died in a month. The intesiind matted together, and large portions of them were g LS, Imt im perforation of the d be discovered. Th. Pr. adds in his report, ' I.amination, in some hed the See especially the mart remarkable case related by Honucn, nt page 456 of the first edition of his admirable f Obeervn; that the intestines were not perforated by the ball; but how they escaped defies any conjecture I can form on the subject." In another case which occurred at Meaner, the ball was ascertained to have gone fairly through the abdomen, yet not to have injured any of the viscera.
It is impossible, however, to be certain of such a circumstance, unless an after-death examination verify a supposition we are too apt to form. The just and perfect support afforded by the abdominal viscera to one another, and the manner in which they fill their containing cavity, supply a safeguard against effusion after wounds, which has ever been the astonishment and admiration of observers. The smaller and less torn the wound in the gut is, the more likely is this favourable result to occur. Littre's celebrated case of the madman, has ever served as the type of such wonderful acts of " conservative effort." The pressure, too, favours that adhesion between the viscera which is so potent a preservative against evil.
The following case, reported by Dr. Taylor when surgeon of the 80th, affords an example of a gun-shot wound injuring the smaller gut, while at the same time it shows the effects of such a wound, and also the stntr of the parts a considerable period after the infliction of the injury. It is taken from the Records of the Medical Department: Private Paul Massy was shot through the abdomen at Ferozeshah. Very slight symptoms followed, so that it was supposed the ball had coursed round the cavity, and had not penetrated. He mentioned having passed some blood in his stools after receiving his wound. The ball had escaped near the spine, having entered in front. 1 Ic WOUNDS AND BLADDER, >wly, but perfectly, except tliat lie continued 'omplaint, and linally died of spasmodic cholera, a cle time (exact ])eriod not specified) vounded.