335. Gunshot wounds of the chest, penetrating the cavity, are always
exceedingly dangerous. After the battle of Toulouse, on the 10th of
April, 1814, one hundred and six cases of wounds in the chest in
officers and soldiers, in all of whom the cavities were not penetrated,
were received into hospital. Between the 12th of April and the 28th
of June thirty-five died, fourteen were discharged to duty, and
fifty-seven were transferred to Bordeaux to proceed to England, some to
die, some to be pensioned, but few in all probability to return to the
service--being an ultimate loss of nearly one-half, if the fifty-seven
cases sent to England could be traced. M. Menière, in giving an account
of the wounded carried to the Hôtel-Dieu of Paris, in the three
remarkable days of July, 1830, where every case was immediately taken
care of, says forty cases were received into the hospital; of these
twenty died; he states the case of ten more, seriously wounded, who
recovered; and he gives the names of seven more, in six of whom the
cavity of the chest was not perforated, and alludes to three wounded
by small-swords, who recovered--the loss being thus one-half, even if
the rest happily and perfectly recovered, which may be doubted, thus
showing that with the ablest assistance the Hôtel-Dieu of Paris could
afford the loss was one-half. After the battle of Waterloo the loss was
much greater; with the army on the Sutlej the loss was deplorable, in
consequence of the want of a sufficient number of medical officers and
of means--a state of destitution to which I have drawn the attention
of the directors of the East India Company in the strongest possible
terms, but which they will not rectify, but which will some day, I
hope, become the subject of Parliamentary discussion, and, I doubt not,
of public reprobation. That the wounds of the chest with the army in
the Crimea will afford a more satisfactory result, cannot, I fear, be
expected, and for similar reasons.
336. When a musket-ball fairly passes through the cavity of the chest,
the orifice of entrance is round, depressed, dark colored, and more or
less bloody in the first instance; the orifice of exit is generally
more of a rugged slit or tear than a hole. The alarm is great, and the
powers of life are much depressed. The wounds may or may not bleed; the
sufferer may spit up more or less blood; respiration may be difficult,
countenance pale, extremities cold, pulse variable--symptoms dependent
on particular constitutions and circumstances connected with the extent
of the injury.
It has been said that balls are apt to run round the body, coming out
at a point opposite to that at which they entered, without penetrating
the cavity of the chest; this, whenever it does take place, is a rare
exception to a general rule, dependent on the ball being reflected from
something solid which it cannot penetrate, such as a button, a piece of
money, a rib, etc. If the ball run under the integuments exterior to
the fascia covering the intercostal muscles, it is usually marked by a
tenderness in its course on touching the part and a discoloration of
the skin. A ball may, however, run between two ribs for some distance,
injuring the muscular structures between them without penetrating the
cavity, in which case, after the first moments of alarm have passed
away, the symptoms indicative of a penetrating wound either cease or do
not occur, although those of inflammation of the pleura or lung may and
often do follow to a considerable extent.
When the ball cannot be traced, the absence of symptoms, after the
first period of alarm has subsided, will enable the surgeon to form
the surest prognosis; their absence, however, cannot too certainly be
relied on.
A ball will occasionally rebound from the sternum, leaving merely
a black mark; from the spongy nature of that bone in which they
frequently lodge, they require the application of the trephine. If a
ball should be felt through a wound in the sternum, the broken portions
of bone should be removed by the small saw or by the trephine, and the
ball extracted.
337. An enlargement of the wound, the “_debridement_” of the French,
does no harm beyond the pain it occasions, unless there be something to
be removed, when an incision becomes necessary, in many instances, for
the removal of extraneous bodies or for the evacuation of blood, etc.
When a wound from a musket-ball appears likely to have penetrated the
cavity of the chest, and is too small to admit the end of the finger,
the opening ought to be enlarged so as to allow its introduction as far
as the ribs, in order to ascertain whether those bones have sustained
any injury, or whether anything is lodged exterior to or within them.
It is not necessary that a man should be cut simply because he has been
shot; and an enlargement of the wound should be of no greater extent
than is absolutely necessary for the purpose intended. When pieces of
shell, or of a sword or lance, are broken off and partly lodged in
the cavity of the thorax, which is more likely to happen when they
enter through the large muscles of the back, they will require larger
incisions to give room for their removal. Great praise was given of
old to Gerard, surgeon-in-chief of La Charité in Paris, who, having
perceived that a small sword, after going through a rib, was broken
off close to it, thought it advisable to make an incision through
the intercostal muscles into the chest, and then to introduce his
forefinger, armed at the end with a thimble, with which he pressed back
the point of the broken blade. In a case of this kind, the surface and
outer edge of the bone should be removed, until the piece of steel can
be firmly seized and withdrawn by a fine pair of pincers or pliers.
When a ball sticks firmly between two ribs, it requires some care
to remove it, as the rib both above and below may be more or less
interested, although not actually fractured. The attempt should be
made during inspiration, when the lower rib should be depressed, and
some thin but not sharp-pointed instrument like an elevator should be
gently pressed around and under the looser edge of the ball, in order
to extricate it.
When a musket-ball fractures a rib, there ought to be no hesitation
about the propriety of enlarging the wound, to allow the splintered
portions of bone to be removed. It is possible that in doing this some
pieces of cloth or other matters may be extracted, which might else
glide into the cavity of the thorax, or stick in the lung itself.
A soldier of one of the regiments on the left of the position of
Talavera was brought to me, wounded by a ball in the left side of the
breast; it had struck the sixth rib, and passed out about four inches
nearer the back. As the point of the finger indicated the presence of
broken bone, I enlarged the anterior wound, and then found that the
ball had driven some spiculæ of bone into the surface of the lung,
which appeared to have been previously attached to the pleura costalis
at that part. These having been removed, together with a piece of coat
which had been carried in with the ball, a small, clean wound was left,
which gradually healed up, the man accompanying me on the retreat over
the bridge of Arzobispo.
338. When a ball impinges with force on the center of one of the ribs,
and passes into or through the chest, the bone is usually broken into
several splinters of different lengths, some of which frequently
accompany the ball in the commencement of its course, or are even
carried into the substance of the lung, together with a part of the
wadding of the gun, or of the clothes of the patient. These should if
possible be extracted if they can be seen, and the sharp ends of the
rib rounded off. When the ball fractures a rib on passing out of the
chest, the splinters are driven outwardly, and should be removed by
incision.
339. When a ball strikes a cartilage of one of the ribs, it does not
punch out a piece as it were, but merely divides and passes through
it, bending it inward, rarely tearing away a portion. The parts of
the cartilage thus bent and turned inward are to be drawn outward,
and replaced by the end of the finger, a bent probe, or other curved
instrument.
A ball, when striking obliquely but with force on the chest, will
frequently penetrate, and then run round, between the lung and the
pleura lining the wall of the chest, for a considerable distance,
before it makes its exit. In this case the lung may be only slightly
bruised, without the pleura pulmonalis or costalis being more than
ruffled. In others the lung shows a distinct track or hollow made by
the ball. A shade deeper, and the ball penetrates, and forms not a
hollow, but a canal. The patient in all these cases spits blood, and
the first symptoms are severe; they frequently, however, subside, and
are not always followed, under proper treatment, by effusion, although
it may always be expected.
340. When a ball fairly passes through the lung, it leaves a track
more or less bruised, which continues for a time to bleed according to
the size of the vessels which are injured, thus making a wound more
dangerous as it approaches the root of the lung where the vessels
are largest. More or less blood is spit up, or, if effused, it
gravitates in the chest, until it rests on the diaphragm or other most
depending part, according to the position of the patient. If it should
be in quantity, the filling up of the chest may be ascertained by
auscultation, if the wound be closed. As the quantity of effused blood
increases, the lung becomes more and more compressed, until at last
the hemorrhage ceases under pressure, if the wound be covered; and the
patient is saved for the moment, unless he should die of asphyxia, from
the lung on the other side being also compressed through the bulging of
the mediastinum on it; to prevent which, if possible, the wound should
be reopened or enlarged, so as to take off the pressure of the effused
and perhaps coagulated blood. If the person wounded shall have suffered
formerly from inflammation, and the lung has adhered in consequence to
the wall of the thorax, at the parts where the ball enters and goes
out, the cavity of the chest will not be opened, and the track only
of the ball will communicate with the external parts, unless the ball
shall have perforated some of the large vessels, when he will continue
to bleed by the mouth. The pressure of the blood effused into the track
of the ball, which may become coagulated, will sometimes suffice, under
even these circumstances, to effect the suppression of the hemorrhage
which the loss of blood, the faintness of the patient, and the weakness
of the circulation, under proper treatment, will materially assist in
rendering permanent.
General Sir G. Lowry Cole, G.C.B., was struck at the battle of
Salamanca, on the 22d of July, 1812, by a musket-ball, which entered
immediately below the clavicle, fractured the first rib, and, inclining
inward, came out through the scapula behind; as he spat blood for
three days, the upper part of the lung was shown to have been injured.
The ball appeared to have passed so close to the under part of the
subclavian artery that the greatest fears were entertained for his
safety; more particularly as a marked difference in the size of the
pulse was perceived in the left arm, which did not exist before. He
remained three days on the field of battle, in a Portuguese officer’s
tent I always carried with me. Under repeated bleedings, and the
strictest antiphlogistic treatment, several splinters having come away,
and a large piece of the rib and of the scapula having exfoliated, he
gradually recovered, so as to be able to resume the command of the
Fourth Division in October at Madrid. The subclavian artery never
resumed its power, and the radial always beat less forcibly on the left
side. He perfectly recovered his health, the respiratory murmur of the
lung being natural. He died suddenly in 1844, from rupture, I believe,
of an aneurism of the abdominal aorta.
A dragoon of the King’s German Legion, shot in a nearly similar manner
on the same occasion, suffered more severely: the clavicle and first
rib were splintered to a greater extent, and he lost a large quantity
of blood by the mouth. The splinters having been removed, after
enlarging both wounds for that purpose, and the inflammatory symptoms
subdued, he appeared to be going on favorably for three weeks; when,
having eaten some meat obtained irregularly, he suffered what seemed
to be a bilious attack of vomiting and purging, attended by fever and
oppression in the chest; an ipecacuanha emetic having been given with
full effect, relieved him much. During the efforts to vomit, the wounds
discharged a quantity of sero-purulent fluid, a piece of the cloth
of his coat, and another of bone, which had gone in with the ball,
and in all likelihood had been lying with the matter at the bottom of
the chest. After this he slowly recovered. This case is peculiarly
instructive.
General Sir Andrew Barnard, G.C.B., was wounded when in command of the
Rifle Brigade, at the passage of the Nivelle, on the 10th November,
1813, by a musket-ball, which entered between the second and third
ribs, in front of the right side of the chest, passed directly through
the cavity and through the shoulder-blade, from under the integuments
covering which it was removed. He not only felt but heard the sound of
the ball as it struck him, and he fell from his horse. Blood gushed
from his mouth, and continued to do so until after he was completely
exhausted by bleeding from the arm to the amount of two quarts. He was
again bled at night, and the subsequent morning, which relieved all
the material symptoms. During six weeks he suffered from difficulty of
breathing and cough, and from night-sweats. Some pieces of bone and
cloth came away from the wounds, with a free discharge in the first
instance, which gradually diminished until the wound closed. In eight
weeks he was able to resume his command.
More than forty years afterward I found the lung pervious; the
vesicular murmur could be freely heard even up to the situation of
the wounds, to the internal parts of which it may be concluded the
lung adhered, from the sound conveyed to the ear on auscultation. He
suffered little or no subsequent inconvenience from the injury, and
died in January, 1855, aged 82.
_Case of Major-General Broke, by himself._--Toward the close of
the battle of Orthez, on the 27th of February, 1814, a musket-shot
struck me between the second and third ribs on the right side, near
the breast-bone. I was then on horseback, being aid-de-camp to
Lieutenant-General Sir Henry Clinton, commanding the Sixth Division.
The sensation was precisely as if I had been struck a violent blow with
the point of a cane, but it did not unhorse me. I was attended in a
very short time by the surgeon of the 61st Regiment, when, on removing
my clothes, the air and blood bubbled out from the wound as I drew my
breath. The surgeon, turning me on my face, discovered the ball to
be lodged under the thin part of the blade-bone. This he cut through
and extracted the ball, and with it pieces of my coat, waistcoat, and
shirt, which were lodged between the ribs and the blade-bone. This
occurred about four P.M. I was then removed to the town of Orthez, a
distance of about three miles, and in the course of the afternoon the
veins of both arms were opened in at least seven different places, but
scarcely any blood came away; breathing became exceedingly painful in
a day or two, and I felt nearly suffocated, when, in the evening, my
brother, Sir Charles Broke Vere, arrived with my friend, Mr. Guthrie,
who examined me carefully. The agony of drawing breath was such that
I could scarcely endure it. He opened one of the temporal arteries,
and desired that it might be allowed to bleed without interruption.
He afterward left me to visit some other wounded men, and returned in
about three hours, when I told him that I felt relieved, and had much
less of the suffocating pain in breathing. He then opened the other
temporal artery, directing as before that its bleeding should not be
checked. I shortly after that dropped asleep, and on waking could
breathe freely; my recovery was progressive from that time, the wound
in front, where the ball entered, being the first closed; but both were
healed at the end of about eight weeks, and in about ten I was able to
rejoin the army at Bordeaux.
H. G. Broke, _Major-General_.
He is now, in 1855, in perfect health, the respiratory murmur being
free all over the chest.
The Duke of Richmond, then Earl of March, was wounded by a musket-ball
at the battle of Orthez, while at the head of his company in the 52d
Light Infantry. He was standing at the moment with his right face
toward the enemy. The ball entered that side of the chest, between the
fourth and fifth ribs, nearly in a line with the lower edge of the
scapula. He fell to the ground with great violence, and was speechless
for some time. He stated to me at a subsequent period that the
sensation he felt at the moment was as if he had been “_cut in two_.”
On immediate examination there was no other opening to be found but the
_one_ where the ball had entered; nor were the medical officers able to
feel the ball anywhere under the skin or under the muscles.
The wound having been dressed he was laid on a door and removed to
Orthez, about three miles from the scene of action, during which he
complained of excruciating pain, extending from the wound to the top
of the os ilii on the same side, the pain being much aggravated by
frequent and severe cough, with copious expectoration of frothy mucus,
and much florid blood; respiration hurried; countenance pale.
The moving him to Orthez occupied nearly three hours; a great part of
the ground being very rough and broken, the men could not well step
together, and the consequent unavoidable shaking and jolting caused him
much pain. On his arrival at Orthez, he was extremely languid, with a
tendency to syncope. Pulse feeble; extremities rather cold.
Seven in the evening: After having been faint for an hour, he
became hot and restless; pulse 108, and full; skin more hot, and
the respiration short and more hurried. After he was placed in bed
hemorrhage from the wound took place to a very considerable extent.
Eight ounces of blood were taken from the arm. (Could bear no more.)
15th inst., nine A.M.: After the bleeding he became more quiet, and
had less pain; but he has since become very restless, and the pain
returned, with a full, hard, and frequent pulse. The wound has again
discharged a very considerable quantity of blood. Bleeding repeated as
before.
Nine P.M.: Deputy-Inspector Thomson and Staff-Surgeon Maling examined
the wound. Mr. Maling introduced his finger (the whole length) between
the ribs into the wound without any interruption to its progress, and
without being able to reach the termination of the passage of the ball;
and Dr. Thomson then passed a probe (its whole length) straight into
the chest, with a similar result; thus leaving no doubt on the minds of
all present that the ball had passed directly into the posterior part
of the chest.
Midnight: The blood last taken is very buffy; and there has again been
an _immense discharge_ of blood, etc. from the wound; the sheets,
mattresses, etc. are saturated with it; and on the floor, under the
bed, there is a large pool of blood which had soaked through the
bedding. Pulse 114, low and frequent; cough and expectoration as
before; pain violent, and great restlessness. Repeat the bleeding.
_Mem._--Perhaps enough has now been stated to show the nature of the
wound; and any further detailed statement of his lordship’s sufferings,
or the treatment of his case, would be unnecessary. On the latter
point, however, it may be mentioned that, exclusive of the _general
treatment_, he was bled _seven times_ between the evening of the
27th of February and the morning of the 2d of March, the _cough_,
_expectoration_, _breathing_, _pain_, _etc._ being much relieved by
each bleeding.
A. Hair, M.D.
Mr. Guthrie saw the Earl of March on the same day as Colonel Broke,
and suggested that no further efforts should be made to find the ball,
while the treatment adopted should be steadily pursued; and in 1846,
he pointed it out lying under the edge of the base of the scapula. His
grace is now, 1855, in good health, and the chest, well formed, sounds
clearly and healthily in every part, even at the point injured.
341. The ball in passing through the lung, in these cases, destroyed
the life of that part only which it touched; and although air would
pass out at the time, this would not be of long continuance. The wounds
being kept covered, the lung did not and does not usually, in similar
instances, collapse or recede from the wall of the chest, but quickly
recovers its state of expansion, however impaired it may be at the
moment by the injury. The track made by the ball gradually suppurates
and heals, leaving merely a depression or cicatrix on the surface
attached around or in part to the wall of the chest by adhesion. The
track through the lung may be readily seen in such cases after death;
although during life it interferes so little with the respiratory
murmur as not to be observable, unless by its greater distinctness,
from the thinness of the intervening parts.
Mrs. M. was wounded by a small pistol-ball, which entered on the right
side from behind, between the seventh and eighth ribs, just under the
arm when hanging down, and passed out in front over the cartilage of
the sixth rib, more than an inch from the pit of the stomach. She had
not spit blood, and the ear declared the lung to be pervious to air
at the wounded part, which raised a hope that the ball might not have
penetrated the cavity, although it might have injured the pleura.
As she suffered great pain twenty-four hours after the injury, the
breathing being oppressed, Mr. Adams bled her into a hand-basin,
until about to faint. She lost nearly thirty ounces of blood, but her
symptoms were quite relieved, so as to render any other bleeding during
her treatment unnecessary. At the end of the third day she spat a very
little blood after removal in a carriage to another lodging, and then
gradually recovered. After four different stethoscopic investigations,
I came to the conclusion that the ball had not struck the lung in the
first instance, although the lung adhered to the pleura costalis, and
suffered from some abrasion or ulceration at that point, which gave
rise to the expectorated blood.
These cases are instances of wounds of the upper part of the lung,
which are in general more dangerous than those of the lower, from the
vessels being larger, and from the greater difficulty with which any
extravasated blood or fluids can escape. They also prove that when
blood is poured out in small quantity, it may be absorbed, but what
that quantity may amount to is doubtful.
342. In cases in which the external opening or wound does not
communicate freely with the cavity of the chest, the principal danger
arises from the inflammation of the pleura ending in effusion, which,
if not evacuated, leads to the loss of the individual. _It is the great
fact to be attended to in the treatment of pistol wounds of the chest,
or those made by small balls which do not pass out._ All the persons I
have seen die from small balls have died with the affected cavity more
or less full of fluid. The post-mortem reports of all persons killed
in England in duels by wounds through the chest, unwittingly attest
this fact, as well as the insufficiency of the surgical treatment they
received; and the necessity, for the future, for its amendment. It is
in these cases that the stethoscope is most valuable--its frequent use
indispensable. When the respiratory murmur ceases to be heard except
at what is the upper part of the chest, whatever the position of the
patient may be, it is full time to enlarge the original opening, or to
draw off the fluid by the trocar and canula.
Laennec thought that when a considerable effusion took place in
pleuro-pneumonia, filling the posterior part of the chest when the
patient lay on his back, it nevertheless diffused itself over the
whole surface of the lung; but dissection has shown, in cases of
wounds, that the fore part of the lung may be applied to the anterior
part and sides of the ribs, while a serous effusion fills the hollow
behind, the respiratory murmur being distinctly heard above it. It
is the most important fact to ascertain, particularly in pistol or
small penetrating wounds of the chest, in which the opening is not
sufficiently large to allow any fluid effused to run out.
Sir C. B. was wounded by a pistol-ball in the back, which passed into
the chest through the lower part of the lung of the right side, and
lodged on the inside of the wall of the chest in front of the same
side, sticking in and against a rib, but giving rise to no external
marks or signs of mischief at that part, so as to admit of an operation
for its removal. The inflammatory symptoms having been restrained,
it was nevertheless obvious that the cavity of the chest was full of
fluid, and that the oppression in breathing arose from it, and not
from the injury done to the lung. The stethoscope was then unknown,
the ear was not in use; my older colleagues were obstinate; they would
not hear of an operation for enlarging the wound into the chest; and
as our patient was, unfortunately for him, shot in London, instead of
at the pass of Roncesvalles, or on the bridge over the Bidassoa at
Irun, we let him die on the eighth or ninth day, without all the aid
which surgery might have given him. It is possible he would not have
recovered under any circumstances, from the ball having lodged, and
from his advanced age.
A soldier of the Fifth Division of Infantry was wounded at Toulouse by
a musket-ball, which entered between the fourth and fifth ribs of the
right side, near the sternum, and came out behind nearly opposite,
fracturing the ribs, the splinters of which were removed. The first
symptoms of inflammation, having been in some degree subdued by the
sixth day, were followed by those more immediately indicating effusion;
such, particularly, as great oppression, difficulty of breathing,
and inability to lie in the recumbent position, which induced me to
introduce, after a little pressure, a gum-elastic catheter into the
posterior wound, through which a quantity of red, serous fluid was
withdrawn, exceeding, perhaps, three pints by measure. On the removal
of the catheter the discharge of fluid ceased, and, under a strict
antiphlogistic treatment, the man gradually recovered, so as to be
sent to England in the following June. If the symptoms of oppression
had returned, I should have repeated the operation perhaps lower down.
Auscultation, if it had been then known, would have smoothed away many
doubts and difficulties.
A soldier of the 40th Regiment was wounded at Toulouse on the 10th
of April by a musket-ball, which entered about two inches below the
nipple of the right breast, passed through the cavity and the lung, and
came out behind at a nearly opposite point, injuring the ribs above
and below, without entirely destroying their continuity. He was bled
largely on the morning of the 11th, and again at night. On the 12th
the bleeding was repeated; some small pieces of ribs were extracted
from both orifices, and some part of his dress from the anterior
one. He spat blood when he coughed, and respiration was difficult.
Calomel, opium, and antimony were given in pills every six hours,
and the bleedings were repeated daily, and sometimes oftener, for
the first eight days, during which time a free discharge, at first
serous, afterward purulent, took place from the wound, after which
the inflammatory symptoms subsided; the cough became easier, the
expectoration less, and free from blood; breathing easy. The calomel
was omitted; a mild farinaceous diet was allowed instead of a little
gruel, and a very little bread and milk. In a fortnight the wounds
began to heal. On the 1st of May, some small pieces of rib were removed
from the anterior wound, after which both gradually closed, and he was
forwarded to Bordeaux on his way to England in the beginning of June,
cured.
Corporal Dunleary, of the 69th Regiment, was wounded on the 16th of
June, 1815, at Quatre Bras, by a musket-ball, which entered the
thorax, fracturing the seventh rib on the fore part of the right side,
and lodged. He said he had lost a large quantity of blood from the
mouth, and some from the wound, between that and the 19th, when he was
brought to the hospital in Brussels. The pulse was then quick and hard,
respiration difficult and anxious, and a bloody discharge issued from
the wound on every respiration; bowels confined since the accident; was
bled to forty-four ounces; saline purgatives, with calomel, antimony,
and opium, were given until the 29th of June, when the wound discharged
good pus. From this time, at different periods for six weeks, he lost
ninety-two ounces more blood, being strictly placed on milk diet.
Several pieces of rib exfoliated. He was sent home on the 31st of
August, declaring himself quite as well as ever he had been in his
life; the ball remaining undiscovered.
A soldier of the Fusilier Brigade was struck by a musket-ball on the
right side of the front of the chest, at the battle of Albuhera; it
entered between the fifth and sixth ribs, passed through the lungs,
and lodged. Three days afterward, when the first symptoms were in part
subdued, he complained of pain in a particular spot, nearly opposite
to where the ball had entered, at which part something could be felt
deeply seated. An incision being made, the ball was found lodged in the
intercostal muscles between the ribs, whence it was easily removed. A
considerable discharge of reddish-colored serum followed, with great
mitigation of the symptoms, after which, under strict treatment, the
man recovered, and was sent to Elvas with every prospect of a cure.
Lieutenant-Colonel Harcourt and Major Gillies, of the 40th Regiment,
were both shot through the chest, at the head of the regiment, at
the successful assault of Badajos; the wounds were as nearly similar
as possible, from before directly backward. They were taken to the
same tent, and treated alike with the same care by the late Mr.
Boutflower, the surgeon of the regiment, with whom I saw them daily.
The inflammatory symptoms ran high in both. In Major Gillies, a tough
old Scotchman, they could not be subdued, and he died, at the end of
a few days, of pleuro-pneumonia. Colonel Harcourt slowly recovered,
and died Marquis d’Harcourt, near Windsor, more than twenty-five years
afterward, suffering little or no inconvenience from his chest, when I
last saw him.
Captain Cane, 23d Fusiliers, was wounded at the affair of Saca Parte,
in front of Alfaiates, in 1812, by a musket-ball, which struck him
below and a little to the outside of the left nipple, fractured the
rib, and entered the chest, giving rise to the sensation as if the ball
had passed diagonally downward and backward to the loins of the same
side. He spat blood, and was very faint. The next day he could scarcely
breathe, was in great pain, continued flushed and anxious; pulse 100.
He was bled into a washhand-basin until he fainted, and every day
afterward, some days twice, to a less extent, for ten days, and once
again until syncope was induced, on an accession of symptoms after an
imprudence in taking a little wine, which nearly smothered him, he
said. Some pieces of flannel shirt, of braces, coat, etc. were removed
from the wound, and several portions of bone gradually followed,
together with a quantity of matter, which continued to flow from May
until the end of the following September, when the wound healed.
On the 23d Jan., 1821, I had an opportunity of examining this
gentleman. My report says, he is never free from a little pain in
the loins, where the ball is supposed to be, and cannot take a full
inspiration without pain in the chest; expectorates more or less
constantly, and occasionally a little blood about once in three or
four months in half congealed lumps. Cannot ride or take any exercise
because it brings on the pain. The cicatrix shows a large, deep hole,
and the deficiency of the rib is well marked. The side of the chest is
altogether contracted and flatter; the heart has been moved behind the
sternum; the beat of the apex being on the other side of the xiphoid
cartilage, and that of the heart, as a whole, is more indistinct than
usual. In other ways in good health. It is possible that the ball may
be lodged in or be retained by layers of coagulable lymph in the angle
formed between the diaphragm, the ribs, and the spine.
William Downes, of the 11th Regiment of infantry, aged thirty-three,
was wounded by a musket-ball, on the 31st of August, 1813, in the
Pyrenees; it fractured the fourth rib of the left side, passed through
the chest, and came out behind through the scapula. He spat a good
deal of blood, although little flowed from the wound. The next day
he was bled largely twice, to relieve the bleeding from the lung,
and was sent to Passages, where he was bled daily; and thence, a ship
being ready, to Santander, where he arrived on the 14th of September.
A free, bloody, purulent discharge took place from the anterior wound,
but little from the posterior, and he expectorated a bloody, purulent
matter, and occasionally a little blood. Toward the end of September
the sanguineous expectoration ceased; but the soft parts of the chest
had sloughed and separated under an attack of hospital gangrene, from
which he had a narrow escape during the month of October. The wound in
the chest gradually closed during the month of November; and on the
14th of December he was discharged convalescent, his health tolerably
good, but his breathing by no means free; no expectoration. The left
arm was impaired in power, in consequence of the mischief done to the
muscles of the fore part of the chest and shoulder by the hospital
gangrene. The chest was altogether somewhat flattened and shrunk, but
there did not seem to be any diseased action going on within.
_Case of Lieutenant-Colonel Dumaresq, aid-de-camp to Lord Strafford,
by himself._--While turning round, after a successful charge of
infantry, at Hougomont, on the 18th of June, 1815, I was wounded by a
musket-ball, which passed through the right scapula, penetrated the
chest, and lodged in the middle of the rib in the axilla, which was
supposed to be broken. When desired to cough by the medical officer who
first saw me, almost immediately after receiving the wound, some blood
was intermixed with the saliva. I became extremely faint, and remained
so about an hour and a half, after which I rode four or five miles to
the village of Waterloo, where I was bled, which relieved me from the
great difficulty I had in breathing; this difficulty was accompanied
by a severe pain down my neck, chest, and right side. I was much
easier until the evening of the 19th; but in the course of the night,
the difficulty of breathing becoming much greater, and the spasmodic
affection having very much increased, I was bled seven times, until the
middle of the next day.--20th. I continued better, but was then seized
with the most violent spasms imaginable in my neck, chest, and stomach.
I could scarcely breathe at all, and was in the greatest possible
pain; I was again bled twice very largely, and my stomach and chest
fomented for a length of time with warm water and flannels. I passed a
very tolerable night, and continued pretty well until two o’clock the
following day, when I was again very largely bled, by which I was very
much relieved. I continued pretty well, and free from much pain; but my
pulse having very much increased, and having a good deal of fever, on
the 23d I was bled again; after this I continued free from much pain or
difficulty of respiration, and on the 26th was removed into Bruxelles,
when I came under your care. I forgot to mention that when I was so
violently attacked I had two lavements most vigorously applied; salts,
etc. proving of no avail, took digitalis, commencing with ten drops
every four hours, increasing to fifteen from the second day.
N.B.--Up to this period, the 2d of July, the devil a bit have I eaten.
While with fat mutton-chops, and nice loins of veal,
You stuff your d--d guts, your hearts are all steel.
Oh! ye doctors and potecaries, you’ll all go to hell,
For cheating our poor tripes of their daily meal.
H. Dumaresq.
The ball in this case was lodged in the rib, which ultimately became
thickened around it. He recovered with good health, but with occasional
spasms in the chest; and died of apoplexy, in Australia, twenty-five
years afterward. His doggerel lines show the buoyant and unconquerable
spirit of a soldier, who knew that his chance of recovery was small. It
was a most gallant, a most friendly spirit. Peace to his manes.
If the ball had caused a greater degree of irritation, I was prepared
to cut down upon the rib, and remove a part of it, if necessary; for
I have seen balls so situated slip from their lodgment, roll on the
diaphragm, and cause general inflammation, suppuration of the cavity,
and death, which must almost always ensue in such cases, unless the
ball can be removed, and the matter evacuated by an operation to be
hereafter described.
General Macdonald, of the Royal Artillery, was present at Buenos Ayres,
when a bombarder of that corps received a wound from a two-pound shot,
which went completely through the right side, so that when led up
to the general, who was lying on the ground, he saw the light quite
through him, and supposed he was of course lost. This, however, did not
follow, and some months afterward the man walked into General (then
Captain) Macdonald’s room, so far recovered from the injury as to be
able to undertake several parts of his duty before he was invalided;
thus proving the advantage of a shot, however large, going through
rather than remaining in the chest.