In three cases that recovered one had 16 wounds of the small intestine; one, 14, and another, 10, and it would seem almost impossible to imagine that re covery could have taken place in these cases without operation. The after treatment is regarded as all-important. During the first twenty-four hours only cracked ice was allowed and stimulants. On the second day the patients were fed with chicken-broth at intervals of two to four hours. Rectal feeding with pre digested foods and alcohol was practiced. A. B. Miles (Annals of Surg., Dec., '93).
The bowels should be kept freely movable. Large doses of Epsom salts sometimes serve to thwart the danger of peritonitis, without compromising the intestinal wounds, by removing all nox ious material that may have accumu lated in the bowel.
Liquid food may be permitted by the evening of the second day, and soft, easily digested food after a week, rectal alimentation being continued until then.
The sutures can be removed on the ninth clay. The closure of the external wound must be complete before the pa tient can be allowed to leave his bed, and the danger of a ventral hernia should be counteracted by means of an abdominal supporter.
Hypodermic injections of strychnine, to 7„ grain, three times a day, ac cording to indications, will prove most effectual in maintaining the strength of the patient and toning the muscular wall of the intestine.
Wounds Due to Military Fire-arms. [See supra, PENETRATING WOUNDS, for details.] During the Franco-Prussian War Ger man soldiers were frequently found suf fering from wounds of so frightful a nature that the French were accused of using explosive bullets contrary to the International Convention to that effect. Wounded limbs showed lesions of so de structive a character that the hole made was a magma of muscle, tendon, bone, blood, etc. Dead subjects were found with their heads completely shattered, the brains being scattered on all sides. The good faith of the French was soon demonstrated, however, experiments hav ing shown that their rifle, the Chasse pot, was capable, when fired at close quarters, of creating unusual lesions on account of the initial velocity and the greater rotation of the bullet. This was attributed mainly to the reduced eter of the bore, 11 millimetres, and to the increased quantity of powder used.
In 1886 France adopted S millimetres as the calibre of her military arm, and the other nations soon followed her ex ample. The 'United States Government adopted two calibres, one of 7.62 mil limetres for the army, and one of 6 mil limetres for the navy. Contrary to all expectations, the effects noted in recent wars, the war between Chili and Peru, in which a 7.6-millimetre calibre was used; that between China and Japan, in which a 7.9-millimetre was used on the Japanese side, and the more recent Chitral expeditions and Abyssinian cam paigns, in which 7.9-millimetre and 6.5 millimetre arms, respectively, were em ployed, were less destructive than the larger calibres, while the wounds caused by them healed with greater rapidity than those following lesion due to the action of larger balls. During the Chil ian War there were instances where men completely perforated through the chest would suffer from slight shock, a slight Incinoptysis, and soon be out.
This radical difference between the destructive power of large and small cali bres, or, rather, between the destructive effects of an arm such as the Chassepot {11 millimetres) and the modern rifle (6 to S millimetres), is mainly attributed the fact that lead was formerly em ployed in the manufacture of bullets; whereas, at present, in order to avoid destruction of the bullet during its prog ress through the barrel, resulting from the great increase of the powder-charge, and with the view of reducing the weight carried by the soldier, owing to the in troduction of repeating arms, the bullet itself is either made of some hard metal, or it is covered with some such substance as nickel, steel, German silver, etc.
These physical features, added to the smaller diameter of the projectile, the much greater velocity with which it travels, its more or less pointed tip, causes it to penetrate soft tissues as would a long, thin blade, separating rather than destroying them. There fore perforations in a muscle are clean cut; at times their walls are even col lapsed; as a rule, the channel is about the size of the bullet; large blood-vessels are severed and bleed until the heart ceases to beat, etc.