Experiments on dead bodies seemed to show that very different effects were to be expected as soon as any resistance was offered to the passage of the bullet. When the skull was struck even at long range (1100 metres, Kocher), for in stance, the brain was completely disor ganized and the skull was fractured in all directions, while at short range ex plosion of the head might be said to have taken place. But experiments on dead bodies are now known to furnish but little accurate information as regards the effect of projectiles, the living tissues being affected differently. At short range destructive effects on soft and hard tissues are produced, but these do not vary from those by older weapons at equal distances.
Accepting only as evidence that fur nished by the use of small-calibre bullets on the living, it may be said that the arms now furnished to armies do not give rise to injuries such as those met with in civil life, when weapons of vari ous kinds, imparting to bullets a much smaller velocity, are used.
It is evident, judging by the practical evidence at present at our disposal, that military gunshot wounds cannot be con sidered absolutely as belonging to the category reviewed in this article. But it is only a question of degree as to the injuries inflicted, and the military sur geon, by exercising his usual powers of discernment, will find a larger number of curable eases, whenever the severe hwmorrhages frequently attending the use of these new weapons will not have caused death soon after the receipt of the injury.
Wounds of the thorax and abdomen divide themselves into penetrating and perforating. It must not be forgotten that a slight luemoptysis may accom pany the first type, from the mere im pact of the blow. In all wounds the probe is always contra-indieated. As to the prognosis of chest wounds, sta tistics are very pessimistic, for, unless the cases die within the first two or three hours or are killed by meddlesome surgery, they recover in a vast majority of cases. It is certain that here a masterly inactivity should characterize the operator. In dealing with lodged balls the author cannot do better than quote Abernethy, who, in speaking to his students, said that when Sir Ralph Abercrombie, who had received a bullet in the thigh, was placed under the sur geon's care. "they groped and they groped and they groped, and Sir Ralph died." It must be remembered that per forating wounds of the abdomen do not in many cases enter through the ab dominal wall. have entered via the pelvis or the chest. In wounds above the umbilicus, probably, there are 3 per cent. which penetrate without per forating. The direction of the bullet has importance, the antero-posterior being better than the oblique, and these, in turn, being more favorable than the flank-to-flank type. Prognosis is based properly upon the statistics of many cases. These in general show that un operated cases give a 55-per-eent. mor tality. In patients operated upon dur ing the first 4 hours, there is but 15 per cent.; in 4 to S hours, 44 per cent.; in 9 to 12 hours, G3 per cent.; after 12 hours, 70 per cent. The speaker emphasizes the importance of early diagnosis. Faecal extravasation usually
does not occur until after the fourth hour. This is due partly to the in testinal paresis resulting from the im pact. The treatment is to cover the wound and not handle it too much. Infusion of very free type and equally generous drainage, particularly in civil practice, are both indicated. injuries of the posterior cavity call for posterior drainage. Seeking the ball is contra indicated; unless, indeed, it comes into view without effort, it should be let alone. (William L. Rodman.) Alany men are led astray by the old and erroneous teaching that the circuit ous route in the abdomen is an utter impossibility. It may chance that a spent bullet striking the skull may be deflected by the bone, but no bullet can be turned aside by the soft viscera. Another point is that the shape of the abdomen is constantly changing. It is by no means difficult to place an athlete in such a position of strain that the anterior abdominal wall is in contact with the backbone. This, no doubt, explains the anomalous conditions where bullets have traversed the abdomen without injuring the viscera. (Mc (iraw.) Army surgeons are averse to early operations on the field. The fact that officers who had lain in the open for twenty-four hours with no care save a protective dressing, with absolutely no food or drink. have recovered. is in structive; it may very likely be that such absence of eating or drinking is a desideratum. (Grant.) The import a nee of veil e,ection in in cipient pneumonia following bullet wounds should not he overlooked. Shock is entirely distinct from Inemor rhage. (Roberts.) All-important treatment in the ease of chest wounds is absolute costal im mobilization. The manner of accom plishing this is to put on a east of either plaster of Paris or rubber plaster, extending from the umbilicus to and over the shoulders. (Ochsner.) The prognosis depends very materially on whether the viscera are full or empty. If (:mpty. the same forces which when full extrude food close the wound. The value of aseptic food has been al together overestimated. for the alimen tary canal contains about every known pus-producing It is the in ju•y to the mucous membrane which kills the patient. (Laplace.) In controlling the hwinorrhage from chest, wounds a most valuable method was that of eording three extremities for fifteen minutes, then passing on to the fourth. alternating in this way for several hours. It serves the same pose as venesection, but preserves the blood. The author has heard from a great many of his old students, who have been operating in the Philippines and Cuba, and gave their reports to him in detail. They agreed that on the tlefield operations cannot be done canse of the absence of two essentials: tire and water. The value of morphine, pushed to its limit, which constitutes a opium splint and which makes the patient comfortable, is ably a very important factor in saving (1)a w ba rn. ) Proc. Amer. Med. Assoc. (N. Y. Jour., June 14, 1002).
Our recent campaign has but verified the teachings just outlined.