Fragilitas ossium may be considered the opposite of mollities, although, according to Boyer, the two diseases are combined. In this, there is a super abundance of the phosphate of lime in the bones, and hence it occurs in advanced life, and in either the syphilitic, scorbutic, arthritic, cancerous, scro fulous, or rachitie constitutions, and therefore symp tomatic of some other disease. It is only in the scorbutic and syphilitic cases that any hopes of cure, always very doubtful, can be held out. Saviard details a very remarkable case of this disease, where all the bones after death crumbled under the fingers. Anchylosis, the last remaining disease of the bones, has been already described under affections of the joints, a result much to be desired on many occa sions; but it has occurred without any marked in creased action, as in the extraordinary case of Clark, detailed in the forty-first volume of the Phil. Trans. where all the bones, from the crown of the head to the sole of the foot, were completely soldered together, and whose skeleton is still pre served in the Museum of the College of Surgeons of Dublin.
This species or variety of wounds has ever been considered an important branch of surgery, either in military, naval, or private practice. These wounds are considered by systematic writers to be essentially different from all other kinds of wounds, and to require a different kind of treatment, as men tioned by J. Bell and Mr. Guthrie; but we contend, that they in no degree differ from contused wounds, and demand precisely the same kind of treatment. If a round stone or bullet is thrown from a sling, as in the days of Celsus, with the same velocity with which a musket bullet is fired, it will inflict precisely the same kind of wound; besides, we know there is no difference between the wound inflicted with an air gun, and that exploded with powder. It would appear that the whimsical notions of the writers on surgery before Pare", who conceived that musket bullets were poisonous, still haunt us. If the above be correct, it is easy to apply the same reasoning with respect to all the variety of gunshot wounds, and it consequently follows, that these wounds differ in no degree from contused wounds caused by stones and other foreign bodies, but in the contusion which the rapidity of the projectile produces. When a person is wounded with a musket bullet within half or quarter musket shot, the missile will most pro bably pass through the body, and there are then two wounds with a long sinuous tube between them; the aperture made by the entrance of the bullet is of a livid ecchymosed colour, is depressed inwards or indented, and smaller and rounder than that made by its exit, which is rugged and lacerated, having everted edges. These, however, sometimes vary,
the exit appearing a mere slit, and in cases where the musket has been close to the wounded person, the entrance is as rugged and everted as the exit; much, therefore, depends on the velocity of the_pro jectile, and the medium of the resisting body. Bullets run most circuitous routes in the body, if their course is diverted by a bone, and the position of the patient when wounded may throw light on this point. Bullets flying with great velocity and striking a part of the body which is clothed, seldom carry the clothes before them; the reverse, however, occurs if they are nearly spent in their career. If, therefore, this projectile has passed through the calf of the leg, or any other fleshy part, there will be little or no pain in consequence of the parts being chemosed, and no bleeding, because the blood-vessels are of small diameter and cau terized; but if the bullet is nearly spent, or has been rendered rugged, which is a very common occur rence, there will be some bleeding both from the arteries and veins. The treatment is to confine the patient to bed, and to apply poultices or fomenta tions to the leg, from the knee downwards, with the view of moderating or subduing the consequent in flammation, and of restoring the contused part to a healthy condition. The chemosed tube must sup purate and granulate to a certain extent, conse quently poultices correspond most with the theories, opinions, principles and practices of all writers, even of Mr. Guthrie, who condemns them. After all inflammation has been subdued and suppuration established, the wound should be syringed with cold water, and simple dressings, and gentle bandaging applied. For the after treatment the reader is referred to ulcers. The diet is to be regulated according to circumstances. Sometimes only the part which is first struck with the bullet suppurates, being the most contused; while the rest of the tube unites by the first intention. If pieces of the clothes are carried into the wound, and far from either aperture, they should he left alone until suppuration is completely esL Wished; but if near either of its apertures, they should be extracted. In some cases they are carried before the bullet, so as to resemble a purse, and are then removed with facility along with the bullet. The course of the bullet should, if possible, be ascertained, in order to calculate whether any important artery is wounded, or bone fractured, in which case the patient, by endeavour ing to recollect the attitude he was in when wounded, may facilitate our inquiry.