In gunshot wounds, the brain, the lungs, and the liver are often injured when the wound is quite remote. See Larrey's Sccount of General Caffarelli, Duke of Montebello, lkc. The wind of a ball, as it is termed, is now completely established to depend on the projectile striking the body, but not producing any apparent injury of the skin; many interesting cases of which are related by Schmucker, Hennen, and Guthrie.
Tetanus, which has been already described in the article MEDICINE, VOL XIII. p. 16, supervenes more frequently to wounds made by pieces of shell, langrage, and splinters of wood, than any other kind of missiles, and is then termed traumatic. See Larrey's Military Memoirs, and Si r J. M'Gregor's Observations on the Peninsular War.
Barons Percy and Larrey invented flying ambu lance, that of the latter great surgeon being evi dently the better; it consisted in an admirable ar rangement of surgeons, assistants, soldiers, officers, instruments, and medicines, all at a moment's command, to afford immediate assistance to the wounded, even while under the fire of the enemy. They followed the advanced guard, and the instant a soldier was wounded, he was dressed, or had his limb amputated on the spot, and then put into a light covered wagon, which conducted him to the hospitals in advance. The number of people attached to each division of ambulance amounted to 113, and consisted of one staff surgeon, two staff assistants, twelve assistants, two of the latter of whom did the duty of apothecaries; a lieutenant to command the economy of the division, but under the orders of the staff surgeon; a sub-lieutenant, who was inspector of the police of this division; a serjeant-major; two serjeants;' a trumpeter, who also carried the instruments; twelve horse soldiers, among whom was a farrier, a shoemaker, and a coachmaker; an inferior or deputy commissary; two provision searchers; three corporals; a drum mer, who also took charge of the surgery; twenty five soldiers; twelve light cars or covered wagons capable of being driven on all kinds of ground, with the exception of a very steep hill; four heavier car riages. The light cars were mounted, some on two, and others on four wheels.
In the explosion of gunpowder, an individual is commonly scalded as if with boiling water, but occasionally so severely injured as to be instantly deprived of life. Burns differ in the extent of the surface injured, in the depths of the parts destroyed, and in the vitality of those parts; these three being equally destructive. In cases where
the injury is confined to the integuments, there is no difference between it and that inflicted with boiling water, oil, or lead, or that caused by sliding down a rope from a height, or being by falling from a height along a stone wall; one and all of these evidently may be referred to contused wounds, and since they have no mysterious cha racter, require the same kind or mode of treatment; for on no subject of surgery does there exist more contrariety in the treatment, from the high au thority of Dr. Thomson to the whimsical doctrines of our worthy citizen Mr. Cleghorn the brewer. Burns or scalds should be treated like contused wounds; and when they become ulcers, like these affections, and if they advance to mortification, the same as it; for according to the extent of in jury do they inflame, suppurate and mortify, and involve the constitution. The practice long pur sued in the Greek islands, in America, and now in this country, of enveloping the scalded or burned surface with raw cotton, or the wadding employed in ladies' dresses, is truly an invaluable and soothing remedy. It seems to act by excluding the external air, in the same way as when vesication takes place and left alone, no pain is felt, but whenever the vesicle is freely laid open, the pain is most severe: in vesication, therefore, a small puncture should be made to evacuate the serous fluid. Powdered chalk, and flour out of the cook's dredge box, so ably advocated at present, act on the same prin ciple as the cotton. In extensive scalds or burns, there is generally great prostration of the vital powers, and if the patient rallies, violent reaction follows; occasionally wild delirium and coma; at other times an oppressive difficulty in breathing; in other instances inflammation of the mucous membrane of the alimentary canal, in others, hy drocephalus supervenes. When the grains of gun powder are lodged in the skin of the face, they may be removed by a needle. In the healing of extensive burns, great attention should be paid that no unnatural adhesions or contractions of the in teguments occur, as the union of the fingers, or of the chin to the neck, or of the latter being twisted to one side. The eye-lids, particularly the lower, is occasionally allowed to adhere to the cheek so as to form ectropium.