Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

5th.—Passed a sleepless night, and was evidently suffering from considerable internal mischief; wandered occasionally; pulse quick, 120, and small; felt very weak and desponding. A little light, red wine given, with beef-tea and bread; opium night and morning.

6th and 7th.—Much the same; pulse always quick, with much general irritability.

15th.—The wounds discharged considerably, particularly the posterior one; has a little cough; pulse continues very quick; spasms of the diaphragm troubled him for the first time, and caused great pain and uneasiness; they were relieved by opium in large and repeated doses.

On the 18th the spasmodic affection of the diaphragm and the pain returned with great violence, so as to threaten his dissolution, which took place on the 20th.

On examination, I found that the ball had passed through the under part of the inferior lobe of the left lung, and through the pericardium under the heart, through the tendinous part of the diaphragm, and into the liver, before it made its exit. The wound in the lung was suppurating; the matter and fluid from the cavity of the chest had a free discharge by the shot-hole; the edges of the wound in the diaphragm were smooth as if cicatrized, leaving between them an elliptical opening an inch long. The injury to the liver was through the substance of the anterior part of its right lobe; the matter having a free discharge, and generally slightly yellow, as if tinged with bile in small quantity. The skin did not show a yellowish tinge, neither were the conjunctivæ discolored.

A soldier of the 23d Regiment was wounded at the same affair, by a musket-ball, on the right side; it fractured the sixth rib, from three to four inches from the sternum, and passed out behind, between the ninth and tenth ribs, near the spine. The rib being fractured, the splinters were removed after an enlargement of the wound by incision, when the opening into the cavity of the chest was manifest, air being discharged freely from it. The shock in the first instance was great; but after a time reaction took place, and he lost a considerable quantity of blood in six bleedings during the first sixty hours. The discharge, at first serous and bloody, gradually became purulent, and the occurrence of jaundice showed that the diaphragm and liver had in all probability been injured. Under the administration of calomel, antimony, and opium, this symptom was gradually disappearing, when I left him to rejoin the army. He was sent to the rear at the end of ten weeks nearly well.

On the day preceding the battle of Fuentes d’Onor, in 1811, Sergeant Barry was wounded in the chest. The ball entered close to the nipple of the left breast, and passed out at the back, between the eighth and ninth ribs. The anterior opening of the wound soon healed, but the posterior one did not do so for a considerable period, when he became affected by such severe cough, with expectoration, that his medical attendant deemed it proper to reopen it. The symptoms were relieved, and portions of his shirt and jacket were discharged. After this his health improved so rapidly as to enable him soon to rejoin his corps. The wound in the back repeatedly opened and healed—generally at intervals of twelve or fourteen months; but for five or six years it ceased to do so. His appetite was small and delicate; flatulence was much complained of; and if the stomach at any time happened to be overloaded, vomiting occurred. He died of mortification of the left leg, January 4th, 1833.

On examination, the whole of the stomach and the greater part of the transverse arch of the colon were found in the left cavity of the chest, having passed through an opening in the diaphragm extending about three inches in a transverse direction, near the center of the dorsal attachments of that muscle. The peritoneum lining the diaphragm was firmly attached to the parts passing through it.

The wound in this instance was through muscular, not tendinous parts. The preparation is in the museum at Chatham, No. 63, Class 6.

A French soldier was admitted into the Gensd’armerie Hospital at Brussels, in consequence of a wound from a musket-ball, at the battle of Waterloo, which entered behind between the eighth and ninth ribs, near the spine, and lodged internally. After many severe symptoms and much suffering, he died on the 1st of December, worn out by the discharge, which often amounted to a pint daily, for the free exit of which the external wound had been early enlarged. On examination, the lung was slightly ulcerated on its surface, opposite to where the ball had entered, and a little matter contained in a sac had formed between it and the wall of the chest. That the ball had gone on was proved by the fact of there being an opening in the tendinous part of the diaphragm, through which a portion of the stomach had passed into the chest, from which it was easily withdrawn. The ball could not be found in the abdomen; in all probability, it had passed into the intestine and had been discharged per anum, as has happened in other instances.