16th. Eight A.M.—The tendency to vomit continues. One grain and a half of chloride of mercury with a grain and a half of opium, made into a pill, to be taken in the morning; to be bled. Seven P.M.—Vomits whatever he swallows in any quantity; skin hot; thirst great; tongue red; two motions; says abdomen is not painful; pulse 112. A blister to be again applied to the epigastrium; foot-bath in the evening; repeat the mucilaginous mixture for cough.
17th.—Rested ill; blister has not risen; cough has been severe and continues so; two motions; pulse 120, and not soft; cough augmented by deep inspiration, and pain produced. Take blood from the arm to eight ounces; foot-bath in the evening; continue pill.
18th.—Bad night; cough gone; respiration easy; pulse 100; skin cool and moist; no thirst; one motion of a natural kind. Repeat mucilage and the calomel and opium pill.
24th.—Has this morning experienced a severe attack of dyspnœa, attended by cough and pain of chest, both increased by full inspiration. Pulse 120; face flushed; says he caught cold from exposure to the night air. Bled immediately, and as much blood taken as his strength would permit; foot-bath repeated in the evening.
25th.—Six ounces of blood drawn; surface buffy; bad night; cough, pain, and pyrexia abated this morning; in the evening severe dyspnœa; cough and pain of chest have recurred; pulse 120. Six ounces of blood to be drawn, should strength permit; mucilaginous mixture to be continued; another blister to be applied to the chest.
28th.—In a fair way of recovery; was discharged for England in June, with little or no complaint.
John Murray, Surgeon to the Forces.
Sergeant Matthews, of the 28th Regiment, was wounded at Waterloo by a musket-ball, about an inch below the umbilicus, a little to the right side, which lodged. He walked to a village in the rear, where he remained for three days, having been bled each day to fainting, before he was removed to Brussels, where my attention was particularly attracted to him, in consequence of his having passed the ball (a small rifle one) per anum, three days after his arrival, or the sixth from the receipt of the wound. The wound was healed by the end of August; and he felt so well that he marched to Paris with other convalescents, to joint his regiment. After some weeks he got drunk, and suffered from an attack of pain in the bowels, in the situation of the wound, requiring active treatment. On attempting one day to have a motion, he found, after many efforts, that something blocked up the anus, and on taking hold of and drawing it out, he found it was a portion of the waistband of his breeches, including a part of the button-hole—a fact verified by Staff-Surgeon Dease, who wrote to me an account of this peculiar case. After this the man recovered without further difficulty, although, as in all such cases, there was a herniary projection. He was afterward subject to costiveness, to pain in the part after a copious meal, probably from the stretching of the adhesions formed between the intestine and the abdominal peritoneum, which inclined him to bend his body forward to obtain relief.
In all such cases, the extraneous substance having lodged, and mainly injured in all probability the vitality of the part which assists in the lodgment, the ball becomes covered with a layer of coagulable lymph or fiber, capable of retaining it in its new situation, whence it is gradually removed by ulceration, or by the sloughing of the injured parts into the cavity of the bowel; much in the same manner as an abscess in the liver is evacuated into the duodenum or neighboring intestine, to which it may become attached. It is always fortunate when the canal from the external wound is cut off by the deposition of lymph, as it expedites the cure, and renders the injury less formidable; but if this should not take place, the contents of the bowel are discharged through it for a greater or shorter length of time, until the canal between the parts gradually closes, and cicatrization takes place, in default of which an artificial anus may remain in addition to the natural one, the functions of the bowels generally being performed with more or less difficulty.