A grenadier was wounded at the battle of Dettingen, in 1743, by a musket-ball, which entered above Poupart’s ligament, near the opening of the external oblique muscle on the left side, and lodged. Thirteen days after his reception into the hospital at Landau, La Motte felt with the probe what he thought was the ball lying on the outside of the psoas muscle against the bone. He made the patient lie on his face, and touched the foreign body every day in order to loosen it. On the thirty-fifth day he was satisfied it was the ball, and on the forty-fifth, after many attempts, it was at last extracted. His fifty-second observation relates to a case as nearly similar as possible to those of Sir H. Packenham and Colonel Wade. He made several deep and long incisions in search of the ball, which he could not find; the wound became fistulous, and at the end of a year closed, in all probability to reopen from time to time.
The difference in practice between 1743 and 1855 ought to be, that in 1855 the ball should be found first, and the deep and long incisions made afterward for its extraction; which do not preclude any previous external openings that may be necessary to facilitate the first examination.
Captain Campbell was wounded by a pistol-ball, on the 5th of September, 1805; it penetrated the abdomen on the middle of the right side, and was extracted from nearly the same situation on the left; from its irregular denticulated shape, it would appear to have impinged against a vertebra. He complained of violent pain in the loins and belly, with numbness and pain of the left leg and thigh, and suffered also from the greatest oppression, anxiety, and sickness. An enema was administered, and twenty-four ounces of blood were taken from the arm; lower extremities nearly paralyzed; anxiety and oppression great at night. Blood-letting to ten ounces. Cannot pass his urine; hot fomentations; and at twelve at night sixteen more ounces of blood were drawn. At three P.M., had three motions, the two last containing apparently a pint of pure blood. Pain and other symptoms being urgent, eight ounces more blood were taken away. At six P.M., passed urine for the first time, highly tinged with blood; has had two motions, also mixed with blood. Pain continuing, ten ounces of blood were abstracted, although occasionally almost fainting on any movement; belly fomented. At eight at night, sixty drops of laudanum. At ten, being very restless, twenty drops more, which procured some sleep, although he vomited frequently; belly relieved by the fomentation; three stools mixed with blood.
Sept. 6th.—All the symptoms relieved; passes blood with his urine; sickness and vomiting troublesome; pulse 90, rather firm than feeble. One o’clock.—Complains of violent pain in the left leg and thigh, belly, and loins; pulse 116, full and strong. Blood-letting to sixteen ounces. Barley-water with niter for common drink. Six P.M.—Pulse 96; bowels open, with discharge of blood; symptoms generally relieved. Tincture of opium, twelve drops at night.
8th.—Slept better; less pain; paralysis continues. In the evening symptoms aggravated; lost twelve ounces of blood; enema, etc. repeated; pulse 120.
9th, 10th, 11th, 12th.—Pulse 96; bowels open; urine bloody; is generally better.
15th.—Wound of exit healed; urine bloody; bowels open. Chicken-broth for the first time.
20th.—The opening of entrance having nearly closed was enlarged, and a free exit allowed for the matter.
Oct. 20th.—Wounds quite closed; is free from pain, is able to move about the house on crutches; warm, stimulating applications to the limbs seem to have given most relief.
Nov. 20th.—Paralytic affection gone; he can now mount his horse, and has only a feeling of numbness and torpor in the left leg and thigh.