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

COMMENTARIES
ON
SURGERY.

LECTURE I.

ON GUNSHOT WOUNDS, ETC.

1. A wound made by a musket-ball is essentially contused, and attended by more or less pain, according to the sensibility of the sufferer, and the manner in which he may be engaged at the moment of injury. A musket-ball will often pass through a fleshy part, causing only the sensation of a sudden and severe, although sometimes of a trifling blow. If it merely strike the same part without rupturing the skin, the pain is often great. Major King, of the Fusiliers, was killed at New Orleans by a musket-ball, which struck him on the pit of the stomach, leaving only the mark of a contusion.

2. Wounds from musket-balls, particularly of the face, sometimes bleed considerably at the moment of injury, and for some little time afterward, although no large vessel shall be injured to render the bleeding inconvenient or dangerous. The application of a tourniquet is then seldom if ever necessary, unless a vessel of some magnitude should be partially torn or divided.

3. When a limb is carried away by a cannon-shot, any destructive bleeding usually ceases with the faintness and failure of strength subsequent on the shock, and a hemorrhage thus spontaneously suppressed does not generally return; it is the effort of nature to save life. The application of a tourniquet is rarely necessary, unless as a precautionary measure, when it should be applied loosely, and the patient, or some one else, shown how to tighten it if necessary. A musket-ball will often pass so close to a large artery, without injuring it, as to lead to the belief that the vessel must have receded from the ball by its elasticity. A ball passed between the femoral artery and vein of a soldier at Toulouse without doing more injury than a contusion, but it gave rise to inflammation and closure of the vessels, followed by gangrene of the extremity. General Sir Lowry Cole was shot through the body at Salamanca, immediately below the left clavicle; a part of the first rib came away, and the artery at the wrist became, and remained, much diminished in size. General Sir Edward Packenham was shot through the neck on two different occasions, the track of each wound being apparently through the great vessels. The first wound gave him a curve in his neck, the second made it straight. His last unfortunate wound, at New Orleans, was directly through the common iliac artery, and killed him on the spot. Colonel Duckworth, of the 48th Regiment, received a ball through the edge of his leather stock, at Albuhera, which divided the carotid artery, and killed him almost instantaneously.

4. Secondary hemorrhage of any importance from small vessels does not often occur. On the separation of the contused parts, or sloughs, a little blood may be occasionally lost; but it is then generally caused by the impatience of the surgeon, or the irregularity of the patient, and seldom requires attention.

5. A large artery does sometimes give way by ulceration between the eighth and the twentieth days; but the proportion is not more than four cases in a thousand, requiring the application of a ligature; exclusive of those formidable injuries caused by broken bones, or the inordinate sloughing caused by hospital gangrene, when not properly treated.

6. A certain constitutional alarm or shock follows every serious wound, the continuance of which excites a suspicion of its dangerous nature, which nothing but its subsidence, and the absence of symptoms peculiar to the internal part presumed to be injured, should remove. The opinion given under such circumstances should be very guarded; for if this symptom of alarm should continue, great fears may be entertained of hidden mischief. Colonel Sir W. Myers was shot, at Albuhera, at the head of the Fusilier Brigade, at the moment of victory, by a musket-ball, which broke his thigh, and lodged. The continuance of the alarm and anxiety satisfied me it had done other mischief. He died next morning, of mortification of the intestines. General Sir Robert Crawford was wounded at the foot of the smaller breach at the storming of Ciudad Rodrigo, by a musket-ball, which entered the outer and back part of the shoulder, and came out at the axilla. There was a third wound, a small slit in the side, apparently too small to admit a ball. The continuance of the anxiety and alarm pointed out some hidden mischief, which I declared had taken place; and when he died his surgeon found the ball loose in his chest. It had been rolling about on his diaphragm. Surgery was not sufficiently advanced in those days to point out the situation, or to authorize an attempt for the removal of the ball. It must in future be done.

This constitutional alarm and derangement are not always present to so marked an extent. A soldier at Talavera was struck on the head by a twelve-pound shot, which drove some bone into, and some brain out of his head: he was walking about, complaining but little, immediately after the accident, although he died subsequently.