(146) Entry, in the fourth right interspace, 3 inches from the middle line; exit, in the seventh left interspace, in the mid-axillary line. This wound was received at a distance of 500-600 yards, but the bullet penetrated both sides of a stout silver cigarette case and some cigarettes before entering the body. There were minor signs of pulmonary injury, 'coughing day and night,' and slight discoloration of the sputum on three or four occasions. The respirations were quickened to 32, and as much as ten days after the injury the pulse only beat 48 to the minute; it then rose to 56, but beat in a very deliberate manner.
In other cases the signs were almost nil.
(147) Entry, in the fourth right intercostal space 3/4 of an inch from the sternum; exit, in the sixth left interspace in the posterior axillary line. This patient had no symptoms, beyond quickening of the pulse to 100, and a 'feeling of tightness at the heart.' He shortly returned to active duty.
(148) Entry, situated in the third right interspace 3 inches from the sternal margin; exit, in the fourth left space 2¾ inches from the sternal margin. In this case the bullet without doubt passed through the anterior mediastinum, and slight injury to the lung was evidenced by transient hæmoptysis.
Some remarks regarding wounds of the thoracic vessels have already been made in Chapter IV., where instances of injury to the innominate and left subclavian arteries are recounted. The escape of the large trunks was generally quite as astonishing as in other parts of the body, especially in the superior mediastinum.
(149) Entry, over the first right intercostal space beneath the centre of the clavicle; exit, at left anterior axillary fold. The great vessels must have been crossed here in immediate contact, and considerable hæmorrhage from the wound of entry caused great anxiety; this ceased spontaneously, however, and, beyond transient hæmoptysis and a right pneumo-thorax, no further trouble occurred.
(150) Entry, in the ninth interspace, just anterior to the anterior axillary line; exit, through the right half of the sternum, 1/2 an inch below the upper border. No primary hæmorrhage of importance followed, but I believe this patient subsequently died. The wound was received at a range of within fifty yards.
Wounds of the lungs.—Numerically, pulmonary wounds formed the most important series of visceral injuries met with in the thorax, the frequency of incidence corresponding with the proportionate sectional area occupied by the organs. Although these injuries did well, and needed little interference on the part of the surgeon, many points of interest were raised by them.
Thus the comparative importance of the wound in the chest-wall to that in the lung itself, was scarcely what, without actual experience, would have been expected, the former proving so very much the more important element of the two.
The question of velocity on the part of the bullet took a very secondary position in these injuries. I saw a number of cases in which the patients estimated the range at which they received their wounds as from 30 to 50 yards, and although some of the wounds were of a severe type, the increased gravity depended rather on the injury to the chest-wall than to that of the lung. If the bullet passed by the intercostal space, avoiding the rib, I very much doubt if the relative velocity was of any importance, further than from the fact that a sufficiently low degree to allow of lodgment of the bullet was distinctly unfavourable.