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Show 256 or Woounzn Anremas. .0! THE SEAT OF THE VITAL PARTS IN THE CHEST. artery. I see a man wounded where the ball has entered by the side of the insertion of the deltoid muscle, and passed out by the back of the arm, it must have gone betwixt the bone and the artery. I see another just brought in where the ham-string tendons are perforated, and it is miraculous that the popliteal artery could escape ; yet in these instances no blood flowed on the coming away of the sloughs." " I have noticed to day a great many wounded in the axilla, some where the ball has lodged, some where it has pass- ed through. I see a wound where the ball has taken off the preputium, and passed into the thigh, and over the femoral artery, and there was bleeding as I imagine from the ramus inguinalis magnus, but there is no secondary hmmorr- huge." " In the next bed a. lad lies wounded on the inner condyle of the humerus ; he was on the retreat, the firelock .mi.",o.v-- throw. mar - -‘ ' * <- mm, trailed, he received the ball on the inner condyle of the humerus, it was cut out upon the biceps, how did the artery escape? My inquiries were at last suspendedii‘. I found no instance of secondary haemorrhagy. I began to think it was equally incorrect to say that every artery touched with a ball must slough and bleed, as it is to say that every bone touched by a" ball must exfoliate." In examining these fine fellows it was often exclaimed among us, how could the artery escape here? I can only suppose that the artery is the most limber and elastic, and (being a tube) the most compressible of any part in the limb, and that by its yielding to the push of the cellular membrane before the ball, it escapes the degree of attrition which would destroy life, when any thing opposing more resist- ance would inevitably sufl‘er. 257 nor to the reasoning upon it. I only offer these observa~ tions as some relief to the anxiety from such a sentence as this :-" The patient lying easy even for ten days, is no security that in the end he shall not bleed to death." When large sloughs hang from the wound, when bags of matter form among the muscles, &c. in the tract of cellular mem. brane which accompanies the arteries, (a very frequent consequence of gun-shot, especially if the bone is injured) we must not consider all this extensive loss of substance as the of feet of the contusion of the ball, nor the bursting out of blood as the consequence of the ball brushing by the artery. This case is in no respect different from the secondary hmmorrhagy after amputation, when there is a sloughing stump. I acknowledge that these introductory observations to the following description of the manner of taking up the arteries, when out in wounds, have been extended to a great comparative length ; but I hope my reader will make the best use of the error, if it be one, and learn to consider it as a much more difficult thing to determine on the propriety of an operation than to do it. OF THE SEAT OF THE VITAL PARTS IN THE THORAX. A menu made with a small sword on the left side of the chest, immediately above the seventh rib, perpendicularly to the convexity of the chest, will pass through the diaphragm into the stomach, the heart escaping. A thrust immediately above the left pap, and above the fifth rib, perpendicularly to the surface of the chest, transfixes the body of the left ventricle of the heart, perforatingjhe an- Let my ‘i‘eader, however, beware of the injunction in Mr. , va‘fl‘} uw‘Mu-w ,. a»; i. Hunter's work, p. 525, regarding the sloughing of arteries and secondary hwmorrhag . I neither object to the fact " Let me here intrcat those of my pupils who have been in Spain or Portugal, or who have had opportunities of watching their patients on the shot-holes becoming moist and the slough coming away, to satisfy me further on this head terior and extreme margin of the right. A thrust made perpendicularly to the convexity of the chest, immediately under the anterior head of the fifth rib, will pass through the anterior edge of the right lung, and pierce the apex of the heart. Perpendicularly to the convexity of the right side of the chest, and immediately below the anterior head of the third vor. 11. .‘1. . "Agra". K 2 WA rem" 1'. " w 0N) |