Report on gun-shot and sabre wounds of invalids sent to Fort Pitt during the years 1860-61 / by Thomas Longmore.

  • Longmore, Sir Thomas, 1816-1895.
Date:
[1863]
Catalogue details

Licence: Public Domain Mark

Credit: Report on gun-shot and sabre wounds of invalids sent to Fort Pitt during the years 1860-61 / by Thomas Longmore. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    from pleurisy, felt—particularly at the bottom of the left pleural cavity. According to statement, the dyspnoea was very severe for about a week, and the patient was told he had been constantly wanderin|? during that period, iixpectoratiou of blood and the pleuritic symptoms continued for about a fort- night. The wound healed in about six weeks. Local application of lint to the wound of the shoulder was the only treatment: no venesection was practised. After all active symptoms had subsided, tonics were administered. The following was the state of the chest noted on his admission at Fort Pitt: There is an appearance of fulness of the left supra and infra clavicular regions, but the girth of each side of the cliest on measurement is nearly equal. No flattening observable. Very slight differential dulness is noted on per- cussing the left side, near the apex of lung; but the vesicular respiratory sound is normal throughout. The chest expands well on botli sides. Tlie man states that he cannot bear the pressure of belts across the chest, and that any fettering in its movements, when he is under exertion, causes much feeling of oppression. He states also, that he has some stiflFness about the shoulder and tenderness on pressure in tlie neighbourhood of the cicatrix. A small conical exostosis can be felt almost immediately below the cicatrix, projecting from one side of the bicipital groove. The bone was probably struck by the ball in this situation. There are many points of importance in this case. A recovery, after an undoubted wound of the lung, so perfect that the respiratory murmur sliouId be left normal throughout the organ, without any depletion by venesection having been liad recourse to, is a fact that would have been regarded as little short of an impossibility in the time of the Peninsular campaigns. It serves, however, to strengthen the experience afforded by several similar cases which occurred during the Crimean war. It seems not unworthy of consideration how far the partial collapse of the lung, whicli must have been caused by the pneumo-thorax in this instance, may have prevented general adhesion between the pulmonic and costal pleui'EB, and modified other accidental consequences which are not unfrequently found to attend chest-wounds involving the organs of respiration. This case also affords an example of lodgment of a bullet in the chest—pro- bably in the lower part of the pleural cavity. The fact that the pleuiitic pain was referred chiefly to this situation, notwitiistanding its remoteness from the site of injury—and this, too, almost immedialy after the wound was received,— points to this conclusion. The bullet is now probably fixed by lympth thrown out at the time the pleural membrane was in a state of inflammation ; so that its presence is not rendered perceptible by changes of posture. A sergeant of the 4Ist Regiment was wounded in the trenches before Sebastopol by a rifle- ball, which passed through the apex of the left lung, and fell to the bottom of the pleural cavity. He survived the wound ten days. At the post mortem ex- amination the bullet was found embedded in lymph on the upper surface of the cms of the diaphragm. Mr. Guthrie and others have recorded similar cases. The next two cases are illustrations of perforating wounds. The first occurred to Private William Moore, aged 41 years, 2nd Battalion Rifle Brigade, of 20 years' service, and the i'ollowing are the notes taken on his aduiission at Fort Pitt on July ]2th, 1861 : When engaged in loading his rifle on the 28th of November, 1857, at Cawnpore, lie was wounded in the lower part of the left side of chest by a musket-ball. The projectile was fired from a dis- tance of about seven or eight yards by a Sepoy, who was standing on the same level as himself, but a little to his left. The ball entered about three inches below the left nipple, and two and a quarter to the left of the mamillary line, fractured the eighth and ninth ribs, and made exit on the same level, six inches external to the spine, fracturing the tenth rib in passing out. His stomach was (a provision which no surgeon in tlie field should be without), and he was kind enough to lot me peiiise tlio notes which ho then made. These confirmed tlio accoimt of the case given above, especially tlio pleuritic pain at the lower part of the chest (about the eleventh or twelflh rib), and tho extent of the cmpli.ysoma. Mr. Murray said tliat there was a ronmrkablo abscuoo of symptoms in tho liirther progi-ess of'this case, and that had it not boon for (ho expectoration of blood and emphysema, no one woidd linvo believed tho lung had boon woimdod.