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the lung would have been disproved, if at death an examination had been performed. M. Baudeus, at page 226 of his Clinique, fully recognises this fact.
I venture to doubt even the evidence of the celebrated Larrey upon this point. He gives five cases of wounded in the lungs during the fights in July 1830. What is his proof? « Ce que s'est caracterisé par le passage, au dehors de l'air mêlé au sang, l'expectoration sanguine et tous les signes de l'épanchement." The little value I place upon these signs will appear in the course of this Treatise. In my opinion, in only two of the five cases were the lungs actually wounded. On the other hand, however, a case is given by the same writer (page 225) which occurred during the war in Egypt, in which recovery took place, and there was no doubt that the lung was wounded.
In estimating from the symptoms whether the lungs be, or be not, wounded in any one individual case, we should remember that the lungs may be wounded, and the ordinary symptoms altogether absent, from the wound entering exactly at a spot where, from previous adhesions, the lung is so firmly glued to the thoracic parietes, that it neither collapses, nor can effusion take place, nor much blood nor air escape.
There is a case, however, mentioned in the Medical Times, of 20th August, 1847, of a stab wound, where it appears certain that the lung was wounded, and recovery took place : also, another
case is recorded by Sir Everard Home, in the second volume of the Medico-Chirurgical Knowledge Society, page 169, where an officer was shot through the chest, and lived for thirty-two years afterwards. The post mortem examination showed that both lungs had been wounded. Dr. McLeod, in his notes at page 248, speaks of several cases of recovery. The following case, published in the British Medical Journal, of 15th May, 1858, probably has been cited as a case of cure :
“ William L., age 24, late a private in the 33rd Regiment, and who died in the University College Hospital, towards the end of April, 1858, was wounded in the attack on the Redan in September 1855, and when invalided, was considered a decided case of recovery from a wound of the lung. 66 The ball was found to have entered the left side, and wounded the lower lobe of the left lung, passed through the diaphragm, took a piece out of the anterior margin of the spleen, passed behind the pancreas, across the left kidney, and through between the supra-renal capsule and kidney, without injuring either, and into the vertebral column, scraping a piece out of the vertebra, turned a little forward, passed close to, and behind the aorta, and finally lodged behind the vena cava.” It was noticed that the wound in the diaphragm had not healed. The preparation is in the University College Museum, and a careful inspection has been made of it. It may well be doubted whether the
substance of the lung had been wounded : at all events, the injury must have been very slight, in fact, merely marginal. It is probable that the slight laceration visible may have resulted in the act of removing the lung from its cavity, it having been strongly adherent.
A remarkable case occurred, in the Regimental Hospital of the Grenadier Guards, under the care of Mr. Blenkins. The ball entered near the angle of the right scapula, and made exit at the sternal end of the clavicle. It had passed through the apex of the lung. A deposit of lymph was seen in the track. A complete circumscribed pleuritic adhesion had been formed near the wound, separating the diseased from the healthy structure. The ball had passed between the subclavian artery and vein, wounding the latter. Phlebitis ensued, and except from this untoward occurrence, Mr. Blenkins considers that the wound of the lung would have healed.
The older writers held in great dread an opening into the pleural sac, and viewed that event as almost certainly fatal, thinking that it could scarcely occur without the lung also being wounded. I am satisfied that the lung frequently escapes in penetrating wounds of the chest, and that a simple wound of the pleura is not of necessity productive of dangerous consequences, unless under circumstances to be hereafter mentioned.
Several of my cases and experiments show this ; and an experiment by Hewson, at page 296, is well in point: “I fractured the chest of a rabbit, but so cautiously as not to hurt the lungs; and having blown into the chest, I immediately made a compression upon the wound with some lint, a compress, and a bandage, in order to confine the air in the cavity of the thorax. I then observed that the animal breathed more frequently and laboriously; on removing the compress, the air rushed out, and the animal gradually recovered its natural manner of breathing. In a few days, it was perfectly well.”
In concluding this chapter, I cannot but remark on the fact of the small number of penetrating wounds of the chest recorded in our English periodical literature. Thus, in Table No. 6, I have given, I believe, all the cases reported in the Lancet, Medical Times, Medical Gazette, and Medico-Chirurgical Transactions from their commencement.
August 11.... 1832 page 604
350 Augunt 14.... 1841 , 724 May !) ...... 1846
The MEDICO-CHIRURGICAL TRANSACTIONS :
Vol. VII...... 1825 page 315
» ...... 1842 , 615
March 29 .... 1828 page 512
October 18 .. 1850 713
April 6 ...... 1844 - 21
December 17.. 1853 „ 638
604 No less remarkable is the small number of preparations of lung wounds to be found in our Hospital Museums. For example; at the College of Surgeons, there are but 7; at St. Thomas's Hospital, 3 ; at St. George's, 2; at University College, but 1; and at Chatham Museum, not one.