is to be attributed to an accidental attack of pneumonia unconnected with the wound altogether. It is also remarkable that the inflammation should have attacked the sound lung, and not the one already in a state of disease.

In whatever manner the fatal result is to be explained, there can be little doubt that the wound in the chest influenced, in a most serious and baneful manner, the last fatal attack of pneumonia terminating in gangrene of the lung.*

78th Regiment.-Private Walter Knox, wounded at Lucknow, October 29th, 1857, by a musket ball, which struck him on the right side of the chest, near the nipple; the wound sloughed, and some pieces of bone exfoliated, leaving the respiration much impaired. The man stated that he was struck by a portion of shell, and that for three days after receiving the wound he expectorated blood. He was admitted into hospital at Gravesend from the ship "Argo" in the last stage of debility. A large abscess had formed, extending from the nipple to nearly the crest of the ilium, with numerous openings, through some of which the fractured ends of the broken ribs and the points of the false ribs protruded. On the post-mortem examination it was found that there was no cicatrix or trace of injury to the lung in the position of the wound, but that the lower and posterior portions of the right lung were a mass of disease, studded with tubercles in different stages, with several cavities, varying from the size of an acorn downwards. There was no communication between the cavity of the thorax and the wound, nor with the abdomen; but the peritoneum was generally much thickened with adhesions, and that portion corresponding with the seat of the abscess was almost of a cartilaginous texture, and divided by the knife with much difficulty. Body reduced to nearly a skeleton; the wound with the sinuses extended from the nipple to the crest of the ilium; the ribs on either side were detached from the lower portion of the sternum, and on the right side the fractured ends and also the points of the false ribs protruded through the skin. Heart large; pericardium contained

*It is to be regretted that there is no record of the early treatment in these cases of perforating gunshot wounds of the thorax, as to whether venesection was prevalent to a great, or only to a moderate extent. Still, I am inclined to think that it was not resorted to. In the case of O'Neill no venesection was employed.

about half an ounce of greenish, straw-coloured fluid; liver healthy; the gall-bladder was loaded with bile; intestines healthy.

14th Light Dragoons.-Private John O'Neill, æt. 29 years, wounded, November 23rd, 1857, at Mundesand in the Deccan, by a musket ball in the right side of the chest; the ball entered posteriorly at the inferior angle of the scapula, five inches above the spinous processes of the vertebræ, apparently between the eighth and ninth ribs, and was cut out immediately after from the right nipple. It had broken a rib at its exit. He went some distance on his horse from the field, and bled considerably; at the time his respiration was almost gasping, his countenance anxious, and pulse very feeble. He was almost in a state of collapse, and was thought to be dying. He was kept at perfect rest, his chest bandaged, and opium administered; for some days this treatment was continued; he was fed on barley-water; the pulse became rapid, and breathing painful; tongue dry and brown; thirst always urgent. On the 28th the wound began to discharge healthy pus; he had no cough, nor did he expectorate blood. The skin became cooler, and tongue began to clean, though the pulse continued frequent; the bowels had not been relieved since the wound had been received. 30th.-1 oz. of castor-oil relieved the bowels, and he was carried a march in a dooley, and took light puddings, milk, &c. On the 4th December, 3 oz. of port wine; no medicine. On the 9th could sit up for a few minutes to have his wounds dressed; they were both closing. The ends of the fractured ribs could be plainly felt; he was now allowed a little chicken diet. On the 15th the wound in the nipple had healed; he had gained strength, although he was very much prostrated. The chest did not act much on the right side during inspiration. On the 20th he could walk a little about the hospital; the posterior wound had nearly closed; there was slight crepitation about the lung near the wound, readily heard by the stethoscope; tongue had become quite clean; appetite good, and pulse natural. The chest was tender on pressure over the track of the ball, and he could not exert himself without a dull pricking pain there. The right side of the chest still acted very imperfectly. On the 5th September, 1858, the wounds healed; respiration at entrance and

exit of ball, and along supposed track through the lung, normal; and percussion clear. September 8th.-Duty.

90th Regiment.-Patrick Farrell, æt. 24, wounded, November 17th, 1857, at Lucknow, by a musket ball in the right side of the chest; the ball entered over the angle of the ninth rib of the right side, and passed out half an inch from the spinous process of last dorsal vertebra; several pieces of bone came away from the aperture of exit; he spat up blood at the time and also on several occasions afterwards. On the 10th October, 1858, the wounds healed. It is difficult to say whether the internal organs were wounded or not, and if so, whether it was the lung or liver; respiratory murmur and percussion on this side normal. October 15th.-Duty.

2nd Battalion Rifles. - Private William Moore, æt. 37, wounded at Cawnpore, November 28th, 1857, by a musket ball, which penetrated the left side of the chest, three inches below and a little to the left of the nipple, and came out at a corresponding point, behind where it injured the rib. The man states that wind came out of the wound, and that he spat blood. July 13th, 1858.—The anterior wound is healed; the posterior is still discharging, and a piece of diseased bone can be felt. September 30th.-Duty.

Private James Moore, 75th Regiment, æt. 23. Wounded on the 18th July, 1857, at Delhi, by a musket ball, which entered the thorax, one inch and a half below and a little internal to left mammilla, and after a course of seven inches made its exit behind. The lung seems to have been wounded, but not deeply; abscesses formed in the track of the wound, and many fragments of rib were subsequently extracted. The lung seems to work well; the wound is quite sound, but tender to the touch along the whole track; percussion in the immediate neighbourhood of the wound is dull, and the respiratory murmur not very audible. He is stout and in excellent health. Sent to modified duty.

Private J. White, 3rd B. Rifles, æt. 23. Was wounded 8th October, 1858, at Sandelah, by a musket ball, which entered four and a half inches above the nipple, and one and a half to the right of the middle line in front, and made exit behind, about centre of body of scapula, four inches to the right of the

spine, wounding the lung; both wounds are soundly healed. The ball at entrance seems to have gone between the ribs, but at exit a hole in the scapula can still be felt. Had been previously wounded in the Crimea by a musket ball in left shoulder, which seems to produce a partial fracture of left scapula. The right lung now (two years after the injury) works well, but that side of the chest is scarcely so much expanded as the opposite; there is no dulness on percussion. He was not bled locally or generally. Invalided.

CHAPTER VI.

GUNSHOT WOUNDS OF THE DIAPHRAGM.

In the Report on the Medical and Surgical History of the British Army in the Crimea, vol. ii, page 317, it is stated that "it occasionally happened that both chest and belly had been wounded." One case is detailed, that of Dolan; and another is mentioned to have occurred in the 4th Regiment. The first died on the tenth day, and the other sixteen hours after being wounded; but no case is recorded where a hernia of the abdominal organs had taken place into the pleural cavity. There appears to be a doubt as to whether Corporal Burke, 18th Regiment, was a case of rupture of the diaphragm without an external wound.

In the case of Greenfield, from India, there is every reason to suppose that the diaphragm was wounded on the left side, as the wound into the chest was so low that it was difficult to say whether the food passed out from the œsophagus or from the stomach just at its entrance. In Private Falloon's case it is probable that there was a wound of the diaphragm on the right side.

When the diaphragm is wounded, the floating viscera of the abdomen sometimes pass into the pleural cavity, and Mr. Guthrie is of opinion "these wounds never heal, but remain open ever after. When the diaphragm is wounded in the neighbourhood of the liver or spleen, adhesions may take place so as to prevent hernial protrusion."

It is always worthy of note, whether the wound is on the left or the right side, as to the probability of a hernia occurring, this being more liable to take place on the left than the right side.

There are three specimens of this rare and interesting descrip