FREE BOOKS

Author's List




PREV.   NEXT  
|<   327   328   329   330   331   332   333   334   335   336   337   338   339   340   341   342   343   344   345   346   347   348   349   350   351  
352   353   354   355   356   357   358   359   360   361   362   363   364   365   366   367   368   369   370   371   372   373   374   375   376   >>   >|  
no doubt could exist as to the perforation of the lung. As a rule, a considerable quantity of blood might be coughed up shortly after the injury; but I never knew this to be sufficient in amount to give rise to any misgivings as to danger from the haemorrhage. After the first evacuation of blood from the wounded lung, the sign varied much; in the majority of instances the patients continued to expectorate small quantities of blood mixed with mucus, for some three or four days, the blood gradually assuming a coagulated condition. Sometimes only the primary haemoptysis was noted, and still more rarely the expectoration of clots was continued for a week, or even longer. This probably depended partly on personal idiosyncrasy, partly on the size of the vessels which had been implicated in the track. Cough was not commonly the troublesome symptom noted in the contused wounds of the lung seen in civil practice accompanying fracture of the ribs. Moist sounds were usually audible on auscultation, but in many cases over a very limited area and only on the first few days. Cellular emphysema was distinctly rare, and usually limited in extent: thus I saw it in the posterior triangle of the neck alone in an apical wound; over about a third of the upper part of the thorax in another wound through the second intercostal space, and in this case oddly enough the emphysema was the only sign of injury to the lung; and very occasionally widely distributed--in the latter case there were also usually multiple fractures of the ribs. Neither issue of air from the external wound nor frothy blood was ever seen with small-calibre wounds, but I saw one instance in a case of Martini-Henry wound. _Pneumothorax_ was also rare. I saw pneumothorax three times out of about half a dozen Martini-Henry wounds, but I do not think it occurred as often in 100 small-calibre wounds. The Martini-Henry wounds all recovered; but convalescence was very prolonged, and the same remark to a less degree holds good in the small-calibre cases. That the slow recovery in cases of pneumothorax in the Martini-Henry wounds was due mainly to the size of the opening in the thoracic parietes was, I think, proved by the fact that in the small-calibre bullet wounds, followed by the development of pneumothorax, the external wounds were usually large and irregular in type; also, that in the only pneumothorax which I saw produced during an extraction operation, the air was very
PREV.   NEXT  
|<   327   328   329   330   331   332   333   334   335   336   337   338   339   340   341   342   343   344   345   346   347   348   349   350   351  
352   353   354   355   356   357   358   359   360   361   362   363   364   365   366   367   368   369   370   371   372   373   374   375   376   >>   >|  



Top keywords:
wounds
 

pneumothorax

 

calibre

 

Martini

 

partly

 

continued

 

external

 
limited
 

injury

 
emphysema

triangle

 

fractures

 

multiple

 

apical

 

Neither

 
occasionally
 

thorax

 
distributed
 

intercostal

 

widely


opening

 
thoracic
 

parietes

 

recovery

 

proved

 

produced

 

extraction

 
operation
 

irregular

 

bullet


development
 

degree

 
posterior
 

Pneumothorax

 

instance

 

frothy

 

occurred

 

convalescence

 

prolonged

 

remark


recovered

 

accompanying

 

wounded

 
varied
 
majority
 

evacuation

 
misgivings
 

danger

 

haemorrhage

 

instances