bruising of the parts by the ball, which may be expected to injure
the superficial layer of parts in its tract so severely, that it must
slough more or less.
Besides, the bones are often splintered by the force with which they
are struck, and loose portions of them lodge amongst the muscles; then
they are the cause of much mischief, for, on account of their long,
sharp, and irregular form, they occasion great irritation, suppuration
ensues in various parts, sinuses form, and the cure is rendered very
tedious. In other cases, the bone is split in a longitudinal direction,
and, in the cylindrical bones, these fissures are often of great extent.
Considering the nature of the body which inflicts the injury in a
gunshot wound, and the velocity with which it is impelled, it is
evident that the cure must be in all cases tedious, in consequence of
the sloughing and suppuration which is induced, particularly at the
aperture through which the ball passed. The foreign body ought always
to be removed as early as possible, provided it can be accomplished
without much violence, or injury to the parts. Dilatation of gunshot
wounds is now had recourse to only to facilitate the removal of balls,
splinters, &c., and even with this view, it ought to be employed but
to a very slight extent, if at all; for foreign substances, when
deeply seated, can be much more easily taken out when the sloughs are
separating, and the parts relaxed by suppuration; then, too, they can
be more readily reached through a counter-opening, when their situation
renders this expedient. In short, the surgeon is not justified in
cutting for balls, unless they are easily felt, and not deeply lodged.
In order to discover the foreign body, probes will sometimes be
required; the finger often answers the purpose best, unless when the
wound is of considerable depth. If, on examination, the ball cannot be
discovered, and if there is reason to think that it has followed an
indirect course, the surgeon will, sometimes, be assisted in his search
by placing the patient in that position in which he received the wound,
and then judging of the circumstances most likely to affect the foreign
body in its passage. In many cases, extraction can be accomplished
by means of the finger alone; in others, forceps and scoops, various
in length and size, are indispensable. Afterwards, light dressings
are to be employed; and in the first instance, cold applications
may prove advantageous in keeping down the inflammatory action; but
when inflammation has commenced, and to encourage suppuration, warm
fomentations and poultices are to be preferred; they will in many
cases be both more grateful to the patient and more beneficial in
their results, when used even from the commencement. Afterwards,
it will be necessary to afford sufficient support to the parts by
bandaging, and to change the applications according to the particular
circumstances:—soothing, if the wound be irritable, stimulating, if
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