Gun shot wound within the cavity of the thorax : read before the Medical Society of the State of New York, February 7th, 1860, and before the Albany Institute, February 28th, 1860 / by Sylvester D. Willard.

  • Willard, Sylvester David, 1825-1865.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: Gun shot wound within the cavity of the thorax : read before the Medical Society of the State of New York, February 7th, 1860, and before the Albany Institute, February 28th, 1860 / by Sylvester D. Willard. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    over the heart, and in a perpendicular line would have discharged its con- tents into that organ, hut as in the first instance, bringing it in contact with the breast, by the right hand, naturally gave the weapon an angle out- ward, and the ball passed obliquely through the muscle and rib, without the pericardium, into the substance of the lung, where, possibly, it became imbedded and still remains. I felt nothing of the ball, which was oblong (of the Minnie rifle shape), and had divided the rib without leaving spiculae. Abandoning the hope of extracting the ball, I cleansed the wound, and drawing its lips together, applied two or three thicknesses of Husband's isinglass adhesive plaster. It seemed most happily adapted to the exigen- cies of the case ; soft and pliant, yet adhesive, it acted as a valve. With each inspiration it collapsed aud closed the orifice. With each expiration the bloody serum oozed from under it without causing its detachment. From the third until the seventh or eighth day after the occurrence of this wound, an offensive bloody serous effusion was poured forth in large quantities, saturating the thickly folded compress and bandage. The cough continued, with occasional bloody expectoration—an evidence of the injury the lung had sustained, and the pulses were one hundred and twenty per minute. The cough was quieted, and rest procured by the free use of morphine, while nourishing diet was early and continuously directed as a means of sustaining the demand that must inevitably be made upon the patient's strength. A few days later and the secretion became purulent and was very profuse. I still apprehended a fatal result from the exten- sive changes such a condition must impose upon the lung and the pleura, although my patient, with perfect mental composure, occupied two or three hours daily at his lithograpic etchings after the eighth day. The air did not, at this time, permeate the apex of the lung, and percus- sion gave a dull flat sound, while efforts to expand the lung, by a full inha- lation, imparted no costal motion. At the end of two weeks, the cough, which had been attended with an occasional purulent expectoration, nearly ceased. At each dressing, I endeavored to empty the thoracic cavity of the fluid that had accumulated below the level of the orifice. In order to accom- plish this, the patient inclined forward, to a position almost horizontal, when, by an effort, of coughing, the fluid would be ejected. On the 19th Novem- ber I introduced through the wound a silver catheter, carrying it carefully downwards into the thoracic cavity, and inclined the patient forward, when a considerable quantity of fluid passed through it. I felt each pulsation of the heart against the instrument, as I had done against my finger, on a pre- vious occasion. November 23d, eighteen days after the wound, the secretion was greatly diminished, the patient was daily gaining strength, the circulation had gained in force, and lessened in frequency, to ninety per minute; and a healthy granulation had begun about the orifice. I again introduced a flexible catheter, which dipped into the cavity, and with a glass syringe, (the piston of which was well fitted) adapted to the end of the catheter, the