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of a mountain echoed with long guttural shouts the taunting challenge, Venez, si vous l'osez, voir de plus près les brigands. The Spaniards meanwhile were not bebind hand in retaliating invectives on their part: the French, they said, were heretics, pires que les Maures, car ils ne croyaient ni en Dieu, ni à la Vieroc, ni à St. Antoine, et pas même à Saint Jacques de Galice, et ne craignoient point de loger dans les églises avec leurs chevaux. The mischief done to the churches throughout the continent, wherever the French have passed, attests but too well the truth of the latter charge : the cluisters and vaults were first occupied, and if these did not suffice, the remainder of the horses were stalled in the aisles; and the towns of Liège and Mayence and Basle still present abundant proof that things sacred were not violated in Spain alone.
(To be concluded in our next.)
ART. III. An Essay on Gun Shot Wounds. By Charles Bell,
Surgeon of the Middleser Hospital, Lecturer in Anatomy, - in the Theatre, Windmill-street, 8c. Svo. Longman and Co. 1815.
The field of Waterloo left scarce a family in the land without its share of grief and anxiety; and there is no man so dull of heart as to acknowledge no sympathy with the brave fellows who are now detained in our hospitals by honourable wounds. Shall we confess the professional course which our thoughts have taken on the occasion i or is it a course of sympathy alloge. ther unnatural? From the glories of ibat day, which seems to set it seal on the steady valour and manly character of this country, and from the more pleasing prospect of that spirit of, charity, which has piled up its hundreds of thousands to minister to the aid of the sufferers and their families;, we have turned to meditate on the state of the wounded, and
provisions which are within the reach of art for their relief. In this frame of mind the title of this little work caught our atten. tion. We have perused it with much interest. And although we are aware that a great part of that interest was the result of circumstances, yet we are happy that we have met with a book ju which we have found a great subject opened, and questions of high importance relative to military surgery discussed. Its author, Mr. Charles Bell, is a man whose profound acquaintance with the anatomy of the human franie is best demonstrated by the many laborious and useful publications of which he has al
ready presented to the medical world. His.“ Anatomy" written in conjunction with his brother of Edinburgh, and his Surgery, are justly considered as standard books in the profession. Having been for some years a lecturer alsn, in the same science, the soundness of his practical knowledge must be considered as fully equal to his theory. And if we are rightly informed, Mr. Bell was for some weeks at Brussels, immediately after the battle of Waterloo, where his services in the hospitals were deemed of the highest importance, and his various operations, and modes of treatment were attended with the most distinguished success. From a man therefore who has laid the foundation of his practice so deep in anatomical knowledge, and raised such a superstructure of experience upon it, we listen with so small degree of attention upon a subject, which has now no ordinary claims upon our attention. Mr. Bell informs us that his object is not to fall into the old question of the peculiarity of the wounds of fire-arms, but rather to place before his readers the difficulties of the service. Now this is precisely what we wished to see, and we think that he has done his task fairly. Together with a great deal of good surgery and sound criticism on the subject of wounds and general treatment, the author has given strong pictures of the various duties of the army surgeon, so as at once to excite restless and uneasy feelings at the thought of how many there are who must fall short, of the necessary qualifications, and to raise very high in estimation the character of a military surgeon truly qualified for liis place.We distinguish throughout solid judgment and good sense: many useful views are given of practice, with a continual reference to principles founded in pathulogy and to cases illustrar tive of the doctrine. In those cases the author has observed with great clearness of conception, both the fact to be yoted anel the practical inference to be drawn; and he has presented them to his reader with that graphic distinctness which alone can raise the interest and improve the lesson. . And on the whole, the subject both as it relates to the cure of wounds, and to the arrangements of the service, is placed in a light which cannot fail, we think, to impress on military surgeons the most salutary lessons, and to be productive of improvement in the publie service.
In coming to particulars we find in the first part of the dissertation, some short notices of the duties of the navy surgeons, and of the nature of the injuries received during a sea-tight as distinguished from those of the field, by the contusions and lacerations produced by bolts and splinters.
The author next proceeds to consider the circumstances in which the army surgeon finds himself. We lament to see this
part of the subject treated so concisely; a subject which might fill a volume, is comprised within the compass of a few pages; more indeed in the nature of short notes to be the subject of meditation for an army surgeon, who is ansious to bring his mind to the right frame for the performance of his duties, and to prepare himself by the anticipation of his difficulties, than according to that full and detailed manner of treating the subject which we think it deserves, and in which it might be treated in order to produce its due effect upon the very young and ignorant men who are often placed in this important station. Short, however, as these introductory notices of Mr. Bell's are, they form not the least important part of his essay, and we confess that we perused them with a very painful interest. They present to us the idea of a young man sufficiently well instructed for the common occasions of practice at home, (where important operations rarely occur, and when they do, may be performed after due consultation, and with all mature and deliberate preparation) hurried into the midst of a scene of many difficulties, where the very number of cases of immediate danger may well appal the most experienced, where perhaps for the first time in his life ,he is obliged instantaneously to determine on matters of life and death, and to perform amidst the roar of cannon and the whisiling of balls, and the threatened charge of horse, operations of the greatest nicety. For amidst the more extensive operations of modern war, and the improvements to which the art has attained, there is one peculiarity of the military surgery of the present day, which we call on every thinking man to reflect on. The operations are done in the field. The imme
. diate dangers of the battle are thus more intimately connected with the skill of the surgeon: and the first anxious question that is asked when we hear of a distinguished officer having a dangerous wound, is what surgeon was on the field? who perfornied the operation ? who saw him? It is indeed a matter of very serious concern, how in such circumstances a surgeon is prepared to do bis office.
If a musket ball strikes the shoulder, the thigh, or the knee, it must be determined on the instant whether amputation is to be performed; for success depends on immediate decision. In saving the leg we have seen the life sacrificed. We have indeed known limbs lopt off wbich might have been preserved; and we certainly have seen many men walking stoutly who have resisted the mandate of their surgeon, and with apparent foolhardiness refused to suffer amputation. We fear that it ever must be so. Yet it may well be asked, whether every possible means have been used to ensure competent surgeons. What are all the alleviations which the country can offer to the relations of the brave men who have suffered; what even the influence of all the subscriptions for the sufferers at Waterloo, when weighed against the importance of the question, whether the surgeons attending upon our armies, are thoroughly well instructed in the duties of their station?
We are drawn into these considerations by the perusal of this work in the frame of miud in which we took it up; and by seeing in it this most momentous question brought forward. We could wish that the author whose mind seems to be full of views on these subjects which appear to us to be correct and judicious, should extend bis observations, and in the same spirit of good sense, which has dictated the remarks we have just perused, should treat the matter more in detail. We fear that the day star of peace has not yet risen on Europe, and that military surgery is still destined to bear a rank of importance in the scale of science which we would have imagined that it was begiuning to lose.
We cannot find room for a very detailed criticism of this work, and shall content ourselves with taking notice only of the most important points. After a few remarks on the peculiarițies in the nature of injuries by gun shot, the author proceeds to explain the course of the ball, and the probable plan of its lodgement. His indications are pointed out with clearness and discrimination, and illustrated by some very curious cases; and both from its direct and indirect usefulness, we should earnestly recommend the prosecution of this view of the subject.
“ In a short time after the infliction of the wound, if the ball has taken a course under the skin, we may perceive the course it has taken by a red stripe on the skin, like a blush of the cutaneous vessels. By attending to this circumstance, I have discovered the ball in a remote and unexpected place. The passage which a ball makes is very seldom direct; a very slight degree of lateral resistance changes its course. The most frequent place of its lodgment is just under the integuments of the opposite side of the limb to to where it entered. For we find that a ball pierces the resisting solids more easily than it does the elastic skin. For example, ą ball after breaking the bone, and passing clear through the muscular substance, being met by the elastic resistance of the skin, has its force subdued, and it remains under the skin, where a touch witha lancet will give it exit.
“ If a ball strikes perpendicular to the surface of a spongy bone, it will enter and lodge in the bone, as in the vertebræ, or in the head of the thigh-bone. In fig. 1. plate II., the ball A is seen sunk into the condyle of the femur ; but this situation of the ball is not so frequent as that exhibited in the second figure, where A is the hole where the ball enterd, and B is the ball itself, lodged not in the bone properly, but on the posterior surface, where, although it had force to penetrate the bone, had not force to overcome the resistance of the elastic ligament, This is
not a solitary instance; in the fourth figure of tlie succeeding plate, the ball has passed through the body of the vertebraæ, but has not been able to burst up the posterior longitudinal ligament. I have in my collection, a ball lodged in the hip joint, where the hall has broken and penetrated the neck of the thigh-bone, but has not had force to pass out of the capsular ligament. A young gentleman consulted me within these few days, with a ball in his foot; the ball had penetrated the tarsus, but was prevented making its exit by the plantar aponeurosis.”
The question of the scarifying or rather enlarging of gun-shot wounds is put we think in its true light, and this increase of pain is shown to be useless severity. The importance of this will be runderstood by those who have attended to the indecisive expressions of our late English writers.
We are happy to find our author expressing himself, when treating upon general weakness, in favour of cold spirituous applica. tions to gun-shot wounds during their period of inflammation. We wish that we could see this practice adopted instead of the slovenly and hurtful method of covering the wound with cataplasms, which confine the heat and increase the inflammatory action.
« To apply fomentations to the wounded limb, and poultices to the orifice, what is this but to confine and generate heat, and promote a high inflammatory action?
" It is a good remark of Mr. Hunter, that bleeding must be had recourse to with great caution where inflammation and fever run high, for to reduce the patient in a degree equal to what the action at the time requires will often be reducing him too much for the constitution to bear after the excitement to action has ceased.
“ If a patient at home and in full blood has received a gun. shot wound, he ought to be reduced by bleeding, and laxatives, and low diet; but if he has been a soldier, has lost his superfluous fat by the fatigues of a campaign, repose and a simple diet will be for him in the place of medical treatment; it will be sufficient that he be covered with cloths wet in vinegar and water, or water and spirits. I have said that on receiving a severe wound, the patient often vomits. In the course of the treatment, the same sympathy continues, and the stomachand bowels are influenced by the state of the wound. It is for this reason that when there is an irritable wound, it is necessary to keep the patient on a strict regimen of soups, and light liquid food, panada, rice, &c. He ought to have by him some mild decoction for drink, and laxatives will be required from time to time during his confinement. When the suppuration is established and becoming profuse and weakening, wine and bark will be required and aromatic confection. If there occur restlessness, threatening delirium, a smart purge followed by an opiate will produce quiet. Now instead of cold applications to the wound, as spirits and solution of sal ammoniac in vinegar, warm spirituous fomentations, and tepid solutions of opium, will be found serviceable. And again, when there is an