21. A ball will frequently strike a bone, and lodge, without causing a fracture, although it will a fissure. It will even go through the lower part of the thigh-bone, between or a little above the condyles, merely splitting without separating it, and some balls have lodged in bones for years, with little inconvenience. It should nevertheless be a general rule not to allow a ball to remain in a bone, if it can be removed by any reasonable operation. The rule is not entirely devoid of exception. Lieutenant-Colonel Dumaresq, aid-de-camp to the present Lord Strafford, was wounded at Waterloo by a ball which penetrated the right scapula, and lodged in a rib in the axilla. The thoracic inflammation nearly cost him his life, but he ultimately quite recovered, and died many years afterward of apoplexy, the ball remaining enveloped in bone.
22. When a bayonet is thrust into the body it is a punctured wound made by direct pressure; when of little depth, much inconvenience rarely ensues, and the part heals slowly, but surely, under the precaution of daily pressure. A punctured wound, extending to considerable depth, labors under disadvantages in proportion to the smallness of the instrument, and the differences of texture through which it passes. When the instrument is large, the opening made is in proportion, and does not afford so great an obstacle to the discharge of the fluids poured out or secreted as when the opening is small. Lance wounds are therefore less dangerous than those inflicted by the bayonet. When a small instrument passes deep through a fascia, it makes an opening in it which is not increased by the natural retraction of parts, inasmuch as it is not sufficiently large to admit of it; and which opening, small as it is, may be filled or closed up by the soft cellular tissue below, which rises into it, and forms a barrier to the discharge of any matter which may be secreted beneath. If the instrument should have passed into a muscle, it is evident that if that muscle were in a state of contraction at the moment of injury, the punctured part must be removed to a certain distance from the direct line of the wound when in a state of relaxation, and vice versa. The matter, secreted, and more or less in almost every instance will be secreted, cannot in either case make its escape, and all the symptoms occur of a spontaneous abscess deeply seated below a fascia. That inflammation should spread in a continuous texture is not uncommon; that matter, when confined, should give rise to great constitutional disturbance is, if possible, less so; but that this disturbance takes place without the occurrence of inflammation, or the formation of matter, may be doubted; and it may be concluded that there is no peculiarity in punctured wounds that may not be accounted for in a satisfactory manner. Serious effects have been attributed to injuries of nerves, but without sufficient reason; nevertheless, those who have seen locked-jaw follow a very simple scratch of the leg from a musket-ball, more frequently than from a greater injury, are not surprised at any symptoms of nervous agitation that may occur after punctured wounds. As many bayonet wounds through muscular parts heal with little trouble, it is time enough to dilate them when assistance seems to be required. Cold water should be used at first; care should be taken not to apply a roller or compress of any kind over the wound; matter, when formed, should be frequently pressed out, and, if necessary, a free exit should be made for it.