A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
had struck, probably penetrated through, some portion of the lumbar
vertebræ in its course from the loin to the intestine. There were no
general symptoms to indicate spinal injury, but, four years afterward,
the opportunity of a post–mortem examination being afforded, the
track of the ball through some of the lumbar vertebræ was distinctly
traced.[2]
It will often appear, at first examination, that the track of a
wound by the cylindro–conoidal bullet, even at full speed, is widely
removed from a straight line, especially when this class of injuries
is new to the surgeon. It is not difficult to understand the apparent
irregularity in the line of the wound, when the many varied positions
in which the body and its parts are liable to be placed are called to
mind, and if, when making the examination, the surgeon has omitted to
place the patient in a similar posture to that he was in when struck.
A certain allowance must also be made for the spasmodic actions of the
various muscles among themselves, and momentary displacement of other
structures, at the instant of receiving the injury.
Occasionally, though rarely, an accidental concurrence of circumstances
may lead to the conical bullet pursuing a circuitous instead of a
direct course, especially when, after traveling a certain distance,
its speed has become diminished; and, as round musket–balls are not
yet wholly discarded from warfare, it is necessary to call attention
to the observations which have been made on this subject. Balls have
been known to pass round the outer convex and the inner concave
surfaces of the abdominal and thoracic cavities, sometimes forcing
their exit at points nearly opposite to those of entrance, sometimes
making a complete circuit. Thus, from simple observation of the line of
direction of two wounds, a ball may be supposed to have passed through
the thorax or abdomen, while really it may not have penetrated the
cavity, but only made its way beneath the integument. In like manner, a
lung may be supposed to have been traversed by a ball, not merely from
the relative position of the wounds of entrance and exit, but also by
some of the characteristic signs of such an injury, when really the
ball, after entering the cavity of the chest, has rolled round the
costal pleura, never penetrating the lung, but at the most bruising
its surface. In the same way, balls have been known to travel round
the cranium beneath the scalp, and to have found their way beneath
the integuments of the neck, without injury to the deeper structures.
Dr. Hennen saw a case where a ball was found lying in a wound by the
thyroid cartilage. It had made a complete circuit of the neck, and
returned to the spot where it had entered. Cases sometimes occur where
two openings are found in a man’s shoulder, in such relation that a
straight line between them would necessarily pass through the head of
the humerus, yet the ball has only made a half circuit, outside the
joint.
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