A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
When the circumstances of a battle admit of the arrangement, the
wounded should receive surgical attention preliminary to their being
transported to the regimental or general field hospitals in rear.
A slight provisional dressing, a few judicious directions to the
bearers, may occasionally prevent the occurrence of fatal hemorrhage,
or avert serious aggravation of the original injury from malposition,
shaking, and spasmodic muscular action, in the course of conveyance
from the neighborhood of the scene of conflict to the hospital. In
the siege operations before Sebastopol, this was accomplished by
assistant surgeons in the trenches, or, according to the French system,
by regular ambulance hospitals in the ravines leading to them. The
provisional treatment should be of the simplest kind, and chiefly
directed to the prevention of additional injury during the passage to
the hospital, where complete and accurate examination of the nature
of the wound can alone be made, and where the patient can remain at
rest after being subjected to the required treatment. The removal
of any missiles or foreign bodies which may be readily obvious; the
application of a piece of lint to the wound; the arrangement of any
available support for a broken limb; protection against dust, cold, or
other objectionable circumstances likely to occur in the transit; if
“shock” exist, the administration of a little wine, aromatic ammonia,
or other restorative, in water,—need little time in their execution,
and may prove of great service to the patient. If hemorrhage exist
from injury to a large vessel, it must of course receive the surgeon’s
first and most earnest care. He should not trust to the pressure of a
tourniquet, but secure it at once by ligature. Without this safeguard
during the transport, and while in the hands of uneducated attendants,
the life of the wounded man might be endangered, either from debility
consequent upon gradual loss of blood or from sudden fatal hemorrhage.
It has been recommended by some surgeons that all attendants whose
duties consist in carrying the wounded from a field of battle should be
directed, when bleeding is observed, to place a finger in the wound,
and keep it there during the transport until the aid of a surgeon is
obtained. The precise spot where compression by the finger is wanted,
and the degree of pressure necessary, will be quickly made manifest to
the sight by the effects on the flow of blood. Such a practice seems to
offer less objection than the use of tourniquets by men whose knowledge
of their proper application must be exceedingly limited.
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