A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
As soon as the presence of a ball or other foreign body is ascertained
it should be removed. If it be lying within reach from the wound of
entrance, it should be extracted through this opening by means of
some of the various instruments devised for the purpose. In case
of a leaden bullet, Coxeter’s Extractor, corresponding with Baron
Percy’s instrument for the same purpose, and consisting of a scoop for
holding and central pin for fixing the bullet, has been found a very
convenient appliance, from the comparatively limited space required
for its action. Instruments of two blades, or scoops, with ordinary
hinge action, dilate the track of the wound injuriously before the
ball can be grasped by them. The way to the removal of a bullet may
often be smoothed by judiciously clearing away the fibers, among which
it is lodged, during the examination, by the finger; and sometimes,
by means of the finger in the wound, and external pressure of the
surrounding parts, the projectile may be brought near to the aperture
of entrance, so that its extraction is still further facilitated. Such
foreign substances as pieces of cloth can usually be brought out by the
finger alone, or by pressing them between the finger and a silver probe
inserted for the purpose. Sometimes a long pair of dressing forceps,
guided by the finger, is found necessary for effecting this object.
Caution must be used in employing forceps, where the foreign substance
is out of sight and of such a quality that the soft tissues may be
mistaken for it.
In instances where the foreign body has not completely penetrated, but
is found lying beneath the skin away from the wound of entrance, an
incision must be made for its extraction. Before using the knife, the
substance to be removed should be fixed _in situ_, by pressure on the
surrounding parts. In the instance of a round ball, the incision should
be carried beyond the length of its diameter; an addition of half a
diameter is usually sufficient to admit of the easy extraction of the
ball. In removing conical balls, slugs, fragments of shells, stones,
and other irregularly–shaped bodies, the surgeon cannot be too guarded
in arranging that the fragment is drawn away with its long axis in
line with the track of the wound. By proper care in this respect, much
injury to adjoining structures may be avoided.
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