A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
When the parts of a lacerated gunshot wound have been brought into
apposition, as in simple penetrating wounds, the only dressing
necessary is moistened lint. It should be kept moist either by the
renewed application of water dropped upon it, or by preventing
evaporation by covering it with oiled silk. The sensations of the
patient may be consulted in the selection of either of these, and
climate and temperature will be often found to determine the choice. In
hot climates cold applications are the more grateful, and by checking
the amount of inflammatory action and circumscribing its extent are
usually the more advantageous. M. Velpeau and other French surgeons
have strongly recommended the use of linseed–meal poultices, above
all wet linen applications. Charpie is still extensively employed
in French military hospitals.[5] M. Baudens and Dr. Stromeyer have
strongly recommended the topical application of ice placed in bladders;
others, the continued irrigation of the wound with tepid water. The
means of applying such remedies are rarely available in the military
hospitals where gunshot wounds are ordinarily treated in their early
stages. When much local inflammation has set in, and when there is
much constitutional fever even without unusual local irritation, the
non–evaporating or warm applications will be found to be the most
advantageous.
When suppurative action has been fully established, the surgeon
must be guided by the general rules applicable to all other such
cases. Care must be taken to prevent the accumulation of pus, lest
it burrow, and sinuses become established—not an unfrequent result
of want of sufficient caution in this regard. If much tumefaction of
muscular tissues beneath fasciæ occurs, or abscesses form in them,
free incisions should be at once made for their relief. In wounds
where the communication between the apertures of entrance and exit is
tolerably direct, occasional syringing with tepid water may be useful,
by removing discharges and any fibers of cloth which may be lying in
the course of the wound. Weak astringent solutions are occasionally
employed in a similar way, with a view to improving the tone of the
exhalents and exciting a more vigorous action in the process of
granulation. The strictest attention to cleanliness and the complete
removal of all foul dressings are essentially necessary, not merely for
the comfort of the patient, but to prevent the accumulation of noxious
effluvia, and also to obviate the access of flies to the wounds. In
tropical climates, and in field–hospitals in mild weather, where many
wounded are congregated, flies propagate with wonderful rapidity,
and the utmost care is necessary to prevent the deposit of ova and
generation of larvæ in the openings of gunshot wounds, especially while
sloughs are in process of separation. Cloths dipped in weak solutions
of creasote or disinfecting fluids, laid over the wound, are found
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