A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
=Progress of cure.=—Simple flesh wounds from gunshot usually heal in
five or six weeks. In the course of the first day the part wounded
becomes stiff, slightly swelled, tender, a slight inflammatory blush
surrounds the apertures through which the missile has passed, and a
slight serous exudation escapes from them. Suppuration commences on the
third or fourth day, and in about ten days or a fortnight the sloughs
are thrown off. Granulation now progresses, more or less quickly
according to the health and vigor of the patient’s constitution.
The opening of exit is usually the first closed. When the wound is
complicated with unfavorable circumstances, whether inducing in the
patient a condition of asthenia or leading to excess of inflammatory
action, the progress of the cure may be extended over as many months
as, under favorable circumstances, weeks are occupied in the process.
GUNSHOT WOUNDS IN SPECIAL REGIONS OF THE BODY.
The circumstances connected with wounds in particular situations of the
body, or in particular organs, are in many respects common to injuries
from other causes than gunshot; and in the following remarks the
attention is chiefly drawn only to those leading peculiarities which
constantly demand the consideration of the army surgeon, and which
spring either from the nature of gun projectiles, or the circumstances
under which this branch of military practice has for the most part to
be pursued.
GUNSHOT WOUNDS OF THE HEAD.
No injuries met with in war require more earnest observation and
caution in their treatment than wounds of the head. The vital
importance of the brain; the varied symptoms which accompany
the injuries to which this organ may be subjected, directly or
indirectly; the difficulty in tracing out their exact causes; the
many complications which may arise in consequence of them; the sudden
changes in condition which not unfrequently occur without any previous
warning,—all these circumstances will keep a prudent surgeon who has
charge of such wounds continually on the alert. Injuries of this class,
the most slight in appearance at their onset, not unfrequently prove
most grave as they proceed, from encephalitis and its consequences, or
from plugging of the sinuses by coagula, leading to coma, paralysis,
or pyemia; and the converse sometimes holds good with injuries
presenting at first the most threatening aspects, where care is taken
to avert these serious results. Much will depend on the part of the
head struck, both as regards the thicker and stronger processes or
portions of the skull, and the situation of the sinuses and parts of
the cerebrum within; on the force and shape of the projectile; the
angle at which it strikes; the age and condition of the patient; and
other matters already referred to in the general remarks on gunshot
wounds. Mr. Guthrie has laid down as a rule that injuries of the head,
of apparently equal extent, are more dangerous on the forehead than on
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