A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
Wounds from cannon–shot occasionally illustrate what terrible injuries
may be borne in this region without life being at once extinguished.
They are the more distressing because the patient lives conscious of
his sufferings without possibility of surgical alleviation. The case of
an officer of Zouaves, wounded in the Crimea, is recorded, who had his
whole face and lower jaw carried away by a ball, the eyes and tongue
included, so that there remained only the cranium, supported by the
spine and neck. This unfortunate being lived twenty hours after the
injury, breathing by the laryngeal opening at the pharynx, while his
gestures left no doubt that he was conscious of his condition. Mr.
Guthrie has recorded a similar case which occurred in an officer during
the assault of Badajos. This patient suffered distressingly from want
of water to moisten his throat, but could not swallow when some was
brought. One eye was left hanging in the orbit, the floor of which was
destroyed, and this enabled him to write thanks for attention paid him.
He did not die till the second night after the injury.
In the treatment of gunshot wounds of the face where the bones are
splintered and torn, the surgeon should always retain and replace
as many of the broken portions as possible. It is often surprising
how small connections with neighboring soft parts will suffice to
maintain vitality and lead to restored union in this region. A case
which occurred to the writer in August, 1855, in a private of the
19th Regiment, is detailed in the _Lancet_, p. 436, of that year. The
wound was caused by a fragment of shell. The right half of the arch of
the palate was jammed in and fixed at right angles to the other half,
and the upper maxillary bone was so comminuted that it was scarcely
possible to note the directions of the lines of fracture. The lower
maxilla was broken in three places, and there was extensive laceration
of the soft parts. Great difficulty was met with at first in unlocking
the parts of the palate which had been driven into each other, and,
when they were separated, the right half hung down loosely in the
mouth; yet favorable union was obtained between all these fractures,
the broken portions being adjusted so that the man recovered with both
the upper and lower maxillæ consolidated in their normal relations to
each other. No teeth had been driven out of their sockets, and they
were very useful as points of support in the steps taken to procure
coaptation of the disunited fragments. In the _Lancet_ of February
24th, 1855, may be found the description of a series of wounds of
the face, from the Crimea, which were examined by Mr. Samuel Solly,
and described by him, some of them illustrating how wonderfully the
larger arteries often escape in these injuries. In one, loss of the
sense of taste on one side of the tongue had resulted; in two, there
was partial paralysis of the portio dura; in another, impaired action
of the jaw.
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