A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
But in discountenancing great bleeding, mention should not at the same
time be omitted that, in many cases, recorded by numerous authors,
and judging _post factum_, the successful issues appear to have been
owing to copious venesection. A remarkable case occurred in a young
soldier of the 33d Regiment, private Thomas Monaghan, under the care
of Deputy Inspector–General Dr. Muir, then surgeon of the regiment.
This man was wounded in August, 1855, through the left shoulder–joint
and chest, the glenoid cavity and head of the humerus being injured
and the lung implicated. In this instance complete recovery as to the
chest, and recovery with partial anchylosis of the shoulder, without
operative interference, followed, and appeared attributable chiefly
to inflammatory action being subdued by repeated depletion, the use
of antimonial medicines, and enforced abstinence. In two other cases,
hitherto unrecorded, which occurred during the same month in the same
regiment, successful terminations appeared to be attributable to
similar means. In one of these the ball entered the front of the chest,
between the third and fourth ribs, and passed out between the seventh
and eighth ribs below; in the other, after passing through the right
arm, it entered the chest at the posterior border of the axilla, and
emerged near the apex of the scapula.
To remove splinters of bone, and readjust indented portions of the
ribs, the finger should be introduced into the wound, and care taken
that in doing so no pieces of cloth or fragments be separated and
projected into the pleural sac. Notice must at the same time be taken
of any bleeding vessel requiring to be secured. A pledget of lint
should be laid over the wound, and a broad bandage placed round the
chest, just tight enough to support the ribs and in some degree to
restrain their movements, but with an opening over each wound large
enough to permit the ready access of the surgeon to it if necessary. If
the patient’s comfort admits of it, he should be laid with the wound
downward, with a view to prevent accumulation of fluid in the pleura;
and if there be two openings, as will be most frequently the case in
rifle–ball wounds, one wound should be thus placed, and the upper one
kept covered. In gunshot wounds, closure of the parietes by adhesion is
of course not to be looked for. The diet, beverages, and medicines must
constantly have reference to the avoidance of inflammatory action; and
should this occur it must be combated on general principles. It is by
such means we shall best assist the natural efforts toward recovery.
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