A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
A brief abstract of some wounds of the neck, which occurred during the
Crimean campaign, will serve to exhibit the leading symptoms connected
with them when the larynx, or larynx and œsophagus, are involved.
Four cases may be found in the _Lancet_ of January 19th, 1856, to
which journal they were communicated by the late Mr. Guthrie, as
“very interesting.” In the Surgical History of the War it is stated
that only three wounds of the neck, other than simple flesh wounds,
occurred among the officers, from the commencement to the end of the
war; of which two proved fatal, and one led to invaliding. The case
of an officer of the 19th Regiment, however, fell under the care of
the writer, which is not included in that number; and in this instance
the neck was completely traversed, the œsophagus perforated from side
to side, and the larynx injured. It is detailed among the cases by
Mr. Guthrie. After the shock had subsided, the leading symptoms were
aphonia, dysphagia, numbness of one arm, edema and stiffness of the
neck, distressing accumulation of mucus about the fauces, and slight
pyrexia. Recovery progressed favorably, and on the twenty–second day
after the injury both external wounds in the neck were healed, and the
two in the œsophagus appeared to be closed also. The patient referred
to still suffers from a certain amount of aphonia, but not enough
to prevent him from performing his duties as a captain, though want
of sufficient power of voice would probably disable him for a more
extensive command. Another of these cases, in which emphysema of the
neck, edema of the glottis, great dyspnœa, and threatened suffocation
gradually supervened in a superficial gunshot wound of the neck, with
fracture of the thyroid cartilage, is related by Assistant–Surgeon
Cowan, 55th Regiment, who performed tracheotomy, and thereby saved the
patient’s life. In another, the ball passed through the thyro–hyoid
membrane, fractured the thyroid cartilage, and tore the lining membrane
of the glottis. Tracheotomy was performed on the day after the injury,
without benefit. Liquids could not be prevented from passing into the
trachea through the wound made by the projectile. The fourth case above
referred to was in a private of the 97th Regiment. The ball entered
at the pomum Adami, and passed out by the anterior edge of the right
sterno–mastoid muscle. Loss of voice, frequent cough, bloody sputa,
slight emphysema at the wound of entrance, and nausea, were the leading
symptoms. When the man attempted to drink, some of the fluid escaped by
the wound of exit. After five days this occurrence ceased; and after
the twelfth day, air no longer passed out of the wound of entrance.
Both wounds gradually healed; but aphonia—the voice being reduced to a
whisper—existed when the man left the regimental hospital. A soldier of
the Rifle Brigade, under the care of Deputy Inspector–General Fraser,
C.B., then surgeon of the battalion, was shot through the trachea, and
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