A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
When portions of the pelvic parietes are fractured by heavy
projectiles, very protracted abscesses generally arise, connected with
necrosed bone; and the vital powers of the patient are greatly tried
by the necessary restraint and long confinement. The great force by
which these wounds must be produced, and the general contusion of the
surrounding structures, cause a large proportion sooner or later to
prove fatal, notwithstanding the peritoneal cavity may have escaped.
Of twenty–nine such cases which came under treatment in the Crimea,
sixteen died. Even apparently slight cases, as where a portion of the
crest of the ilium is carried away by shell, or ball lodged in one of
the pelvic bones, often prove very tedious, from the long–continued
exfoliations and abscesses which result.
=Penetrating wounds.=—A penetrating wound of the abdomen, whether
viscera be wounded or not, is usually attended with a great amount
of “shock.” The prognosis will be extremely unfavorable, if there
is reason to fear the projectile has lodged in the cavity of the
peritoneum; and in all cases the danger will be very great from
inflammation of this serous investment. The liability to accumulation
of blood in the cavity, from some vessel of the abdominal wall being
involved in the wound, must not be forgotten.
When, in addition to the cavity being opened, viscera are penetrated,
and death does not directly ensue from rupture of some of the larger
arteries, the shock is not only very severe, but the collapse attending
it is seldom recovered from up to the time of the fatal termination
of the case. This is sometimes the only symptom which will enable the
surgeon to diagnose that viscera are perforated. The mind remains
clear; but the prostration, oppressive anxiety, and restlessness are
intense; and, as peritonitis supervenes, pain, dyspnœa, diffused
tenderness, irritability of the stomach, distention, and the other
signs of this inflammation are superadded. In ordinary wounds from
musket–shot, scarcely any matter will escape from the opening of the
parietes, the margin of which becomes quickly tumefied; but if any
escape, it will probably indicate what viscus has been wounded. If
the stomach has been penetrated, there will probably be vomiting of
blood from the first. If the spleen or liver be wounded, death from
hemorrhage is likely to follow quickly. In some instances patients,
however, recover after gunshot wounds involving these viscera, and
examples in illustration may be found in various works on military
surgery. Two particularly manifest instances, where officers were shot
through the liver by musket–balls, occurred lately in India, one at
Lucknow, the other at the siege of Delhi: both recovered. The cases are
described in the _Indian Annals of Medical Science_ for January, 1859.
If the small intestines have been perforated, and death follows soon
after from peritonitis, the bowels usually remain unmoved, so that no
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