A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
evidence is offered of the nature of the wound from evacuations; but
in any case of penetrating wound of the abdomen, when the opportunity
is offered, steps should be taken—a matter not unlikely to be omitted
under the circumstances of camp hospitals full of patients—to isolate
and examine all evacuations which may follow. By attending to this
direction, the writer had the satisfaction of ascertaining the passage
of a ball and piece of cloth, after a wound in the loin, in a case
already alluded to. If the kidneys or bladder are penetrated, the
escape of urine into the abdomen is almost a certain cause of fatal
result. The latter viscus may, however, be penetrated without the
peritoneal cavity being opened; and, as experience proves, the wound
is then by no means of a fatal character. Musket–balls sometimes lodge
in the bladder. This was ascertained to have happened in a soldier
of the 20th Regiment, in the Crimea; but the patient died from other
injuries, so that the information could not be turned to account. Mr.
Guthrie performed the usual operation of lithotomy, with success, to
remove a musket–ball which had struck a soldier just above the pubes,
at Waterloo, and lodged. He also records a similarly successful case
in a man wounded at the battle of Chillianwallah: this ball formed
the nucleus of a calculus. Baron Percy removed a ball and a portion
of shirt from the bladder. In all such cases, it is probable that the
bladder has been penetrated at some part uncovered by peritoneum,
so that the cavity of the abdomen has not been opened; or, if
otherwise, the foreign body has found its way in by ulceration, after
adhesions had been established, and thus circumscribed the openings of
communication. Small foreign bodies may also pass into the bladder by
the ureter. A case in which the kidney was wounded came under the care
of the writer, after the 8th of September, 1855. The patient survived
twelve days, and then died from pyemia. He had been taken prisoner, but
was found in Sebastopol, and brought to his regimental hospital on the
second day after the assault. There was only one wound in the right
loin, and the ball had lodged. Extensive abscesses formed among the
gluteal muscles on the left side, and down the left thigh; and though
free incisions were made, great constitutional irritation supervened,
and he sank. The substance of the right kidney had been perforated,
but the ureter had escaped. The ball had passed across the abdomen,
and lodged in the left buttock. Mr. Guthrie mentions some wounds of
the kidney where recovery took place; in one, seven months after the
wound, after an attack of retention of urine, a piece of cloth was
forced out by the urethra, which must have come down from the pelvis
of the kidney. When the abdominal parietes have been opened by shell
or passage of large shot, protrusion of omentum and intestines will
probably be one of the results. This does not always happen. In Dr.
Macleod’s Notes, p.
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