A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
A gunshot wound of the intestine, more especially the colon, may lead
to fecal fistula, and life be thus saved for a time. One such case only
occurred in the Crimea, in the 19th Regiment, of which the writer was
then the surgeon; this case, which has been before casually mentioned,
subsequently passed under the care of his friend Mr. Birkett, of Guy’s
Hospital, in which institution the patient died, from the effects of
albuminuria, four years after the receipt of the wound referred to. The
surgical history of this case has been already published at some length
in the _Lancet_;[9] the medical history, together with the results
of the post–mortem inspection, have been detailed by Dr. Habershon,
in vol. v., Ser. III., of the _Guy’s Hospital Reports_. The fistula
became closed at intervals, and occasionally, before other disease
supervened, hopes were entertained that recovery might result. The
direction and depth of the wound precluded any of the usual operations
for attempting to effect a radical cure. Two cases of abnormal anus by
gunshot perforation are recorded by Dr. Williamson among the wounded
who have recently returned from India; in both instances the descending
colon was the part of the bowel implicated. A similar result is
recorded in a private of the 13th Regiment wounded at Cabul in 1840.
=Wounds of the diaphragm.=—Musket–balls occasionally pass through
the diaphragm; and Mr. Guthrie has remarked that these wounds, in
instances where the patients survive, only become closed under rare
and particular circumstances. Hence the danger of portions of some
of the viscera of the abdomen, as the stomach or colon, passing into
the chest, and thus forming diaphragmatic herniæ, and of these,
eventually, from some cause becoming strangulated. Two very interesting
preparations of these accidents from gunshot exist in the museum at
Fort Pitt. In both instances, the stomach, colon, and omentum form the
hernial protrusions. In one, death occurred, a year after the wound,
from strangulation induced suddenly after a full meal; in the other,
the soldier continued at duty twenty–two years after, and died from
other causes. All the cases which occurred in the Crimea in which
openings had thus been established between the cavities of the chest
and abdomen proved fatal. A case is detailed in the Surgical History
of the War where the patient survived a double perforation of the
diaphragm, together with a wound of the liver, six days; in another
instance, where the lung, diaphragm, liver, and spleen were wounded,
the soldier lived sixteen hours. The direction of the ball, hiccough,
dyspnœa accompanied with spasmodic inspiration, and inflammatory
signs more particularly connected with the chest will be the usual
indications of such a wound; and in case of recovery, the risk of
hernial protrusion and strangulation must be explained to the patient.
Should strangulation occur, it can hardly be expected that division of
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