A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
From the position of these parts of the body, uncomplicated gunshot
wounds of them are comparatively rare. Throughout the whole of the
Crimean war, the number of cases treated amounted, among the men, to
70; among the officers, only to 4. The number of deaths which resulted
were 21 among the men, chiefly cases of extensive laceration involving
the urinary apparatus; among the officers, none. Three men only, out
of 603 who returned from the late mutiny in India to Chatham, are
recorded under this class. In one, the injury was from a spent shot,
which caused a bruise without laceration over the symphysis pubis, and
produced persistent incontinence of urine; in each of the other two,
a musket–ball wounded the left testicle, injured the urethra, and led
to urinary fistula, which was, however, afterward healed. In one, the
testicle was so much injured that it was removed on the day the wound
was received; in the other, it sloughed away shortly after. A corporal
of the 19th Regiment, wounded in this region on the 8th September,
1855, was under the care of the writer. A portion of the ascending
ramus of the ischium on the right side was driven into the perineum,
the soft parts were much injured, and the right testicle was destroyed.
The viscera of the pelvis escaped. He was doing well until nearly a
fortnight after the injury, when nervous irritation and trismus set in,
and he sank.
Perineal wounds are not unfrequently caused by shells bursting and
projecting fragments upward; but they are generally mixed with lesions
of viscera of the pelvis, or fracture of its structure, or injuries
about the upper parts of the thighs or buttocks. In one such case, a
portion of the scrotum, the whole of one testicle, and the greater
part of the other were carried away. This wound healed without fungous
growth from the remaining portion of the testis. Separate wounds of
the external organs of generation are usually caused by bullets. In
two cases in the Crimea, a bullet entered between the glans penis
and prepuce, and traversed upward without penetrating the erectile
tissue. M. Appia records a case where the ball entered the summit of
the glans, traversed the whole length of the corpus cavernosum, passed
under the pubic arch, and went out by the right buttock. The urethra
was not opened. Double orchitis and scrotal abscesses followed; but
favorable cure took place. In another case, a ball carried away the
inferior part of the glans but did not wound the urethra. A soldier of
the Rifle Brigade was wounded in the Crimea by a musket–ball, which
entered the right buttock and came out by the body of the penis, just
below the glans, having ruptured the urethra about four inches from
the meatus. The wound of the penis closed favorably. Mr. C. Hutchinson
has recorded the case of a soldier of the 42d Regiment, treated at the
Deal Naval Hospital, who was wounded in the upper part of the thigh by
a musket–ball, which lodged. Three weeks afterward, the ball was found
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