Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
It is not necessary here to do more than indicate the general characters
of wounds produced by modern weapons. For further details the reader is
referred to works on military surgery. Experience has shown that the
nature and severity of the injuries sustained in warfare vary widely in
different campaigns, and even in different fields of the same campaign.
Slight variations in the size, shape, and weight of rifle bullets, for
example, may profoundly modify the lesions they produce: witness the
destructive effect of the pointed bullet compared with that of the
conical form previously used. The conditions under which the fighting is
carried on also influence the wounds. Those sustained in the open,
long-range fighting of the South African campaign of 1899–1902 were very
different from those met with in the entrenched warfare in France in
1914–1918. It has been found also that the infective complications are
greatly influenced by the terrain in which the fighting takes place. In
the dry, sandy, uncultivated veldt of South Africa, bullet wounds seldom
became infected, while those sustained in the highly manured fields of
Belgium were almost invariably contaminated with putrefactive organisms,
and gaseous gangrene and tetanus were common complications. It has been
found also that wounds inflicted in naval engagements present different
characters from those sustained on land. Many other factors, such as the
physical and mental condition of the men, the facilities for affording
first aid, and the transport arrangements, also play a part in
determining the nature and condition of the wounds that have to be dealt
with by military surgeons.
Whatever the nature of the weapon concerned, the wound is of the
_punctured, contused, and lacerated_ variety. Its severity depends on
the size, shape, and velocity of the missile, the range at which the
weapon is discharged, and the part of the body struck.
Shock is a prominent feature, but its degree, as well as the time of its
onset, varies with the extent and seat of the injury, and with the
mental state of the patient when wounded. We have observed pronounced
shock in children after being shot even when no serious injury was
sustained. At the moment of injury the patient experiences a sensation
which is variously described as being like the lash of a whip, a blow
with a stick, or an electric shock. There is not much pain at first, but
later it may become severe, and is usually associated with intense
thirst, especially when much blood has been lost.
In all forms of wounds sustained in warfare, septic infection
constitutes the main risk, particularly that resulting from
streptococci. The presence of anaërobic organisms introduces the
additional danger of gaseous forms of gangrene.
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