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The effect of a gunshot wound varies, of course, extremely with the nature of the missile as well as the part of the body injured. One of the usual effects is a condition which much resembles fainting, and which is called shock or collapse. This condition may follow any severe injury, and will be discussed in a separate chapter.
Cannon shot grinds to powder any human tissues which it meets within five or six hundred yards of the gun. If it strike a limb, the ball carries it away or grinds it into pulp.
The bleeding from a cannon shot is not usually severe, since the vessels are torn across and the blood clots at once ; moreover, the condition of shock supervenes, during which the heart's action is very feeble, and the blood is not propelled with much force.
After a cannon shot has traveled a greater distance and has thus lost much of its impetus, it is still capable of inflicting severe and even fatal injury. A curious feature about the course of such a spent cannon ball is, that its course may often be changed by objects which it meets, without affecting its power to inflict injury.
" A private in the First Royals was working in the trenches before Sevastopol. He was in the act of shoveling up some earth, with his body bent and his right hand in which he held the handle of a shovel low down in front of the space between his legs. In this position he was struck by a round shot. It shattered his arm, leaving it hanging only by the skin, and passing between the thighs at their upper parts, it tore away from each of them a large mass of the integuments and muscles, and laid bare the femoral artery on one side. It carried in front of it the genital organs, and guided by the curve of the buttocks, it swept away a large portion of the hip on one side."-Druitt.
Cannon shot, when nearly spent, may inflict severe injuries without breaking the skin. Even when rolling along the ground it retains power enough to take off a man's foot - a fact which has surprised many a soldier who attempted to stop one of them by putting out his foot.
A popular notion prevails that the " wind" of a ball, that is, the current of air set in motion by its flight, is capable of inflicting serious injuries without actual contact with the ball itself. Experience on the battle field has shown that this idea is erroneous ; many instances are known in which a person's clothes have been torn away without causing him any serious injury. "A shot ricochetted with great force over one of the parapets, carrying away the cap from a seaman's head. The man was a little stunned, but no further mischief ensued. When the cap was picked up it contained a handful of hair which had been shaved from the scalp by the shot. This would have been a 'poser' for the old wind con- tusionists. "-Dnygan.
Musket and rifle balls produce .the greater number of injuries inflicted during a battle. Although they rarely cause such frightful lacerations as those produced by cannon balls, yet they are capable of destroying bones and flesh quite as effectually.
Small shot fired from a shotgun produce different effects, according to the distance which they may have traveled before striking. The shot always scatter after leaving the gun, and after they have become separated they rarely penetrate the flesh to any great distance. So long as they remain together, however, they inflict very serious injury, which may be indeed more severe than that caused by a musket ball.
Firearms which contain no ball may, nevertheless, cause serious damage by the impact of the wadding. Gunshot wounds of all kinds are furthermore complicated by the effects of the gunpowder, if the weapon be discharged at short distance from the individual who receives the charge.
Bullets frequently pursue a roundabout course in their passage through the body. They are apt to be deviated from their original direction by striking the bones or hard articles contained in the clothing. Even a suspender button may be sufficient to divert a ball from its course. In consequence of this fact, it is often impossible to tell what course the ball has pursued after penetrating the skin, or where it should be looked for. Instances are known in which a ball has entered the chest, struck one of the ribs and traveled clear around the body under the skin, without penetrating the heart or lungs ; sometimes such a ball emerges at the side of the back≠bone at a point opposite the wound made by its entrance at the front ; in such a case the natural supposition is that the bullet has passed directly through the body, though it may really have inflicted no serious injury. The position of the limbs evidently modifies the course of the ball which may strike them ; if the bullet strikes the arm obliquely for instance, it is very apt to glance off and emerge from the skin at a point a few inches from that at which it entered. Many curious instances are related, showing the remarkable effects upon the course of a ball which may be exerted by the simplest accident. Druitt relates the case of an officer who was struck in the abdomen by a musket ball. The bullet came into contact with a button of his trousers, which it bent double.
Its direction was changed by this obstacle, so that instead of entering the abdomen it turned down and lodged in the thigh. Another man was struck in the neck by a bullet ; it entered the skin at the side of the larynx, " Adam's apple," passed completely around the neck, and was found lying in the hole where it had entered. When a bullet passes thus superficially under the skin, it often leaves a track which is marked by a dark red or blue line. This may, however, be so small as to escape attention.
It is often, for many reasons, important to know which of two orifices made by a bullet is the one at which the ball entered. This can usually be decided without difficulty. The opening made by the ball during its entrance into the body is usually smaller than the bullet itself, and its edges are turned inward. The orifice left by the bullet in leaving the body, on the other hand, is usually larger than the ball itself, and its edges are turned outward.
Treatment of Gunshot Wounds.-The plan of treatment adopted for the treatment of gunshot wounds has, like other departments of surgery, undergone essential modification in the past few years. It was formerly the custom of surgeons to probe the wound at once and to make every effort to extract the ball. Experience has shown, however, that the operation of probing may cause far more serious damage than the presence of the ball itself; in fact, if no other body than the bullet have been carried into the wound, no particular danger is to be. apprehended from it subsequently ; the damage done is inflicted by the movement of the bullet ; after this has come to rest, it ceases to exert an injurious effect.
The popular impression still is that the bullet must be extracted at any cost, and that the patient has but little chance of recovery until the ball be removed. Many a surgeon has sacrificed his judgment to this popular prejudice and has attempted to find and extract a bullet when he really believed that it would be better for the patient to omit all efforts in searching for the ball.
There is one feature in many cases which warrants an attempt to find and remove a bullet ; this is, the possibility that particles of clothing have been carried into and have lodged within the wound. If this have occurred, the wound often refuses to heal ; considerable matter is produced and discharged, and the patient may suffer from severe fever and even blood-poisoning (pyśmia).
If the ball be lodged near the surface, it can usually be detected at once by a simple probe or by the finger ; in this case it may be extracted with the pincers or forceps. It is, however, not desirable to search very vigorously for the missile. Sometimes the bullet can be found lying just under the skin ; in such a case a cut may be made through the skin and the bullet extracted.
Generally speaking, we may lay down the following rules for the treatment of gunshot wounds :
First-Be sure that every instrument and finger which approaches the wound is perfectly clean. By this we mean not simply that the fingers and instruments shall be clean in the ordinary sense of the word, but also that they shall be thoroughly disinfected.
Second-Insert a simple probe or, if the wound be large, a finger into the wound and search for the ball; if it be not found at once, without attempting to enlarge the wound, desist from further probing.
Third-Syringe out the wound with one of the following solutions :
Carbolic acid, - Two drachms.
Water, - Eight ounces.
Or, if more convenient :
Listerine, - One ounce.
Water, - Five ounces.
(The ingredients and fingers which are allowed to touch the wound should be thoroughly cleansed with one of these solutions before being introduced.)
Fourth-Place a compress, that is a piece of folded lint wet with one of these liquids, over the wound and hold it firmly in place with a bandage.
Fifth-Keep the wounded member perfectly quiet ; if the wound be severe, the patient should be kept in bed for a day or two.
The bleeding from gunshot wounds is not often profuse or dangerous. The most severe cases are those in which the blood escapes into the interior of the body. In such instances the patient may bleed to death before the bystanders have any suspicion that such an event is possible, since little or no blood escapes from the wound.
The termination is preceded by rapid failure of the patient's strength ; he becomes blanched, his pulse is weak and rapid, and consciousness is gradually lost.
The treatment of hemorrhage into the interior of the body is in many cases ineffectual, though sometimes it becomes possible for a surgeon, acquainted with the anatomy of the parts, to reach and close the bleeding vessels. The only household remedies that can be employed are tincture of ergot, a teaspoonful of which may be given at once and repeated in half or three-quarters of an hour.
The patient should be kept perfectly quiet, and his strength should be rallied by the administration of alcoholic stimulants, such as egg-nog.
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