Gunshot injuries, their history, characteristic features, complications, and general treatment : with statistics concerning them as they have been met with in warfare / by Sir T. Longmore.

Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Gunshot injuries, their history, characteristic features, complications, and general treatment : with statistics concerning them as they have been met with in warfare / by Sir T. Longmore. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    455/884 (page 413)
    The constitutional treatment, the proper kinds and quantities of nourishment to be administered, the successive local applications, as a case of gunshot injury progresses through its successive stages, are matters for subsequent consideration. It will be convenient to keep chiefly in view, first, the treat- ment of such injuries as are caused by the smaller kinds of mis- siles, such as rifle projectiles and shell fragments of limited dimen- sions, and afterwards of those resulting from heavy projectiles of larger sizes. In order that a wound may be satisfactorily examined, it must be fully exposed, temporary dressings that may have been applied hastily on the field being gently removed, any dust, dirt, or clot that has become collected in its neighbourhood carefully cleared away, and the surrounding integument cleaned and purified by an antiseptic lotion. If the wound be on the head or on a part of the body covered with hair, this should be removed from its neigh- bourhood. When the injured part has been thoroughly cleansed, and the wound is fully exposed to observation, the nature and extent of the injury inflicted should be accurately established. In occasional instances, especially in cases of perforating flesh wounds by rifle-shot, the openings may be so well occluded by antiseptic dressings which have been applied in the front, and the wounds may be so manifestly free from all important com- plications, that it would be only a wasteful disposal of time to interfere with them. They can be left without further examina- tion, due attention being given that rest of the injured parts is secured, so long as they remain free from pain and any fresh symp- tom demanding surgical attention. Early diagnosis very important.—In all cases of shot wounds in which there are elements of doubt respecting the amount and limits of the damage done by the shot, existing complications, and therefore of the required treatment, a settlement of the questions involved should be arrived at as soon as possible after the arri- val of a patient at a field hospital. The importance of complying with this precept cannot be overrated. A complete examination of the wound can be made with less suffering to the patient and more satisfactorily to the surgeon at that time than at any later period. The sensibility of the parts adjoining the track of the missile is to a certain extent numbed before reaction is estab- lished ; and there is less swelling to interfere with the examina- tion, so that the amount of disturbance effected among the several anatomical structures, as well as the lodgment of any foreign bodies among them, are more obviously apparent than they will be subsequently. Moreover, the examination, if judiciously con- ducted, with a due appreciation of the importance of excluding and guarding against all septic influences, is at this period free from deleterious effects; while the same proceeding, if it be put