Page images
PDF
EPUB

Gunshot wounds are exceedingly liable to secondary hemorrhage. When secondary hemorrhage sets in, as the result of sloughing, it usually arises between the tenth and the fifteenth day.

The shock in these injuries is generally most intense when the ball traverses the head, chest, abdomen or pelvis.

Treatment. The indications are to promote reaction, arrest hemorrhage, ascertain the condition of surrounding parts, extract all foreign bodies, remove loose pieces of bone, if any, and endeavor to control resulting inflammation.

Reaction is brought about by employing the ordinary restoratives; the patient must be placed in the horizontal posture; cold water should be dashed in his face; he must be made to inhale ammonia water. If necessary, sinapisms must be employed, as well as stimulating injections used, and if he is able to swallow, brandy should be given him, or wine, or ammonia properly diluted.

If the hemorrhage be capillary, it will probably soon cease; if not, cold water, pounded ice, or some mild astringent lotion should be used; if, however, the hemorrhage proceed from an artery, the ligature must be promptly resorted to.

Before deciding upon the condition of the wound, care must be taken to ascertain if there be any foreign substance present, and if there be, to remove it, and also whether any neighboring bone be injured.

The next point is to hunt for, and, if possible, extract the ball.

To control resulting inflammation, great care must be taken to properly dress the wound by gently applying a roller, if necessary; put it on in such a manner as not to impede drainage.

After being dressed, cold or warm applications of water, depending on the season, are indicated; the water dressings may be medicated with opium or acetate of lead; or the usual antiseptic dressings may be employed.

DISSECTION WOUNDS.

Dissection wounds are those contracted in the examination of dead human bodies.

Symptoms.-The disease commences at the inoculated part, from whence it spreads.

The first symptom that attracts attention is a stinging or burning sensation; upon examining the part a little whitish vesicle is observed, extremely sensitive on pressure. When the vesicle breaks a small ulcer is exposed. The pain by this time is very great, the sore enlarges, the swelling increases,

and the part feels hot, tense and numb. A red line is usually seen extending from the point of inoculation, along the arm, to the axilla. As the disease spreads the whole limb becomes enormously enlarged, pitting on pressure, and looking dusky and erysipelatous.

Cases occur where the symptoms begin at the axilla and extend from thence up the neck and down the side.

In the worst forms the disease soon reaches a crisis; the system rapidly falling into a typhoid state.

Treatment.-As soon as a wound of this kind is received it should be thoroughly washed with warm water and soap; this should be followed by suction by the mouth. If the wound is small it should be dilated; if it has bled, thoroughly cauterize with acid nitrate of mercury, or nitrate of silver, hydrochloric, nitric or sulphuric acid.

If a vesicle forms it should be freely opened, and then thoroughly cauterized; a warm water dressing should be applied, and, if necessary, a purgative administered. To relieve the excessive pain and restlessness anodynes should be freely employed, and if the skin be hot and dry aconite or veratrum viride should be administered.

To meet the typhoid symptoms, milk punch, quinine, iron and such other treatment should be resorted to as will support and sustain the patient.

WOUNDS OF THE THROAT.

The usual causes of these injuries are attempts to commit suicide; the parts injured are the pharynx, larynx, trachea or œsophagus.

In these cases the carotid is rarely reached, owing to the incision being made high up, and to the head being thrown backward.

The larynx is most frequently injured; it is characterized by air and blood issuing from the wound with great rapidity, especially when the patient coughs. The arteries that are usually wounded are the sublinguals. Should the external carotid be divided, death would ensue before assistance could be rendered.

When the wound is above the larynx, the lips of the wound must be carefully brought into apposition and kept in place by sutures. The head must be brought down upon the chest, and confined in that position, in order to prevent a separation of the edges of the wound.

The mouth must be kept cool and moist, and for this purpose a slice of lemon dipped in water, or a wet rag, or pieces of ice, may be inserted from time to time.

The patient should be carefully nourished, by nutrient enemata, with

opium added, if necessary, and when food is given by the mouth it is best to commence with semi-solids, such as jelly, etc.

If the wound is in the thyroid or cricoid cartilages, the air rushes through the wound in expiration, and violent coughing is produced. The treatment is the same as the preceding case.

When the wound is inflicted within three inches of the sternum, it is more dangerous than in any other situation; here the trachea is in the forepart, the œsophagus behind, and the carotid arteries are close to the trachea.

In wounds of this kind the first object is to stop the bleeding, and if the wound is not sufficiently large, an incision should be made in a longitudinal direction, to expose the mouth of the vessel, in order to secure it with the least possible delay.

GUNSHOT WOUNDS OF THE CHEST.

These may be divided into the non-penetrating and the penetrating. The non-penetrating are those affecting the soft parts and the ribs; the penetrating are those in which the lung is directly injured. The missile may pass through entirely or partially, and lodge in the pleural cavity, or it may pass directly through the chest and lung.

Symptoms.-More or less collapse, depending on the time that has. elapsed since the wound. Face anxious, breathing labored, respirations frequent. Blood expectorated in more or less large quantities; air generally found passing from surface of wound, and usually there is emphysema in the neighborhood.

Treatment.-Patient must be placed in bed and careful search made for the ball; when there is no counter-opening, the ball may be often found on the opposite side. Splintered fragments of ribs should be removed and any sharp ends of bone rounded off. If the collapse is not severe the patient should not be disturbed, so that an opportunity may be given for clots to form and bleeding to cease.

A light dressing should be placed over the wound and the patient carefully watched.

WOUNDS OF THE ABDOMEN.

Wounds of the walls of the abdomen may be caused by fragments of shell, and large portions of the integuments and muscles may be carried away; bullets and swords will frequently traverse the walls of the abdomen

without penetrating, and missiles may strike the abdomen and inflict severe injury on the viscera without external injury.

Penetrating wounds of the abdomen, with or without injury to the viscera or large vessels, are followed by great mortality. If the contents of the abdomen are not injured, the chief danger is from peritonitis. When the viscera are wounded, the severity of the danger, in a great measure, depends upon whether a solid organ, such as the liver, spleen, or kidney, has been injured, or if the stomach or intestines have been perforated.

Wounds of the liver, spleen and kidney are more fatal than those of the stomach and large intestines, and these latter more so than the small intestines.

Symptoms. Great collapse is the first striking symptom; it is very severe if the viscera have been wounded; and is a common cause of death. Frequent vomiting is a symptom common in wounds of the intestines, particularly if the injury be high in the canal. The pain is great; and blood passed from the bowels is a usual symptom.

The after symptoms are those of peritonitis and such as are referable to the particular organ wounded, e. g., blood with the urine, if the kidney be injured; or bile, if the liver, etc., etc.

Treatment. When the cavity of the abdomen is penetrated, place the patient on the bed, carefully examine the wound, and return any viscera that may protrude. If the intestine be wounded, a stitch or two must be applied, with the serous surface turned in, so as adhesion may take place. The knot must be cut short and disposed between the stitches.

To relieve pain and to arrest peristaltic action, large and repeated doses of opium are called for.

Where there is only a superficial wound, endeavor to procure union by means of sutures.

WOUNDS OF THE JOINTS.

A wound may usually be known to have penetrated the joint by the escape of synovia, though this is not invariably the case.

Treatment. The parts must be shaved, carefully cleaned, and dressed antiseptically, due regard being had to free drainage.

The limb must be absolutely immovable and for this purpose a proper splint must be applied.

E

QUESTION OF AMPUTATION IN WOUNDS. Amputation should never be performed until reaction has set in.

It should be resorted to when the limb has been run over by a heavy vehicle, crushing the bone and tearing open the soft parts; when, in addition to serious injury inflicted upon the integuments, muscles or bones, the principal artery, vein, or nerve has been lacerated; when a large joint is penetrated, accompanied by comminuted fracture. If mortification sets in, amputate high up. If it is an injury of the leg, and the bones are shattered, and the posterior soft parts are not much lacerated, and the main artery is intact, an effort should be made to save the limb.

HYDROPHOBIA.

This disease is the result of poison, caused by inoculation with the saliva of rabid animals.

Symptoms.-The first symptom a person experiences who has been bitten by a rabid animal is pain in the injured part, and this may be felt between the second week and third month after a bite (sometimes a much longer period will elapse). The next symptoms are low spirits, a sense of chilliness, succeeded by rigors and heat, headache, stiffness of the neck, soreness of the throat; then a difficulty of swallowing is felt, not of liquids in particular, but of any substance; so that the patient avoids making an effort; but upon applying a cup to his lips, he will be seized with the most painful shuddering; he will turn away to avoid the sight of what he was about to take, and sit down in a state of exhaustion.

From this time the most prominent symptoms will be difficulty of breathing and swallowing, extreme irritability of the body and disorder of the mind.

Treatment. Immediately after the individual has been bitten, place a tight ligature above the affected part, and, if possible, at once have the wound vigorously sucked, and then, as soon as may be, cut it out and thoroughly cauterize the whole. Mr. Youatt prefers nitrate of silver, but many authorities place a small piece of potassa fusa into the wound, allow it to dissolve, when its cauterizing influence will be communicated to all parts of the wound.

It does not appear that there is any cure for this affection. The general treatment should be that indicated under the head of tetanus.

« PreviousContinue »