SPINAL REGION.
Plate 6.
Rifle—Plate 6.
SPINAL REGION.
Gunshot Wound of the Spinal Region—
Lodgment of the Missile in the Lumbar Muscles.
The bullet is lodged deep in the muscles of the back and not in the abdomen, as determined by inspection of the plate.
(a) The shadow of the bullet is enlarged laterally, because, while on the side of the body next to the plate and to the spine, it is at some little distance from the plate, which accounts for the larger diameter of the shadow; and it is shortened longitudinally, because its long axis is inclined at an angle to the plate.
(b) The outline of the shadow is distinct, an evidence that it is extra-abdominal, as otherwise its outline would be blurred by the diaphragmatic movement of respiration imparted to the abdominal viscera during the Röntgen exposure.
Plate 7.
Rifle—Plate 7.
SPINAL REGION.
Gunshot Wound of the Spinal Region, with Lodgment of the Missile.
The bullet was either dum-dummed or unjacketed because its soft nose mushroomed, striking the crest of the ilium, penetrated the lumbar muscles, and struck the side body of the third lumbar vertebra without producing fracture.
The exposure, as the spinous processes show, was made with the spine next to the plate, and the slight shadow, somewhat larger than the projectile—to judge the size from the undeformed diameter—shows it to be anterior to the vertebra. The shadow is deep enough to indicate the location fairly near to the plate, and, almost certainly, not in the abdominal cavity, where the distance from the plate would have made the shadow less dense and the movement of respiration probably would have given it a blurred outline. The shadow of the localizing cross gives a standard of density to be compared with the shadow of the projectile in making the estimation.
The treatment is conservative; only pain, paralysis, impaired function, or sepsis indicate interference.