In neither of these cases did anything except the position of the external apertures point to the infliction of visceral injury.
General remarks as to the prognosis in abdominal injuries. The prognosis in each form of individual visceral injury has been already considered, but a few points affecting these injuries as a class should perhaps be further considered.
First, as to the influence of range on the severity of the injuries inflicted; I am not able to confirm the greater danger of short range, except in so far as there is no doubt that more shock attends such injuries, and possibly some of the most severely wounded were killed outright as a direct consequence of the greater striking force of the bullet.
Among the cases in which but slight effects were noted, however, many were said to have been hit within a range of 200 yards, as for instance the two injuries quoted under the heading of wounds of the spleen.
I personally saw no cases in which explosive injuries of the solid viscera were to be ascribed to this cause.
Secondly, as to the immediate prognosis in all abdominal injuries, the ensurance of rest and limitation as far as possible of transport were of the highest importance, either in the case of wound of the alimentary canal, or in wounds of the solid viscera in which hæmorrhage was a possible result.
Thirdly, as to the later prognosis in these injuries; very few men are fit to resume active service without a prolonged period of rest. In spite of the insignificance of the primary symptoms, or of the favourable course taken by the injuries, active exertion was almost always followed for some months by the appearance of vague pains and occasionally by indications of recurrent peritoneal symptoms, pointing to the disturbance of quiescent hæmorrhages, or of adhesions. Wounds of the kidney are apparently those least liable to be followed by trouble.
Lastly, the prognosis was influenced in the case of many of the viscera by coexisting injury to other organs or parts.
For instance, at least thirty per cent. of the abdominal wounds were complicated by wound of the thorax; and in the lower segment of the abdomen injury to the extra-peritoneal portions of the pelvic organs was common.
Both the immediate and ultimate prognosis were influenced greatly by this fact.