Mature Scar. Dense fibrous connective tissue with a few fibroblasts. At a, a small bloodvessel. × 250.
Granulation Tissue organizing into Cicatricial Tissue. (Karg and Schmorl.)
Illustrating statements made on several of the foregoing pages.
CONTUSIONS OF THE VISCERA.
Contusions of the viscera may be followed by many and disastrous consequences. They compromise such lesions as rupture of the liver, kidney, spleen, laceration of the bowel, bladder, or gall-bladder, and may occur by blows which do not break the surface; or any of the viscera may be lacerated, punctured, or gashed by gunshot, punctured, or incised wounds. These will be more completely considered in Chapter XLV.
CHAPTER XXII.
GUNSHOT WOUNDS.
Gunshot wounds are usually considered with the special subject of military surgery. Military surgery as such, however, consists in the application of general surgical principles. Nevertheless a gunshot wound is essentially the same whether it be received upon the battle-field or in civil life, and the injury inflicted by a piece of flying shell is in no sense different from that which may be received in a blasting accident.
A gunshot wound is always contused and lacerated, and often punctured. According to its size and shape, its location, the nature and velocity of the missile, the distance at which the weapon was discharged will depend its severity and prognosis.
Shot vary in size from those which weigh but a fraction of a grain to buckshot which weigh nearly one-third of an ounce. Revolver and pistol bullets vary in diameter from 0.22″ to 0.45″, and in weight from twenty-five grains to ten times that amount, and nearly always of conical form. They are usually made of compressed lead, sometimes hardened by the addition of tin or antimony.
The old military weapons, such as the Springfield rifle, have been entirely abandoned, and for them have been substituted rifles of smaller bore, projecting bullets of from 0.25″ to 0.31″, varying in weight from one-fourth to one-half ounce and attaining a muzzle velocity of nearly 2500 feet per second. They have, therefore, a much increased range and may kill at two miles. Their trajectory is flatter and the character of the wound caused by these modern weapons is different from those inflicted, for instance, during the Civil War. The bullets now in use in the armies and navies of the world are nearly all encased in a thin covering of steel, copper, etc., which is known as the jacket or mantle. They are from 3.5″ to 4″ in length, possessing a much greater range than a shell bullet, while the rifling of the weapon is so made as to give them a more rapid rotation. In active service, moreover, these are usually fired with smokeless powder. The so-called “dangerous zone,” i. e., that where mounted men or infantry can be injured, is much wider than formerly.
In India the practice has been introduced of leaving the point of the bullet uncovered by the mantle, so that when it strikes it would “mushroom”—especially in the bone. These “Dumdum bullets,” as they are called, from the place of manufacture, inflict much more serious injuries than do the relatively smooth perforations made by the others, and have been considered so cruel that they are excluded from use in civilized warfare.