Multiple shot wounds of arms and back. The ulcer over the spine was produced by pressure, not by the ball (case in Cincinnati Hospital, 1884). (Conner, Dennis’ System of Surgery.)
6. Multiple Wounds.
—The same bullet may sometimes inflict multiple wounds, and, with modern projectiles, these are now more common, as many as six wounds having been made by one missile in its passage, e. g., wounds of the arm and body. Thus multiplicity of wounds may not indicate that the patient has really been shot more than once. In cases of perforation, for each wound of entrance there should be found one of exit, and at the first examination of the patient the discovery and consideration of each of these injuries should be part of the routine. If on examination but one wound be discovered, then the inference is natural and unavoidable that the bullet is still within the patient’s body ([Fig. 48]).
7. Entrance of Foreign Material.
—The entrance of fragments of cloth or other extraneous matter is now less frequent, for bullets of tremendous velocity rarely carry in any perceptible material, their diameter being small and their surfaces polished. A ricochet bullet may carry tetanus or other spores from the earth, and lockjaw may be the result. In other words, gunshot wounds now are less likely to become infected wounds than they were years ago.
8. Explosive Effects.
—The shattering and explosive effects of the impact of bullets upon certain of the viscera are sometimes disastrous, and yet not easily seen from the outside. This is especially true in the brain, heart, liver, spleen, kidneys, and bones. Almost complete pulpification of the semisolid viscera may occur as the result of perforation by a small missile, and the general condition of the patient should be relied upon to indicate this fact.
9. Perforation of the Large Cavities of the Body
usually implies perforation of at least a portion of their contained viscera. Thus if a man be shot through the chest it may be assumed that perforation of the lung has occurred, while in a case of bullet wound of the abdomen it will rarely be found that the viscera, especially the intestines, have escaped perforation. Still, remarkable cases are occasionally recorded. Thus I have seen a man who had been shot through the abdomen from front to back, the bullet entering just above the pubis and escaping near the lumbar spine, who never seemed to have suffered seriously from his injury, although the bullet was a large soft one from the old Springfield musket.