Perforating gunshot wound of head; two wounds converted into one by removal of comminuted bone. From Russian Red Cross Hospital, Mukden. (Major Charles Lynch.)
Fig. 55
Result of accidental explosion of hand grenade, in a Chinese coolie with Fourth Division of Japanese Army, near Mukden. (Major Lynch.)
Fig. 56
Shrapnel wound of leg necessitating amputation. Japanese soldier at battle of Mukden. (Major Lynch.)
About the head may be seen all varieties of gunshot wounds and their complications. The bullets from small weapons may not penetrate, but those from larger ones usually penetrate and sometimes perforate. Infection is not an uncommon sequel to all of these injuries, even if involving the skin alone; the skull, especially the diploë; the membranes, or the brain itself. (See [Chapter XXXVI].) Septic complications are more likely to occur in proportion to disregard of antiseptic precautions in the first treatment. Usually the most serious head injuries are those connected with penetrating bullets. Sometimes the skull undergoes extensive shattering, and occasionally the base is fractured. Instantaneous death, such as occurs when a soldier is beheaded by a cannon ball, sometimes causes a peculiar cataleptic rigidity, which is a species of immediate postmortem rigidity, by which a body may be maintained in the position it occupied when struck. Obviously, lesions at the base are still more serious than those of the vertex, and wounds of the cerebrum are nearly always fatal. I have seen a number of men who had been shot entirely through the head—by Mauser or smaller bullets—who, nevertheless, recovered more or less completely. In one soldier, I recall, the bullet traversed an orbit in such a way as to divide the optic nerve. He was blinded, but recovered most of his other functions; he remained well for some years, and then developed symptoms of insanity. Epilepsy and other psychical disturbances are all more or less frequent after head injuries. [Plate XIII] illustrates how a bullet may be, apparently, harmlessly embedded in the interior of the cranium. Sometimes years after such injuries active symptoms make their first appearance. There can be no question as to the value of the information usually afforded in such cases by the aid of the x-rays.
The same necessity exists here as elsewhere for primary antiseptic occlusion, including careful shaving and cleansing of the scalp. Inasmuch as nearly every gunshot wound of the skull calls for subsequent operation—just as does almost every compound fracture—the parts should be prepared for it early, and everything else should be left until the time when the surgeon is ready to make a complete operation and meet all the indications. In such a case hemorrhage may be temporarily checked by tampon. The surgeon should not omit to take advantage of all the information which a study of cerebral localization may afford him, since localizing symptoms may reveal not only the course of a bullet, but something regarding its location.
Penetrating wounds of the face are less serious than those of the cranium proper. Occasionally a bullet striking a tooth will displace it and drive it in some other portion of the face, e. g., the tongue. Bullets and loose pieces of bone should be removed in wounds of the face. Hemorrhage can usually be controlled by tampons. Interdental splints may often be used to advantage, and in every case where the mouth has been injured antiseptic mouth-washes should be frequently used; in the case of the nose, an antiseptic spray should be employed.