A Treatise on Gunshot Wounds

by Sir T. Longmore

The still more recent military operations in Algeria, in Sleswick-Holstein, in the Crimea, and in India have afforded the opportunity of testing practically the applicability to army practice of some of the great improvements which have been accomplished in the civil practice of surgery in Europe since the termination of the war in 1815. Among these may be particularly enumerated the avoidance of amputation of limbs by recourse to excision of joints; resections of injured portions of the shafts of long bones; mitigated amputations, by removal only of those terminal portions of the extremities which had been destroyed by the original injury; and the practice generally of what has been styled conservative surgery. In these wars, too, the value of chloroform as an anesthetic agent in military surgery has been fully established. They have also especially illustrated the influence of various states of health and climates on the results of gunshot wounds. All the anticipations which were held out at the commencement of some of these campaigns have not been realized, but still they have added much valuable information and many improvements to military surgery.

The alterations made during the last five or six years in the arms of a great proportion of the troops of the leading powers of Europe, and which will, no doubt, be extended to all soldiers in regular armies—namely, the transformation of muskets into “armes de précision,” with rifled barrels and graduated aims—have led to changes in the severity and almost in the nature of gunshot wounds from small balls; and the consideration of these changes requires the especial attention of army surgeons. The effects of the new rifle-balls were widely witnessed during a portion of the period of the Crimean war. The campaign just concluded in Italy will probably produce additional practical observations from the Continental surgeons engaged in it. The fearful proportion of killed and wounded—greater than in any former experience—will have shown the effects not only of rifled muskets, but of rifled cannon also; and in the French forces engaged an opportunity will have been afforded of instituting a comparison of the results of their treatment under circumstances of bodily health and hospital accommodation very different from those of the French army in the Crimea. It may be hoped that the experience thus gained will advance the knowledge of gunshot wounds and their treatment a still further stride toward accuracy.

In England, one valuable result which emanated from the late war with Russia was the regular collection and arrangement, under government authority for the first time, of the observations and practice of the medical officers employed in the campaign. The value to science of such systematized historical records, if fairly and fully developed, can scarcely be overrated; and it is to be hoped that henceforth a similar course will be always adopted whenever the country may become involved in war.

VARIETIES OF GUNSHOT WOUNDS.

Gunshot wounds are modified in their nature by the form and kind of missile, by the degree of force with which it is propelled, and by the seat of injury. They are, in addition, affected by the circumstances in which the soldier happens to be placed, and by the state of his health when the injury is received.

Form and nature of missile.—The projectiles used in warfare of the present day are cannon and musket shot, shells of various kinds, hand grenades of iron or thick glass, case-shot, slugs, and other minor varieties of such missiles. These are the ordinary instruments of direct gunshot wounds in warfare; but, in addition, there are numerous sources of indirect wounds, resulting from the discharge of cannon and musketry. These are stones, or other hard substances, struck from parapets or from the surface of the ground by cannon-shot; splinters of wood from platforms and framework, or of iron from gun-carriages; fragments of bone from wounded comrades, or articles in their possession; and any other miscellaneous objects which may happen to come into contact with the solid ball or shell in its course.

The objects above enumerated present several varieties of forms. The chief are—1st, spherical, as cannon-balls, grape, musket-shot, and shells; 2d, cylindro-conoidal, as balls belonging to rifled cannon and rifled muskets; 3d, irregular, but generally bounded by linear and jagged edges, as fragments of shells and splinters.

A gunshot wound, whether received from a direct or indirect projectile, may be complicated by the entrance of extraneous bodies of various kinds, most commonly portions of the cloth or buttons of the dress worn by the person wounded. Such foreign substances, though not of themselves causing the wound, often have a special bearing on the progress of its cure.

Not only the form of outline, but the weight, and in some instances the matter of which the missile is composed, influence the nature of gunshot wounds. In the largest kinds of balls, such as are projected from field-pieces or guns of position, the form offers little subject for consideration to the surgeon. So long as there is momentum enough to carry forward the mass of iron of which these missiles are composed, so long will their weight be the most important ingredient in the production of the wounds inflicted by them. Whether the shot come as a solid cone or bolt from one of the new guns or as a round ball from an ordinary cannon, the injury will be equally destructive to life or limb. The same remark is applicable to the heavier forms of shell, before explosion. The only difference surgeons may look for from the use of cylindro-conoidal balls, or Whitworth bolts applied to cannon, should they become general, independent of increase in the number of direct wounds from greater power and precision of fire, will be the less number of indirect injuries likely to result from their action, as they neither ricochet nor roll as “spent balls” in the manner that spherical shot are accustomed to do.