Tiêu đề Medical - Gunshot wounds - V2 ✅

● The peculiar shape of the modern conoidal ball causes it to meet with much less resistance from the air, while the spiral rotatory motion which is imparted to it by the grooves of the modern rifled firearm enables it to retain much more of its initial velocity, & thus to strike with much greater momentum than the old form of musket-ball; moreover, from its centre of gravity not coinciding with its centre of figure, in its passage through the air it acquires a peculiar dip, causing it to strike obliquely, making a large wound, ploughing & tearing up the soft parts, & splintering the bones in all directions. Thus, it is not uncommon for a long bone, such as the tibia or humerus, when struck by a conoidal ball, to be splintered & split both upwards & downwards, to the epiphyseal lines, or even into the ad- joining articulations. Round shot or cannon-balls ● Unless moving with very slight velocity, are apt to tear off an entire limb, or whatever part of the body they may happen to strike; even when almost spent, & rolling along the ground with no more apparent force than a ten-pin ball, they are capable of producing most frightful injuries, as it is said foolhardy soldiers have occasionally learnt to their cost, in attempting to stop such a spent ball with the foot. ● The reason is obvious : though the velocity is slight, the mass and, therefore, the momentum are very great. ● On account of the great elasticity of the skin, it will occasionally escape injury from the blows of spent shot, while the parts beneath, bones, muscles, vessels, & nerves, may be frightfully torn or completely pulpified. ○ Such are the injuries which used to be attributed to the effects of the wind of a ball, passing close to, but apparently not coming in contact with, the person wounded. ○ These injuries are apt to be followed by gangrene, which often seems to be due to rupture of the main artery, at a point higher than the seat of apparent lesion. ● Shell wounds are among the most fatal injuries met with in modern warfare. The explosion of a single shell may kill or mortally wound quite a number of persons; the injuries most analogous to these which are met with in civil life, are such as are produced by accidents in blasting & mining, portions of metal or stone, or splinters of wood, being hurled violently by the force of the explosion against the bystanders, & often inflicting most serious & even fatal lacerations. Nature of Gunshot Wounds ● In whatever way inflicted, gunshot wounds partake of the nature of contused wounds, & are often, as we have seen, attended by great laceration, while in certain cases, especially in the slighter forms of shell wound, the soft parts may be split to some distance from the point of contact of the projectile, & in these cases a portion at least of the wound may be clean cut, & approach therefore to the nature of an incised wound. ● Whatever part is, however, directly touched by the ball, is almost invariably so contused as to be deprived of vitality, & hence it may be laid down as an axiom, which holds good
in this part of the world at least, that every gunshot wound must of necessity be followed by more or less sloughing. ○ Indeed it is often said that every portion of the track of a ball must slough, & that in the case, for instance, of a perforating flesh wound of the extremities, a tubular slough will be separated, representing exactly the course of the ball. ○ I believe, however, that this rule is not invariable; in the early part of our late war, when buckshot were occasionally used in the form of " buck & ball cartridges," several cases of very small perforating flesh wounds thus produced, in which, although undoubtedly both the apertures of entrance & of exit sloughed, the deep parts of the wound apparently healed without the occurrence of sloughing ; & to suppose that such might be the case is not at all unreasonable, for the swelling of the tissues would measurably convert the deeper portion of the wound into a subcutaneous injury, placing it thus in a condition which, as we know, will allow of great laceration without inevitable loss of vitality. ○ The sloughing of gunshot wounds is not due, as was formerly supposed, to any poisonous qualities of the projectile, nor to its temperature, nor to any- fancied development of electricity, but simply to the excessive degree of contusion inflicted by the ball, which, though usually of small mass, strikes with great momentum. Wounds of Entrance & Exit ● Most gunshot wounds have two apertures, one where the ball came in & the other where it went out. ● If there be but one wound, it is prima-facie evidence that the ball has lodged & remains in the part; though more rarely a spent ball may drop out by the same opening as that by which it entered, or striking some prominent part, as the larynx or a rib, may be deflected from its course, and, restrained by the elasticity of the skin, may make a complete circuit around the chest or neck, as the case may be, coming out at last at the same point at which it went in. ● On the other hand, the existence of two wounds is not positive evidence that there is no ball in the part; for a ball may split on a ridge of bone or other projecting object, one portion passing out & making an aperture of exit, while the other lodges; or, which comes to the same thing, two balls may enter at one opening, one passing out & the other remaining. Again, there may be more than two wounds. ○ After the battle of Antietam, a Confederate soldier “Avho” had three wounds in the fleshy part of the thigh; they were all in a line, superficial flesh wounds, almost identical in appearance, & with nearly equal intervals between them. ○ Either two balls had entered together, and, separating in the tissues, had come out by different apertures, or, which from the position of the wounds seemed more probable, two balls had entered by distinct openings, and, meeting in the limb, had come out together.