Emergency surgery, for the general practitioner.

  • Sluss, John W. (John William), 1867-
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: Emergency surgery, for the general practitioner. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    wise practice to make careful and systematic examinations. Learn as much as possible about the character of the fire-arm, the nature of the projectile, the position of the patient at the time of injury. Ex- amine the ears and nose for blood, inspect the mouth, examine the head for a wound of exit, or see if the bullet can be located beneath the scalp. Next examine the wound itself, but not until the field and wound have been sterilized. Begin the disinfection by shaving the scalp about the wound. Wash with soap and water and then with alcohol or bichloride. Enlarge the wound by a cross incision, if necessary, and wipe out with sterile gauze, removing all forms of foreign bodies. Finally examine the skull. If you find a mere depression without penetration, it is sufficient to pack the opening with sterile gauze and bandage. Later the bullet may be located with the X-ray and removed, if it becomes troublesome. If the bullet is visible and re- movable without much difficulty, it is better to take it out at once. If the ball has penetrated the entire thickness of the skull and lodged within the cavity, the size of the orifice will be some index as to its probable depth; if the orifice is large, it argues for close range and deep lodgment. If the opening is small, comparatively speaking, it is likely that the ball has not penetrated deeply. Note the direction of the fissures. If the base is involved the prognosis is always serious. Note the condition of the dura: it may be lacerated and the brain tissues may exude. If such is the case, the bullet is obviously in the brain, but its exact location must remain a matter of doubt. It is not ex- pedient to explore for it; it is not even advisable to attempt to disinfect the cerebral wound. It is sufficient to remove all fragments of bone and debris and wipe the wound dry with sterile gauze. On these two points, however, there may be some difference of opinion. The American Text-book of Surgery insists upon the value of disinfection of the entire cerebral track of the bullet and of through-and-through drainage under certain circumstances; also upon the advisability of attempting to locate the bullet by the aluminum gravity probe, and to remove it. Still it may be said that the general practitioner has done his duty and done it well if he has cleansed the skull and dural wounds and controlled the