An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. 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.
![•with metal. Other methods for utilizing the electric current for detecting and locating a bullet imbedded in the tissues have been devised ; some of these are ingenious and successful as experiments, but none are susceptible of being utilized in general practice. Probing should be done with gentleness antl care. It cannot be too strongly impressed on the mind of the surgeon that all ])robing should be abstained from until such time as the final, thorough examination and dre.ssincr of the wound can be done, when once for all tiie probe may be resorte<l to in accordance with the restricted indications for its use liereafter mentioned. Treatment.—Shock is to be combated in accordance with general princi- ples. Persistent hemorrhage of sufficient extent to refjuire special interference for its arrest indicates a wound of a vessel of considerable size. In such cases the rule is imperative to enlarge the wound sufficiently to expose freelv the bleeding vessel and to ligate it upon both the proximal and distal sides. Should the vessel not have already been completely severed by the ball, it should be divided between the ligatures after their application. Hemorrhage occurring secondarily during the after-histon,' of the wound demands the same treatment, and often involves an extensive dissection in the necrotic tissue. When, by reason of its anatomical position or the difficulty of finding it in the sloughing tissues, it is not practicable to expose the wounded vessel in this wav, ligation of the main artery of supply in its continuity must be resorted to. but only after a determined effort has been made to ligate it in the wound itself From the standpoint of treatment gunshot wounds are divisible into two classes—first, those which are capable of primary occlusion of the external wound and of conversion into practically subcutaneous wounds ; and secondly, those which must be treated as open wounds throughout. A large proportion of gunshot wounds are capable of being kept within the first of these two classes. First class.—The first efibrt of the surgeon, therefore, should always be scrupulously to protect the wound from contamination from without, Tiie one exception to this rule is found when necessity for interference for the arrest of hemorrhage is so great that its urgency may compel the disregard of every other precaution. The external wound may be of such extent as to be manifestly incapable of being sealed up by primary occlusion, but such a condition gives no warrant for the neglect of every possible effort at antisepsis from the beginning. The mere lodgment of a bullet in the tissues is not of itself an indication for the introduction of an exploring finger or probe, nor is it justifiable to disturb the wound by the new traumatism of an exploration until distinct evidence has appeared that the missile is seriously interfering with the repair of the wound by its presence, or unless there is good reason to believe that there has been car- ried into the wound with the bullet septic material, such as fragments of cloth- ing. That exploration of a gunsliot wound which is called for by reason of such manifest extensive laceration and destruction of tissue that the questions of excision and amputation require to be decided, is of an entirely different character from that which has as its end the quest for a bullet and its removal. Such explorations are made on general surgical principles, and become a part of the more formal and extensive operative procedures to which they lead. It is not infrequent, in cases where the foreign body has been allowed to remain undisturbed in its new position among the tissues, and satisfactory and rapid healing of the original wound has been secured, that the body subse- quently becomes a source of irritation, so that its extraction is necessitated. A late operation of this kind, when it can be surrounded by every precaution, and is done among tissues which are no longer infiltrated and from which all](https://iiif.wellcomecollection.org/image/b21217014_0154.jp2/full/800%2C/0/default.jpg)
