Licence: Public Domain Mark
Credit: Gunshot injuries / by Sir Thomas Longmore. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![the extraction of arrows, darts, and otlier similar weapons, and was simply con- tliuied wlieu shot from fire-arms had to he taken out of the body. Ambrose Par^, in the short accomit which he gives of his service at the siege of Perpig- nan, in 1545, mei'tious a case in which he gained great credit by attention to this rule. M. de Brissac, grand master of the artillery, was wounded, on the occasion of a sortie from the town, by a bullet in the shoulder. Lying on a bed in bis tent, he was examined by several of the most eminent surgeons with the army, and they, being imable to find any trace of the bullet, declared it had passed into bis chest. Having known Pari5 before, M. de Brissac sent for him, Va.v6 made him get up from bis bed, and place himself in the position in whicli be was when he was hit. This at once gave Par^ the cue. Following the direction of the wouud with his hand as tlie patient stood in position, be pre- sently came upon a little swelling under the scapula, determined this to be the site of lodgement, and from it shortly exti-acted the bullet. Digital exploration of gumhot womds, note 11, prrge 322. Sorne eminent surgeons have objected to exploring gunshot wounds by the finger for establishing an early diagnosis, but I do not think they do so on suffi- ; cieut grounds. That the evil ellects, desciibed in the text, of abstaining fi-om exploring wounds in the way mentioned are not imaginary, I will quote a portion of a letter, written to me by a very experienced surgeon in 1865, during the last ; war in New Zealand :—' Some cases have shown how extremely necessary is a careful examination by the finger of all wounds on the field. I may especially i mention the shoulder-joint cases. These were first seen by inexperienced i assistant-surgeons, who neglected examining them with the finger, and, conse- f ] quenlly, with the probe were not aware of the real nature of the injuries. The ' ■ wounds were not diagnosed, as affecting the joints, at the very period above all ; others when it was easy to do so. Days passed on before it was possible to de- i cide from the great swelling, inflammation and infiltration of the tissues, what was the real nature of the damage done. In some of the cases in which an examination was tried, it bad to be desisted from, owing to its causing extreme pain and suffering. After being from five to six days in hospital, the peculiar I character and odour of the discharge gave indubitable indications of the exact 1: nature of these wounds. The case of , also, well exemplifies what I have * ' remarked. He was wounded in the shoulder-joint, no digital examination was made ; and, being under another surgeon, I did not examine the wound. I was repeatedly assured the joint was safe, although I never agreed to this ; pai-ticularly on account of tbe nature of the discbarge. After three weeks of intense suffer- ' ing, and serious constitutional disturbance, I urged tbe propriety of placing the patient under chloroform, and thoroughly exploring the wound. This being done, not only was fracture found to be present, but the greater portion of the bead of the humerus was dislocated back on tbe scapula. You may picture to ^ yourself the eflects of this on a patient of an irritable and highly strumous con- f stitution ; it nearly cost bim his life. Had all these cases been at once recog- 7 niped on tbe field, primary operations woidd certainly have been resorted to, with a most considerable reduction in the constitutional suffering, and bad after- effects to the patients. ' In 's case, too, it was self-evident how very different woidd have been the final results in a man of his constitution, had a primary operation been practised; and the extreme severity of the injury would have settled the neces- sity of the procedure, had it been diagnosed at once, by examination with tie fmger, after the receipt of the wound.' I have quoted this passage at length, as it so strongly illustrates the neces- sity for establishing a correct diagnosis of penetrating gunshot wounds at the j earliest opportunity, by digital exploration. If further evidence be necessary for impressing tlie importance of this point of practice on the minds of young j field surgeons, I may mention that on asking my able friend. Dr. Frank, who ^ was activelj- engaged in volunteer ambulance work throughout the late Franco- ,](https://iiif.wellcomecollection.org/image/b21511421_0690.jp2/full/800%2C/0/default.jpg)
