GUN-SHOT WOUNDS. 



GUNNER, NAVAL. 



obliquely on iU surface ; and then, while one piece passes out the other 

 may run in any other direction among the tissues, where iU pretence 

 is not likely to be suspected. 



Lastly, a part of the surface, or of the whole tubetanoe of a limb, or 

 of the trunk, may be completely ahot off, either by one large ball, or 

 by a whole charge of small ahot. The surface thus left U uneven, 

 ragged, and bruiaed ; the vessels and nerve* lie exposed, or hanging 

 out ; the bono protrude*, and i* often split up, even to the next joint. 



In all ciare in which the ball has penetrated, the parts with which it 

 hai come in contact are ao much injured that their vitality U destroyed, 

 and sloughing to * greater or leas depth ensues ; to a greater distance 

 aroiind also all the tissues are severely bruised. The part divided pre- 

 sents a torn uneven surface ; the vessels roughly rent across generally 

 contract and close ao that but little blood is lost at first ; if a nerve be 

 divided, unusual pain is produced, and the port is paralysed ; if a bone 

 be struck, it splinters, especially in the longitudinal direction, and is 

 besides so shaken that death ensues in it, as in the softer tissues : after 

 penetrating part of a bone, the ball often loses so much of its power 

 that it remains firmly impacted in the medullary canal. If any of the 

 cavitiee be penetrated, it is indicated by effusion of their contents, and 

 other peculiar symptoms, as in the lungs by spitting up of frothy 

 blood, extreme drspniea, air passing through the wound, and Home- 

 time* emphysema; in the abdomen, by protrusion of the viscera, passage 

 of bile, fecal matter, &c., into the cavity, producing at first extreme 

 depression, followed by intense peritonitis. 



The first process for the repair of the injury which gun-shots have 

 occasioned U the separation of the slough or dead portion around the 

 track of the ball. As in similar cases from common causes, the inflam- 

 mation necessary for this purpose supervenes but slowly, though when 

 established it is very intense, accompanied with great swelling, heat and 

 pain of all the surrounding ports, and severe constitutional disturbance, 

 fever, sleeplessness, disordered stomach, &c. As the slough separates 

 and protrudes at the orifices of the wound, these (when double) pre- 

 sent appearances just the reverse of those which they had when first 

 made ; that at which the boll entered (then the smallest) is now the 

 largest, its edge* are wide open, and it is generally filled with a large 

 piece of sloughed tissue hanging from it, like tow dipped in pus ; while 

 that at which the ball passed out is contracting, or has been already 

 healed by the first intention. This difference depends on the ball 

 having lost much of its velocity in passing through the several tissues : 

 hence the part last traversed is less bruiaed or destroyed ; and if , as is 

 often the case, the ball hag been flattened in its course, it may have 

 passed out with it* sharp edge forwards, and given the latter part of 

 the track so much the character of a common penetrating wound, that 

 it might heal by the first intention. The constitutional symptoms 

 change when suppuration is fairly established, the surrounding inflam- 

 mation is lessened, the fever subsides, and in slight injuries the health 

 may seem but little affected. In more severe ones, where, with con- 

 siderable loss of substance, a very copious suppuration occurs, or where 

 it involves some important tissue, as a joint or bone, &c., hectic fever 

 supervenes, with debility, a small rapid pulse, speedy emaciation, 

 copious night-sweat*, diarrhoea, &c. A chief danger accompanying the 

 separation of the slough is, that some of the large vessels, which, when 

 torn by the ball, did not bleed much, if at all, may now ulcerate, and 

 produce severe lucmorrhage ; but if this be avoided, the further pro- 

 gress of the wound presents nothing that could distinguish it from one 

 of the same extent produced by any penetrating instrument, and in 

 process of being filled up by granulations. 



Gun-shot wounds partake of the natures at once of penetrating, 

 lacerating, and contused wounds, and they present the characters of all 

 these in an extreme degree of intensity, from the velocity with which 

 the ball, ill fitted by its shape for penetrating, has been propelled. 

 The general rules of treatment must, however, bo the same as for 

 similar injuries from common causes ; but it will be advisable here to 

 notice a few point* peculiar to this class alone, and to point out what, 

 after long discussions, are now the most generally received rules of 

 practice. 



The extraction of the ball and other foreign substances, though its 

 necessity has been very much exaggerated, is first to be considered. If, 

 on examination of the wound i which should be made as much as possible 

 with the finger), the ball and the substance it has carried in with it be 

 J' it t'llerably moveable, and in a part where forceps can be easily applied, 

 they should certainly be at once extracted ; and sometimes, though 

 very rarely, it may be advisable even to dilate the wound by incisions 

 along its sides fur this purpose. No violent attempts should ever be 

 made at first to accomplish the removal ; for as the walls of the wound 

 slough and nuppurate, the track will become larger, and they may then 

 fall out or be easily displaced; or they may sink down, and, 

 presenting a dependent part, may be taken out after merely dividing 

 the skin over them ; or they may become imbedded in the surrounding 

 tissues, and as the irritation at first produced subsides, the adhesive 

 inflammation may form a loose sac around, in which they may lie for 

 years, without producing any further inconvenience. 



It has been already said that the ball may pass through a part, and 

 lodge just beneath the skin of the opposite side, or that, after a cir- 

 cuitous course, it may be found under the skin at a distance. In 

 either case, if it can be felt, even at the distance of an inch below the 

 surface, it should be cut down upon and removed. If it strike against 



a bone, it may lodge in it superficially, and may then be displaced with 

 the forceps, or with the end of a scoop, or, if more deeply fixed, with a 

 bullet-screw. If it pass through its wall into the canoellous texture, 

 many surgeons recommend that the bone should be cut down upon, 

 and a trephine applied over the ball, so as to cut out a piece of bone 

 sufficiently Urge to draw it through. If the ball or other substances 



extracted at first, and remain fixed after the sloughing n> 

 puration, no further attempt to remove them should be made till tlm 

 inflammation that has supervened is fairly subdued : then, if much 

 irritation continues to be excited, if abscesses form about iU track, and 

 much constitutional disturbance is produced, it may be necessary to 

 use every effort to find out their seat, and if possible remove 

 but if still impracticable, and amputation cannot be performed, or is 

 not deemed advisable, the future treatment must consist in supporting 

 the patient by tonic and anodyne medicines, and by the mildest anti- 

 phlogistic local applications. 



U "in -tlier the' ball be extracted or not, the simplest possible dressings 

 should be at first applied ; a piece of linen spread with some mild oint- 

 ment, fixed on lightly by strips of adhesive plaster, and covered by a 

 rag kept constantly moist with cold water, are the best and most 

 comfortable applications. Tight bandages, stimulating and heating 

 ointments, &c., ore especially injurious. It may be frequently advisable 

 to bleed the patient immediately, or soon after the accident ; and ape- 

 rient medicine should always be given, and a mild antiphlogistic diet 

 strictly enjoined. After three or four days, when suppur;.' 

 established, the cold application will probably cease to be agreeable to 

 the patient, and then it should exchanged for some warm emollient 

 poultice, or lint dipped in warm water or spongio-piline ; and th> , 

 tutional disorder altering with the condition of the sore, the reducing 

 remedies may be laid aside, and soon replaced by mild tonics, a nutritious 

 diet, tc. 



The question of amputation, when that operation is applicable, must 

 be decided aa in common coses by the character of each ; no general 

 rule con be given, except that, cattri* paribut, it will be advisable in 

 many cases in military practice, in which in civil practice it would be 

 scarcely justifiable. If the difficulty of removal from the field to any 

 permanent hospital, the insufficiency of accommodation and nursing, 

 which must be experienced when large numbers are simultaneously 

 wounded, the badness of the air to which they will probably be exposed 

 in crowded barracks, and other circumstances inseparable from the 

 movements and arrangements of large military or naval forces, be con- 

 sidered, it will be evident that it would be advantageous to convert a 

 severe wound, contused and lacerated, which even under the most 

 favourable circumstances would be uncertain and most tedious in its 

 progress, into a clean incised one like that of an amputation, in which 

 danger from bleeding may be lessened and which will require far less 

 attention than the other. As to the long-debated question, at what 

 time amputation should be performed, it is now agreed, that the best 

 period is as soon as possible after the patient has recovered from the 

 immediate depressing effects which often follow the reception of the 

 wound. 



Wounds of the head, chest, and abdomen must be treated as in 

 common cases : if the ball be lodged in these cavities, it will be 

 improper to use more than the most gentle means to extract it; and if 

 in thu abdomen, it will generally be quite useless to search for it. The 

 . porous antiphlogistic treatment will be necessary to give the 

 patient a chance of recovery. 



Secondary hemorrhage not unfrequently ensues, when the ports 

 around the track of the wound slough by ulceration of the larger 

 vessels injured by the ball. The bleeding vessel must, if possible, in 

 this case, as well as if it is observed at the first receipt of the injury, be 

 at once cut down upon and tied both above and below the opening. 

 In the same way, portions of various organs may slough from the 

 injuries received, and, by giving issue to their contents, may produce 

 rapidly fatal symptoms. 



In cases where the skin is not injured, but the parts beneath greatly 

 bruised, it is recommended to make one or more incisions in order to 

 clear out some of the coagulated blood, &c., and to permit the dis- 

 charge of the slough. Where the bones and vessels are considerably 

 broken, as sometime* happens in these coses, amputation is at once 

 neoesssary. In all oases when the sloughs have separated the wound 

 commences to granulate, and from this time, whether its progress be 

 towards recovery or death, its treatment need not differ from that of 

 \vimniU in a similar condition from common causes. 



(John Hunter, Trraliie on the Blood, Inflammation, and Gun-that 

 Worntdt, ' Works/ by Palmer, voL Hi., 1837; Larrey, Mimaira dt 

 Ckiruryie Militairc, 4 vols. 8vo, 1812 ; Guthrie, On (iun-tknl Woundi of 

 the Kxtrrmuut, 1 vol. 8vo, 1815 ; John Hennen, Oiuerratiotu on torn* 

 ImporlnHt Pointt of Military Surgery, 1 vol. 8vo, 1818.) 



OUNNKIl, NAVAL, the highest rank in the grade of warrant 

 officers in H.M. navy. A class of naval officers of whose multifarious 

 duties very little is generally known, and a detailed account of which 

 would excite surprise. It is sufficient herein to remark, that a naval 

 gunner must of necessity be a man of considerable intelligence, as the 

 benefits of all the evolutions necessary in the presence of an enemy 

 would be neutralised, if he be deficient in skill, self-command, and 

 decision. The following are some of his acquirements, duties, and 

 responsibilities : he must, hi the first place, have received a good ordi- 



