GUNSHOT WOUND. A wound produced by a, missile projected from a pistol, rifle, cannon, etc., by the force of any explosive. Such wounds may vary in severity from a simple bruise to the tearing away of a whole limb. Single balls pro duce an incised, bruised, or lacerated wound, ac cording to the amount of their velocity when they strike the body. The effects of small shot vary with the distance and power of the gun; when at short range the pellets enter so close to gether as to make one wound like that of a single ball. It was once commonly believed that the `wind of a large shot' could produce serious in juries; this belief may have arisen from the cir cumstance that when a heavy ball, which has lost some of its force, strikes the body at a par ticular angle, the skin does not always give way, but the deeper structures, such as the muscles, or large organs, as the liver, may be completely crushed. When a perforates the body, the entrance opening, which is generally depressed, round, and regular, is often smaller than that of the exit. The modern conical ball makes a well-defined oblong wound; but it may shift its direction, strike longitudinally, and cause a. more extensive injury to the skin. When a bullet strikes the shaft of a bone, it cracks or splinters it, and either remains or passes through the cancellated ends. in its course the ball may carry before it pieces of cloth, coins, or other foreign bodies, which increase the danger from the wound. The modern bullet of small calibre, traveling at a very high rate of velocity, such as the bullet projected by the Mouser, Lee-Met ford, or Krag,-.BIrgensen rifles, produces a small round wound of entrance and a wound of exit of nearly, if not quite, similar character. As a rule all tissues, including bone, are clearly perforated; but occasionally, usually at close range, or where a soft-nosed bullet is employed, the destruction of tissue may be very great.
Hemorrhage is as a rule very slight, though occasionally a blood-vessel of importance may be perforated. Injuries to the blood-vessels are con siderably more frequent with modern high-velo city projectiles than they were with the old fashioned bullets of low velocity, which occa sionally bruised the vessels, but more often pushed them aside instead of cutting them. Many per sons who have been shot during the excitement of battle describe the sensation as the sharp stroke of a cane; but in most instances the man soon begins to tremble, complains of cold, his face becomes pale, his pulse is scarcely per ceptible, and he appears as if about to die.
This is the condition termed shock; and though death sometimes does ensue during this state of prostration, it is not so serious as it appears, and the patient will probably pass out of it in a few hours, with the help of stimulants and rest. Although excessive bleeding is not so common after gunshot as after other kinds of wounds, it may occur immediately and to a fatal extent, if assistance be not afforded. The first assistance in the treatment of a gunshot wound is to preserve cleanliness in the locality of the injury. This is to be done by immediately applying a dressing or compress of gauze to the injured surface. In modern warfare every man who goes into the field is supplied with one of these sterile dress ings in a compact form, with directions for ap plying it. In private practice, or under circum stances where a sterile dressing is not immediate ly at hand, the dressing should be wet with some antiseptic solutidn, such as carbolic-acid solu tion of a strength of 1 to 00, or mercuric chlo ride (corrosive sublimate), 1 to 1000. Where hemorrhage is free, pressure should be applied directly to the wound by means of compresses or with the hands or bandage. If this does not control the bleeding, an improvised tourniquet (q.v.) should be applied to the limbs. When a bone has been broken by the shot, a suitable splint or support must be applied. The further management of a case, beyond the administration of such stimulants as may be needed, should be at the hands of a surgeon.
At the present time, surgeons do not probe for a bullet except in rare instances. To pass a probe through the opening made by a missile in several layers of tissue it is necessary to place the pa tient in the same position in which he was when the wound was received, if the tissues are mov able or slide one upon the other. This is gen erally impossible; and very often the probe will make a false passage, opening up a new‘ track for possible infection, and never strike the bullet. in the case of the imbedding of a bullet in the brain, the substance of which is not. contractile, and which alters but little in relative position to the skull after a gunshot wound, probing is al lowable if the probe enters easily. It is most desirable to remove the bullet in such a case. Frequently its position may be inferred with con siderable accuracy from the symptoms.