be sparing of time and patience. Trim away the lacerated tissues. If satisfied with the cleansing, suture the deeper layers over the joint so as to close it completely, and drain only the superficial wound; otherwise, drain the joint cavity as well. Apply an antiseptic dressing and immobilize, and expect a good result. The situation is again different if the case has been treated first by the uninstructed. The wound is seen some time after injury and found covered with dirty cloths, or a handkerchief, the worse for usage, is ‘stuffed into the wound. No covering at all is always better than anything less clean than a sterile dressing. <Callout type='important' title='Proper Cleaning'>You cleanse, drain, immobilize, and watch.</Callout> You watch for beginning infection, which for that matter may develop in the simpler cases if the cleansing is not complete. Fever, pain, swelling of the joint, all rapidly increasing, are the signs of beginning infection and suppuration and call for immediate action. It is indicated to open the joint and drain. (See page 423, Arthrotomy.) Bullet wounds produce similar lesions, although usually they are of the milder type. Hemarthrosis indicates injury to bone as well as soft parts. Sometimes these wounds occur with scarcely any injury to the joint structure, the bullet lodging in the epiphysis. In the milder cases, wherever the bullet may be, it is better merely to cleanse and immobilize, and at a later date, if necessary, the ball may be removed. If, however, the hemarthrosis is voluminous, it is better to open the joint at once and clean out the cavity and, by a happy chance, the bullet may be found and extracted. (See also gunshot wounds of joints in military practice, and compound dislocations.) <Callout type='risk' title='Incomplete Cleaning Risks'>Fever, pain, swelling of the joint, all rapidly increasing, are signs of beginning infection.</Callout> GUNSHOT WOUND OF HAND. A pawnbroker, examining a revolver brought in for a loan and which was supposed not to be loaded, was shot through the hand. The 42 bullet passed between the heads of the third and fourth metacarpals, splintering the fourth in some degree. The tissues were powder stained along the track of the bullet and the wound bled very freely. <Callout type='tip' title='Effective Drainage'>Pass a slender forceps through the bandage, attach a piece of gauze, and pull it into place for through-and-through drainage.</Callout> The work of entrance in the palm was jagged; the wound of exit smooth. The wounds were cleansed and a slender forceps passed through the band. A piece of gauze attached and pulled into place for through-and-through drainage by withdrawing the forceps. The ill SUPERFICIAL WOUNDS FROM FOWLING-PIECE. 165 bleeding stopped, but later began again soaking the bandages. Syringing the wound with peroxide and packing with gauze served to check the bleeding for a few hours. This intermittent hemorrhage persisted for two days. The hand was soaked twice daily for a half-hour in hot normal salt solution; the swelling and pain rapidly subsided and after three or four days the wound began to heal without the least evidence of infection. The ring finger was stiff and painful for some time, but under massage and passive motion gradually regained its use. Injury to the tendons constitutes one of the chief complications of gunshot wounds of the hand. Free trimming away of the shattered tissues, free drainage and free use of hot normal salt solution seem best calculated to promote repair in this class of wounds. SUPERFICIAL WOUNDS FROM FOWLING PIECE. A farm hand, charged with trespass, was brought to the county jail sorely wounded. Two charges of bird-shot had caught him on the fly and peppered his back, buttocks, and the posterior surfaces of thigh and calves. Evading his pursuers, aided by the darkness, he had reached his cabin exhausted and, without changing his bloody clothes, lay thus unattended for two days, when he was discovered and arrested. By this time infection had set in. His buttocks and calves, particularly, where the shot were thickest, were swollen and inflamed. Many of the shot had carried shreds of clothing into the tissue: each was a focus of suppuration; none had penetrated beyond the skin. The whole injured area was cleansed, first with soap and water, and then rubbed vigorously with peroxide of hydrogen; the more superficial of the shot were picked out, and finally the inflamed surfaces were smeared with Reclus’ ointment and covered with sheets of gauze held in place by adhesive strips. The relief from pain was great. In three or four daily sessions the shot were all picked out and the inflammation practically gone. 166 GUNSHOT WOUNDS IN CIVIL PRACTICE. WOUNDS FROM TOY PISTOLS AND BLANK CARTRIDGES. Two things are noteworthy in connection with these wounds: first, the surprising power of penetration of cartridges supposed to be harmless; and, second, the great danger of a tetanus infection. The “wad” may be buried out of sight in the tissues, it may entirely perforate the hand, or it may produce a superficial laceration. As a rule, the hemorrhage is insignificant, which may in a measure account for the development of infection, since bleeding is nature’s means of disinfection. These wounds often present the appearance of punctured wounds, which, more than others, are likely to furnish conditions favorable to the growth of the tetanus bacillus. It may be that the disposition of the wad is such that the wound is in a manner stopped up, so that oxygen cannot reach the recesses where the bacillus finds its lodgment. It is true that tetanus develops in only a small percentage of cases, but one can never foretell positively what such a wound may do. It is the duty of every doctor to warn his clientele of the danger of these “Fourth of July” injuries. Every case is to be treated as if lock-jaw is not merely a remote possibility, but a probability. Free cleansing and douching with peroxide of hydrogen is indicated. Luckett says (American Journal of Surgery, July, 1906); “These wounds should be freely incised, particularly if not seen on the first day of the injury, and thoroughly curetted with a small sharp spoon until all the small pieces of wad, the unburned grains of powder, and all the dirt have been removed. If the wad has entered a metacarpal space a counter-incision must be made for through-and-through drainage. Having cleaned the wound as thoroughly as can he done mechanically, we now resort to chemicals and irrigate with some mild antiseptic. After next drying the wound thoroughly, the entire cavity should be swabbed out with one of the following, named in order of choice: 1, Pure carbolic acid followed by alcohol, 2, Twenty per cent, tincture of iodine (made by dissolving iodine crystals, 20 parts, in ether and alcohol, each so parts). 3, Plain tincture iodine. The wound should now be packed with moist iodoform gauze. A wet dressing is then applied, to be changed daily. Permission should be obtained for a prophylactic injection of antitetanic serum. Ten c.c are intra-muscularly injected in the buttocks or thigh, under thorough antiseptic precautions.” Antitetanic powder may be applied to the wound, as advised by Calmette. Experiments conducted by Joseph McFarland, of Philadelphia, corroborate Calmette’s statements as to the prophylactic value of this substance. By its use McFarland was able to protect from infection animals which he had inoculated with the tetanus bacillus.
Key Takeaways
- Proper wound cleaning and drainage are critical for preventing infection.
- Hemarthrosis can indicate injury to both soft tissues and bone, requiring careful treatment.
- Tetanus is a significant risk from toy pistols and blank cartridges, necessitating prophylactic measures.
Practical Tips
- Always clean gunshot wounds thoroughly with peroxide of hydrogen to prevent infection.
- Use antiseptic dressings and immobilization techniques to promote healing.
- Be vigilant for signs of infection such as fever, pain, and swelling in the injured area.
Warnings & Risks
Failure to properly clean a wound can lead to severe complications like tetanus. Leaving wads or other debris in the wound increases the risk of infection and lockjaw.
Modern Application
While the techniques described in this chapter are rooted in early 20th-century practices, many principles still apply to modern survival scenarios. Proper wound care, including thorough cleaning and drainage, remains crucial for preventing infections like tetanus. The use of antiseptics and prophylactic measures against infection is also essential, even today.
Frequently Asked Questions
Q: What are the signs of beginning infection in a gunshot wound?
The chapter mentions that fever, pain, swelling of the joint, all rapidly increasing, are the signs of beginning infection. These symptoms call for immediate action and may require opening the joint to drain it.
Q: How should superficial wounds from fowling pieces be treated?
The chapter advises cleansing the wound with soap and water, then rubbing vigorously with peroxide of hydrogen. The more superficial shot are picked out, and the inflamed surfaces are smeared with Reclus’ ointment before covering them with gauze.
Q: What is the risk of using toy pistols or blank cartridges?
The chapter warns that these can cause significant internal injuries due to their surprising power of penetration. They also pose a great danger of tetanus infection, necessitating thorough cleansing and antitetanic measures.