WOUNDS BY FIREARMS AND EXPLOSIVES

It is not necessary here to do more than indicate the general characters of wounds produced by modern weapons.  For further details the reader is referred to works on military surgery.  Experience has shown that the nature and severity of the injuries sustained in warfare vary widely in different campaigns, and even in different fields of the same campaign.  Slight variations in the size, shape, and weight of rifle bullets, for example, may profoundly modify the lesions they produce:  witness the destructive effect of the pointed bullet compared with that of the conical form previously used.  The conditions under which the fighting is carried on also influence the wounds.  Those sustained in the open, long-range fighting of the South African campaign of 1899-1902 were very different from those met with in the entrenched warfare in France in 1914-1918.  It has been found also that the infective complications are greatly influenced by the terrain in which the fighting takes place.  In the dry, sandy, uncultivated veldt of South Africa, bullet wounds seldom became infected, while those sustained in the highly manured fields of Belgium were almost invariably contaminated with putrefactive organisms, and gaseous gangrene and tetanus were common complications.  It has been found also that wounds inflicted in naval engagements present different characters from those sustained on land.  Many other factors, such as the physical and mental condition of the men, the facilities for affording first aid, and the transport arrangements, also play a part in determining the nature and condition of the wounds that have to be dealt with by military surgeons.

Whatever the nature of the weapon concerned, the wound is of the punctured, contused, and lacerated variety.  Its severity depends on the size, shape, and velocity of the missile, the range at which the weapon is discharged, and the part of the body struck.

Shock is a prominent feature, but its degree, as well as the time of its onset, varies with the extent and seat of the injury, and with the mental state of the patient when wounded.  We have observed pronounced shock in children after being shot even when no serious injury was sustained.  At the moment of injury the patient experiences a sensation which is variously described as being like the lash of a whip, a blow with a stick, or an electric shock.  There is not much pain at first, but later it may become severe, and is usually associated with intense thirst, especially when much blood has been lost.

In all forms of wounds sustained in warfare, septic infection constitutes the main risk, particularly that resulting from streptococci.  The presence of anaerobic organisms introduces the additional danger of gaseous forms of gangrene.

The earlier the wound is disinfected the greater is the possibility of diminishing this risk.  If cleansing is carried out within the first six hours the chance of eliminating sepsis is good; with every succeeding six hours it diminishes, until after twenty-four hours it is seldom possible to do more than mitigate sepsis. (J.  T. Morrison.)