Bullet wound

“ If a bullet is doing any harm, pressing on some nerve, interfering with a joint, or in any way causing pain or inconvenience, by all means let it be removed, though even then it should in most cases never be touched until the wound is completely healed. But the mere presence of a bullet inside the body will of itself do no harm at all. ”

“ No gun-shot wound, at least none of importance, appeared in any part. There was, indeed, a bullet-hole in the left shoulder, and, as it seemed, very recently inflicted: but it was bound up with leaves and vulnerary herbs, in the usual Indian way, showing that it must have been received at some period anterior to the attack which had robbed the warrior of life. The gashes across the ribs were the only other wounds on the body; that on the head, made by a hatchet, was evidently the one that had caused the warrior's death. ”

“ Was the Weapon Fired from a Distance or Near By?—A gunshot injury from a bullet implies at least one wound, namely, that of entrance, and perhaps another, that of exit. It does not always happen that the bullet passes through the body. The appearance of the wound of entrance is usually one of irregular circular puncture, its edges perhaps slightly torn or lacerated, with a purplish or dark areola, varying in width from a line or two to one-half inch. ”

“ The right-hand bullet is probably a 'man-stopping' revolver bullet; it flattened against bone
Other information beyond that furnished by the external wounds may be gleaned from the presence of fragments of lead in the wound; these, if unaccompanied by portions of casing, afford some presumptive evidence of the use of an unsheathen bullet, especially if found on the fractured surface of the [Pg 106] bones; but it must be borne in mind that in the case of ricochet bullets the leaden core often perforates when entirely freed from its mantle. ”

“ And why is a wound, or death, from an explosive bullet worse than a wound from the most ordinary bullet or splinter, inflicted on a very tender part? The suffering in that case also reaches the utmost limit, and is followed by just the same death as results from any other weapon. ”

“ Martini-Henry bullets make larger apertures, while soft-nosed or “dum-dum” bullets spread out as soon as the bullet strikes, causing great mutilation and destruction of the tissues. Shell wounds cause extensive lacerations. Small shot may inflict serious injury should one of the pellets enter the eye. In gunshot wounds at short distance the skin may be blackened owing to the particles of carbon lodging in it. The chief dangers of gunshot wounds are hemorrhage, shock and the carrying in of septic material or clothing into the wound. ”

“ A ricochet bullet, on the other hand, may upset all our calculations, if size alone be taken as an indication; but here the irregularity of the wound often serves to exclude one of the larger varieties as the cause. The appearances of the exit wound are less useful in determining the nature of the bullet employed, as irregularities of outline are so much more common whatever projectile may have emerged; but examination of this wound often gives us useful information as to the existence of an injury to the bones not involving loss of continuity. ”

“ We found the inside partially destroyed by the explosive shell, which had shattered the lungs, but there was an old wound still open where a bullet had entered the chest, and missing the heart and lungs in an oblique course, it had passed through the stomach, then through the cavity of the body beneath the ribs and flank, and had penetrated the fleshy mass inside the thigh. In that great resisting cushion of strong muscles the bullet had expended its force, and found rest from its extraordinary course of penetration. ”

“ The course of the bullet, with reduced energy of long range, was anteroposterior, striking the inner border of the bone and punching out a circular area of small fragments with a single transverse line of fracture.
The wound of exit was slightly larger than the wound of entrance.
The treatment is conservative. Infection is not probable if emergency dressing is clean. ”

“ In suicide or accidental discharges of a shot-gun the muzzle is so near the body that the charge of shot acts very much as would a single bullet of the size of the bore of the gun, and near wounds thus inflicted, while necessarily large, have about them a minimum laceration and disturbance of tissue, so that perhaps only by their size could one say, viewing the wound alone, that the weapon used had been a shot-gun. ”

“ Men with arms in slings; men with trousers torn away at the knee, and bandaged legs; men with brow, face, mouth, or [Pg 152] throat swathed; men with no shirts, but a broad swathe around the chest or stomach—each bandage grotesquely pictured with human figures printed to show how the wound should be bound, on whatever part of the body the bullet entered. ”

“ When the bullet perforates, the exit wound is usually larger and more extensively lacerated than the wound of entrance. Its margins are as a rule everted, and it shows no marks of flame, smoke, or powder. These features are common to all perforations caused by bullets.
Pistol wounds only produce dangerous effects when fired at close range, and when the cavities of the skull, the thorax, or the abdomen are implicated. In the abdomen a lethal injury may readily be caused even by pistols of the "toy" order. ”

“ If death has been caused by a bullet which has not passed through the body, but lodged, it should by all means be obtained, since evidence of the greatest value may inhere in it. Moreover, in first noting the position of the body, the direction of the wound, or the location of a blood-clot upon the floor or clothing or elsewhere, may indicate to the surgeon or other astute person the point at which the bullet may be found concealed or buried in some soft or hard object. ”

“ Instruments of two blades, or scoops, with ordinary hinge action, dilate the track of the wound injuriously before the ball can be grasped by them. The way to the removal of a bullet may often be smoothed by judiciously clearing away the fibers, among which it is lodged, during the examination, by the finger; and sometimes, by means of the finger in the wound, and external pressure of the surrounding parts, the projectile may be brought near to the aperture of entrance, so that its extraction is still further facilitated. ”

“ One man reported that his thumb had been taken off by a machine-gun bullet. Another said he had a scalp wound. A third had lost a whole leg, severed at the thigh. A fourth had a fragment of shell in his stomach. A fifth was completely blinded. A sixth was suffering from gas poisoning. ”

“ The wounds produced by shrapnel bullets are similar to those caused by the lead bullets of the infantry weapons of the past. When the bullet strikes normally to the surface, it produces a wound circular at the point of impact and considerably enlarged at the point of exit; bones are frequently shattered ”

“ In some cases a soldier may, by digital pressure or by improvising a rough tourniquet, check the flow of blood from a wound, but the nervous prostration which accompanies a wound inflicted by a bullet travelling nearly 2,000 feet a second is so great, that most men seriously wounded are physically incapable of rendering such assistance to themselves, even if they understand the elementary amount of anatomy requisite for the treatment. ”

“ The wound of exit in such cases hardly differs enough from the wound of entrance to be distinguishable. This condition so often obtains that the great majority of perforating rifle wounds of the forearm do not show the blow-out or “explosive” effect which seems to be generally misunderstood as a classic accompaniment.
The bullet was traveling at high velocity of perhaps less than mid range.
The treatment is usually that of a simple fracture, and warrants no interference except in case of occasional infection.
Results are almost always good. ”

“ It is probable that an ordinary wadding such as loosely wrapped paper, rag, or similar material, especially as prepared by one not accustomed to military use of a weapon, would not produce a wound which would resemble that made by a bullet, and it is doubtful whether such a wound could be produced at a greater distance than six inches from the body. ”

“ One is glad to know that the latest type of bullet usually inflicts quite a small, clean wound, which heals up quickly. In old days it was thought that no one could survive being shot through the heart, but it has now been 164proved that a bullet may actually puncture the heart without doing any permanent harm. ”

“ In another fatal case, a rifle-bullet passed through the right cheek, and lodged near the base of the skull. There was no paralysis, but delirium and coma supervened, and the patient died five days after receiving the wound. The bullet was found after death, lying just below the basilar process, and a large piece of the atlas was broken off and almost detached. The spinal cord did not appear to have been primarily injured, but acute inflammation had been set up, and had extended to the membranes of the brain. ”

“ The hard covering is employed to enable the bullet to take the grooves in the rifle, and to prevent it stripping as it passes through the barrel. It also increases the penetrating power of the missile, but diminishes its “stopping” power, unless a vital part or a long bone is struck. By removing the covering from the point of the bullet, as is done in the Dum-Dum bullet, or by splitting the end, the bullet is made to expand or “mushroom” when it strikes the body, and its stopping power is thereby greatly increased, the resulting wound being much more severe. ”

“ The entering wound is the size of the projectile, the edges are inverted and often scorched. The wound produced in case of the bullet's exit is larger than the projectile, the edges are turned out and ragged. A bullet heated by the friction of the barrel or air often softens and becomes flattened on striking a bone or other tissue. Modern bullets that have an outer steel layer may pass through bone without splintering it. Lead bullets may split, producing two exit wounds. Spent bullets may only produce a bruise. ”

“ The carrying forwards of the subcutaneous fat into the lips of the skin wound by the bullet. This illustrates the manner in which lightly supported structures are carried forward by the bullet, and throws some light on the mode by which vessels and nerves may escape by a process of displacement. This figure may be compared with fig. 25 (b) which shows a tag of omentum similarly carried forward by a bullet crossing the abdominal cavity and plugging the exit wound. 2. The second feature of interest is the amount of hæmorrhage into the subcutaneous tissue. ”

“ The wound is on the right temple, and as the skin and hair are burned and blackened with gunpowder, the shot must have been fired at close quarters. Death must have come very speedily, my lady. We can find no bullet, as it passed right through the deceased's head, and no weapon, although we have searched the orchards. ”

“ The case history places the wound in the right thigh, and the posterior surface of the leg lay next to the photographic plate. As the density of the shadow is not greater than the thickest portion of the bone, the bullet probably lies in front of the border of the outer tuberosity of the femur. ”

“ The bullet in this case was so badly deformed by ricochet that part of both core and jacket were lost. While the appearance of the shadow seems to indicate a direct impact of the nose of the bullet, the line of contact with the skull must have been tangential, with some laceration of the scalp; otherwise a cursory examination of the scalp wound would have revealed the slightly protruding end of the bullet. The dark shadow above the projectile is due to material used in dressing. The great thickening of the scalp in the region of the wound shows a marked cellulitis. ”

“ He’s carrying a bullet in his right hip which made him lame for life, and his left arm is gone at the elbow, the result of a gun fight, in which he received a wound that didn’t get proper attention for three days. ”

“ There is also an obvious practical difficulty in picturing by a single character killing with a bullet, not arising as to arrows, lances, dirks, and hatchets, all of which can be and are in the chart shown projecting from the wounds made by them. Pictographs in the possession of the Bureau of Ethnology show battles in which bullets are denoted by continuous dotted lines, the spots at which they take effect being sometimes indicated. It is, however, to be noted that the bloody wound on the Ree’s shoulder (1806-’07) is without any protruding weapon, as if made by a bullet. ”

“ Wounds by Sporting Guns.#--In the common sporting or scatter gun, with which accidents so commonly occur during the shooting season, the charge of small shot or pellets leave the muzzle of the gun as a solid mass which makes a single ragged wound having much the appearance of that caused by a single bullet. ”

“ Even admitting such exceptional instances, it will scarcely ever occur that a wound from a small shot can be mistaken for one produced by a leaden bullet.
De Vergie has shown that when the ball enters a portion of the body well covered with fat, this often protrudes between the edges of the wound and may alter its character. If clothing have been carried in some shreds of it may show upon the wound, and such fragments of texture will nearly always characterize the wound at once as that of entrance. ”