WAR WOUNDS In the field two classes of wounds are met with: (1) Those due to hostile action.
(2) Those arising from accidental causes.
Under the former heading one meets with injuries produced by mechanical agency, varied in its nature, operating either in close proximity to or at a great distance from the object against which it is directed.
The resulting wounds may be divided into: (1) Gunshot wounds.
(2) Bomb wounds.
(3) Sabre, lance, or dart wounds.
Gunshot wounds fall naturally into two sub divisions: (a) Bullet wounds; (b) shell wounds.
A bullet which is nearly spent will strike a part and inflict a bruise or it may penetrate the skin. Examination will reveal swelling and a degree of soreness, whilst palpation may discover the position of the bullet. On the other hand, if fired at a moderate range and should it not encounter any hard obstacle, the bullet will pass through thick groups of muscles, such as are met with in the region of the neck, forearm, or behind the tibia, through the second layer of skin, and will continue in its course.
The symptoms exhibited in this case will be local inflammation, pain, swelling and sore ness. The wound caused by exit will invariably be larger than that of entrance.
Detonation of the explosive charge generates a very great degree of heat which probably renders the missile aseptic. Bullet wounds may therefore show little sign of infection, and under the conditions above described a favourable ter mination may ensue. On the other hand, hair, mud, and portions of harness may be carried into the tissues, resulting in suppuration sometimes accompanied by systemic disturbance.
A large blood - vessel may be struck and copious may ensue, which however, in many cases, ceases of its own accord. In rare instances nerve trunks are severed or bruised, resulting in paralysis of the muscle groups supplied by the motor fibres of this particular nerve; in the event of bruising such paralysis may wear off in the course of time.
In the case of a long bone being struck by a bullet which does not penetrate it but merely causes local pressure the local symptoms may subside, but if the bullet be not extracted it will sooner or later set up inflammation, resulting in abscess formation, and upon operation the foreign body will usually be found resting on the floor of the abscess cavity.
In many cases the bone will be fractured. This fracture may assume various forms: a piece may be chipped off, and if not removed along with the bullet will lead to a chronic discharge, characterized by the smell of dead bone. Sometimes the part will heal, but eventu ally the fractured part will be cast off from the parent bone after a long period, resulting in swelling, pain, signs of local inflammation, and either abscess or sinus formation.
Should a joint be wounded the case is usually serious, as partial or complete fracture of one of the bones of the joint usually occurs, and in addition the synovial capsule will be bruised or lacerated and open joint will result.
In the region of the sinuses of the skull the entrance-wound will be evident and a degree of hmmorrhage will occur from one or both nostrils, in some cases very severe. Later, a profuse yellowish nasal discharge will appear, though this tends to disappear in time, especi ally in cases in which the bullet has made its own exit. Sometimes the missile will become lodged in some part and recovery may occur, but in other cases it may lie free in one of the sinuses and set up irritation, or pieces of bone may be driven into the sinus or become necrotic, producing symptoms similar to those seen in infected sinuses.
In the region of the thorax bullet wounds may be followed by no ill-effects, whilst on the other hand they may prove fatal according to what particular organs are encountered.
Wounds of the abdominal region are much more serious. Provided that the bullet has penetrated within the peritoneal cavity symp toms of acute peritonitis may be observed in the course of a few hours. The head is held close to the ground, breathing appears difficult, and a frothy discharge issues from the mouth and nostrils. The visible mucous membranes show marked injection and there is a considerable rise in temperature. Death is the usual termin ation.
Sometimes the bullet is extracted from the cartridge and turned round before being fired, resulting in a worse wound than even those caused by flat-nosed bullets. The principle of these latter is that the lead on striking the target flattens out and produces a large wound. Whole pieces of tissue or bone may be shot away.
Treatment. In the simpler cases, such as in muscular wounds, when the bullet can be located beneath the skin the entrance should be enlarged and bullet-forceps employed to effect removal. Long hairs should be clipped off and the skin rendered as nearly aseptic as conditions permit.
Whenever possible the artificial opening should slope from the site of the bullet in a downward direction, thus facilitating drainage. After removal the parts should be swabbed out with a warm antiseptic solution and then plugged lightly with gauze steeped in the same. In wounds involving muscular tissue from which the bullet has made its own exit the treatment is similar, but when the passage is long and tortuous it is rarely possible to practise com plete disinfection; but as, previously stated, bullets seldom carry infection, resolution in many cases is merely a matter of time. It is therefore doubtful if one is justified in inter fering to any extent. Probably medicated fomentations, gentle walking exercise, and atten tion to hygiene will assist nature sufficiently.
Frequently, when the bullet remains lodged in muscular tissue, it is advisable to leave it severely alone, as in many cases healing will occur. There are many animals working to-day which carry bullets embedded in their muscles without any apparent inconvenience.
In some instances harness and other foreign bodies are carried in along with the missile.
This necessitates enlarging the wound to pro vide drainage. Probing may aid in their detec tion. When the channel has become infected a discharge will make its appearance, accom panied in some instances by fever and loss of appetite. The discharge itself tends to enlarge the channel, and after a few days it will materi ally assist in the location of the missile.
When a bullet becomes lodged in the region of a bone and is not extracted it occasionally happens that, sometime after the animal has returned to work, local symptoms arise with abscess formation. In this case the abscess should be allowed to mature, and upon being opened close to the floor of the cavity the missile will be usually found lying free.
Whenever possible the bullet should be re moved, but owing to its great powers of pene tration it is sometimes most difficult, especially when it has partly or entirely perforated a long bone. A generous use of the knife will be required in many instances, but it should be borne in mind when making these incisions that drainage is essential.
All foreign bodies and splinters of bone should be removed, and this will necessitate the use of bullet forceps with a strong gripping head. In the event of a long bone being punctured the exit will have to be enlarged, and after removal of the bullet antisepsis should be practised. Anti tetanic serum should in all cases be administered.
In the event of a joint being involved pro gnosis is unfavourable, and the most we can hope for is a stiff joint, but under war condi tions treatment is seldom attempted.
When hemorrhage occurs from the sinuses of the head, the nostrils should be plugged with pledgets of gauze or lint, to each of which a string or tape is tied to effect removal. Supra renal extract may be used locally and via the blood stream. Tracheotomy may be necessary. Later, infection of the sinuses may result in chronic nasal discharge, which may necessitate trephining, although sometimes it is intermittent in character and produces no ill-effects.
Abdominal wounds require quietude and hygienic surroundings. In the event of recovery a long period of convalescence should be allowed.
In all cases the use of antitetanic serum should be insisted upon. If fresh, 1500 units should be injected subcutaneously and repeated about every six days until the wound is well on the way to recovery.
As a cleansing agent for infected wounds hydrogen peroxide is useful. As germicides the hypochlorites rank high and have given very excellent results in the treatment of gunshot wounds; septic, offensive wounds speedily take on a healthy appearance, smell disappears, a free flow of lymph is obtained, and the walls rapidly granulate.
A 5 per cent solution of hypochlorous acid is a convenient form of preparation. Take of the liquor calcis B.P., 25 drachms, dilute with 1 pint of water and add 1/ drachms of boric acid. Liquor calcis chlorinates is pre pared by dissolving 15 ounces of chlorinated lime in one gallon of water.
The solution of hypochlorous acid should be allowed to stand for twenty-four hours and then should be filtered. It deteriorates after a few weeks.
Haemorrhage from bullet wounds is seldom very serious unless large vessels are severed. Whenever possible it is advisable to ligature the artery, or failing this, to plug with gauze or wool and suture. The packing should be left
in position for two days at least, as secondary is liable to occur through infection and breaking down of the clot.
It is the object of the gunners to cause this charge to explode some yards above and in front of the target. In addition to the impetus given to the bullets by the explosive charge, one has to add the velocity of the shell at the time of its explosion.
The bullets travel in a downward and forward direction, and they have clinging to them par ticles of the burnt charge. The wounds inflicted are, as a rule, of no great size superficially but they may penetrate many inches through mus cular tissue unless their course be arrested by a bone.
If one attempts to probe a wound shortly after it has been inflicted, one encounters a good deal of resistance from the surrounding tissues, which tend to cling to the probe. Pieces of harness, skin, or hair may be encountered. The passage may be fairly straight or tortuous. In many cases, more especially those in which the missile has penetrated some distance, it will be impossible to reach the bottom of the wound.
Later, a yellow gelatinous discharge makes its appearance and in many cases the wound develops into a chronic suppurating sinus. The discharge materially assists in the task of locating the foreign body, it tends to break down the macerated and torn muscular tissue, and to form a channel through which a probe may easily be inserted. As a rule, there is no great difficulty in recognizing the missile itself as soon as it is encountered by the probe, but occasionally splinters of bone and cartilaginous tissue may deceive the operator.
Should the bullet, in its course, come into contact with a bone it may be thereby brought to rest, but as a rule when it hits the bone squarely it drills a hole. In the case of a flat bone, such as the scapula, perforation may be complete, but in long bones the course of the missile is usually arrested in the medullary cavity. The presence of the bullet nearly always gives rise to suppuration, and a condition of purulent ostitis may arise, resulting in systemic disturbance, and as amputation of a limb is of no practical service from a veterinary point of view, usually the animal is destroyed.
The remarks on rifle-bullet wounds apply to shrapnel as regards other parts of the body with the above - mentioned exception that wounds caused by shrapnel have a far greater tendency to suppurate, owing, it has been stated, to the presence of chemical bodies which are generated as the result of explosion of the charge.
It sometimes happens, however, that a minor wound will heal of its own accord without ex traction of the piece of metal. Later this will reopen and commence to discharge, and upon examination one will find a sinus with an extremely thick fibrous wall.
Another type of shell wound is also occasion ally met with. In an endeavour to bring down enemy aircraft by the use of guns both shrapnel and high-explosive shells may be fired. In the case of the former both the fuse and shell-case have to fall; in the latter the shell splits into numerous pieces or, as sometimes happens, it may be a"dud"; consequently, during an aircraft barrage pieces of metal weighing any thing up to a number of pounds are constantly falling to the ground from a great height. The wounds inflicted vary somewhat; the smaller pieces, if they fall in a favourable position, cause punctured wounds and the pieces usually make their own exit.
Empty shell-cases will in certain instances cut away a circular piece of tissue a foot or more in length; such wounds are seen in the region of the scapula and ribs. On the other hand, it is more usual for the animal to be killed outright.
As in the case of particles of shrapnel, ex traction is very difficult, but is rendered less so in the course of a few days when the presence of a copious discharge will lead to the of its position. The provision of drainage is very important, but is often a matter of diffi culty owing to the depth of the wound and its relation to important structures. When enlarg ing a wound of this nature, the incision should, whenever possible, be carried from within out wards in a downward direction. Other treat ment must follow general principles.
Hand-grenades cause wounds of a similar type, but they are usually less severe as the splinters are smaller.
Lance wounds take the form of punctures, sometimes of considerable depth. In some cases the head of the lance snaps off and re mains in situ.
The darts vary in size. If, by any chance, one hits the object at which it is aimed, it may penetrate its entire depth and find lodgment in the ground. It therefore follows that most wounds of this nature cause death. Some con sist merely of punctures or long gashes, com paratively superficial, which admit of ordinary surgical treatment.
Amongst accidental wounds we must include those caused by picked-up nails, which are very common, especially among horses travelling over fascined roads.
Barbed wire is responsible for a large number of injuries. The breast, limbs, and heels are the parts usually injured. The wounds may be either simple incised wounds, usually the result of the horse galloping through the stretched wire, but more commonly triangular pieces of skin are torn away or left hanging in close proximity to each other. It also frequently happens that the animal becomes entangled in the wire and is cast among it, with resulting injury to various parts of the body.
Pickets of wood or iron pointed at the top, and used for fixing barbed wire, inflict ugly gashes and punctures, more especially in the regions of the limbs, breast, and abdomen. Sheets of galvanized iron and empty tins laid upon the country inflict nasty wounds of the coronet and tendons, as also does kicking in stables built of the same material.
Kicks, more especially when frost-cogs are used, result in serious punctures and often in open stifle, elbow, or hock joint.
Lacerated and incised wounds of the coronets and heels are common among animals working on tramways, and in some instances, through the heel of the shoe becoming entangled, it may be pulled off and may result in contusion of the sole, a badly-broken wall, and occasionally punc ture of the sole caused by the horse treading on the toe-clip.
Collision with vehicles, lorries, and other ob jects may result in lacerated wounds. Punctured wounds, principally of the thorax, may arise from contact with the pole of another vehicle. Crushed hoof not uncommonly results from being run over. Cartridges left lying about often cause puncture of the sole; frequently an open navicular joint is the sequel.
Amongst the wounds caused by traps laid by the enemy staking is perhaps the commonest, especially by concealment of the stakes in pre pared pits with false roofs laid on the top.
Another form is punctured sole, resulting from the use of specially designed pieces of metal scattered on the road of cavalry or transport. Such pieces are designed from thickish metal, from which a V-shaped piece projects upwards from a metal base.