mountain-passes, steep and difficult. The rest was by rail in ambulance-carriages, 74 miles to Rawal Pindi, and if proceeding to Nowshera, 78
THE
Jndian Jftediijal (Sasx}ftc.
further.
1899.
FEBRUARY,
In an
GUNSHOT-WOUNDS IN THE LATE
respect
the
one
of these
Of the 193
Afghan deals, particulars
general hospitals,
of this class of
published by Captain
the Lancet.
campaign against
of
interesting study
been
FRONTIER WAR.
In the recent
51
IN THE LATE FRONTIER WAR.
(iUNSHOT-WOUNDS
1899.
Feb.
D. M.
cases
to the
cases
has
I.M.S., in which he
Moir,
with
nature of the
protribes on our North-Western Frontier in 1897-98; jectile or of the weapon used could only be for which as many as 93,061 troops and folobtained in a small number of the cases. All lowers were mobilised, the gunshot wounds that inquiry and examination could elicit was claimed a very large proportion of the deaths in that 16 of the wounds were caused by the oldthe
as
in addition to those deaths fashioned round or spherical bullet, 12 by the Some in the field. immediately Martini-Henry, 11 by the Lee-Metford, 11 by the Snider, 1 information in regard to this class of wound is by a cavalry carbine, and in the Dublin in the Gore 142 cases no reliable data could be given by Surgeon-General remaining
military hospitals
which occurred
Journal
Medical Science for November. ascertained. fighting occurred mainly in the The wounds produced by the Lee-Metford bulTiiah country and Tochi Valley. In the formerlet in this series tend to confirm previous 934 of the 25,175 fighting men and 11,929 followits relative harmlessness
of
The active
experience regarding (so gun-shotlong as a bone is not struck) as compared with wounds, and of these 78 died or 8 3 per cent ofthe damage done by most other projectiles used the cases. In the Tochi Valley, where 6,017 fight-in modern warfare. ing-men and 3,902 followers were engaged, 1,188 On the other hand, the old-fashioned round admitted into
ers were
admitted with
were
with
hospital
gunshot-wounds,and
of these
28 died.
particular regions of the body which were by gunshot amongst the troops in Tirah
The
wounded were:?
Head
Shoulder
? ?
...
?
146
?
...
?
9
?
out
?
55
?
?
35
?
42
?
buttocks
...
?
?
G
?
?
...
...
...
were
admitted into
hopelessly dying condigeneral base-hospitals, however
hospitals
tion.
the
in
a
the results of treatment wound
?
37 147
?
of these wounded
the field
corded,
?
...
...
Lower extremities
as
,,
...
...
In
,,
72
...
Upper extremities Hip joint
Many
? ?
...
...
were
pysemia, hospital
diseases
were
"
the best
ever re-
all gangrene and their by
conspicuous
although the difficulties of transport there were excessive. From the Tirah Maidan 111 miles the wounded had to be
absence,"
transported
before
they
Shinawari,
could be entrained?40 of which to, were
done in field-dandies, and the
bullock-tongas to stage is over two high
remaining 72
in ambulance
Khushalgarh.
The
first
Effects of spherical bullets.?(1) Mostly lodged, requiring an operation for extraction; (2) sup-
3
33 cases
37
...
Arteries Parts not defined Other injuries
with
292
...
in
...
spine Perineum, groin,
contrast
?
...
Face and neck Abdomen Neck and
sharp
bruising of the tissues and the introduction of septic foreign bodies, hence sinuses and slow healing; (8) fractures and injuries of important structures common ; and (4) course of bullet tract often tortuous. Effects of Lee-Metforcl bullets.?(1) Did not lodge (except in the last case), hence much less subsequent manipulation of the wounds; (2) much less tissue injured, cloth, &c., not carried into the wound, hence rapid healing often with-
...
Chest
ball offers in its effects a the Lee-Metford projectile.
puration
usual from the
(3) bones escaped injury in a
suppuration
structures
;
and
important
wonderful way j
and
(4) course of bullet track usually straight. The Martini-Henry bullets, on the other hand, lodged in the tissues much more frequently than the Lee-Metford and much more deeply than the round balls. Consequently they were more difficult to find and also more difficult to extract, partly owing to their greater depth and partly their
being
owing
to
jagged
and flattened.
Henry was
a
more
Owing
deformed,
more
to the Martini-
being more deeply lodged, there greater tendency for them to shift their
bullets
THE INDIAN MEDICAL GAZETTE.
52
planes of the deep Major Beevor's of the greatest Roentgen-Ray apparatus proved in and of use in localising the site confirming the to wander in the
position,
muscles
or
inter-muscular septa.
in the tissues. In a presence or absence of bullets couple of instances men were received with only a single scar, that of the wound of entrance ; but there was no reliable information available as to whether the bullet had been extracted. With the X rays it matter to demonstrate that no
in the limb or part affected. to the introduction of foreign bodies or material, owing to the greater trauma
remained
Owing septic
subsequently a simple foreign body
was
lodged
tissues, or in consequence of increased manipulative interference in extracting deeplyto the
seated and
the wounds the common, and
encapsuled projectiles
suppurated, sinuses patients were longer in hospital. were
damage
done
wounded
to
were
There
was more
important structures,
disabled for
so
the
longer average
a
Wounds of the lower extremity in this series number double those of the upper. Case 70, in which a bullet travelled half way round
period. the
pelvis
without
to the
injury
is
viscera,
one
of considerable interest, as is also Case 193, in which a bullet perforated the chest, lung, and shoulder-joint and fractured the head of the humerus. Of the Snider bullet-wounds, of which there were 11 cases; the most noticeable thing was the of the effects produced, which greatly surpassed the results above described under the
severity
headings of Henry, and
wounds from
wounds recoveiy to
Lee-Metford, MartiniTil all of the Snider
round bullets.
suppuration
slow
was
and to
out of the total bones
imperfect owing
or
traumatism.
severe
In 9
fractured.
The Snider wounds gave the greatest proportion of fractures and also the most severe ones. The
spherical
were
bullet wounds had the next greatest
number of fractures and the Lee-Metford wounds the fewest. As regards the lodgment of
projec-
this occurred in 4 out of the 11 Snider cases, compared with 5 out of the 12
tiles, as
ties
greatly
13 bullets
Martini-Henry
in 12 of the 1G spherical bullet-wound cases. As in the MartiniHenry series, the wounds of the lower extremi-
wounds, and
lodged
outnumbered
those of
the upper
limbs. It is
interesting
to note
bullet-wound of the lung Lee-Metford case there was
that all 3 survived.
rapid
find
cases
In
of
the
complete
recovery in a fortnight, injured ; but the results the two other the the
was
glenoid angle
The
subsequent
very
similar.
bone
no
very different in
one
(Martini-Henry)
opened
was
and the head of
in the other
fractured, of the
been
having
were
In
cases.
shoulder-joint
the humerus
1899.
[Feb.
scapula
(Snider)
fractured.
was
progress of these two cases was They were both received at
Rawal Pindi on the same day, having been b2 and 55 days 011 the lines of communication after
they
for 68 and 69
hospital both
and
wounded;
were
cases
remained at the
The
days.
much
was
they
the
same;
prognosis one
in
was sent
invaliding board as permanently unfit, and the other was given a chance of six months' sick leave in case he might recover sufficiently before
an
to be fit for further service.
I11
of the
proportion
large
a
cases
which
reached the General Hospital, 110 information was obtainable as to the kind of the bullet and which
firearm
at the
inflicted
the wound.
front and
Medical
the lines of
comofficers munication have their hands full; but still, as
Moir
Captain
suggests,
on
it would
not increase
their work much, while it would add ver}7 much to the interest of the cases,
which they
in
supplied following
printed forms might jot down the were
data while events were fresh in their forms proposed by Captain Moir
The
minds.
might contain
such
headings
at which wound
as
(1) place
or
received ; (2) nature of weapon or projectile; (3) nature of injury ; (4) approximate distance at which the shot was
action
fired,
also
the
was
direction,
from in
front, behind, &c.; (5) attitude of patient at the time he was struck, whether he was running, standing, lying down, &c.; and (6) any other facts of
above,
Of course, such information could not be obtained in all instances, but it would be forthcoming in many, and would afford useful
interest.
indications
regarding at varying
for treatment
as
well
as
information
the effects of the different ranges.
projectiles
THE
Jndian Jftediijal (Sasx}ftc.
further.
1899.
FEBRUARY,
In an
GUNSHOT-WOUNDS IN THE LATE
respect
the
one
of these
Of the 193
Afghan deals, particulars
general hospitals,
of this class of
published by Captain
the Lancet.
campaign against
of
interesting study
been
FRONTIER WAR.
In the recent
51
IN THE LATE FRONTIER WAR.
(iUNSHOT-WOUNDS
1899.
Feb.
D. M.
cases
to the
cases
has
I.M.S., in which he
Moir,
with
nature of the
protribes on our North-Western Frontier in 1897-98; jectile or of the weapon used could only be for which as many as 93,061 troops and folobtained in a small number of the cases. All lowers were mobilised, the gunshot wounds that inquiry and examination could elicit was claimed a very large proportion of the deaths in that 16 of the wounds were caused by the oldthe
as
in addition to those deaths fashioned round or spherical bullet, 12 by the Some in the field. immediately Martini-Henry, 11 by the Lee-Metford, 11 by the Snider, 1 information in regard to this class of wound is by a cavalry carbine, and in the Dublin in the Gore 142 cases no reliable data could be given by Surgeon-General remaining
military hospitals
which occurred
Journal
Medical Science for November. ascertained. fighting occurred mainly in the The wounds produced by the Lee-Metford bulTiiah country and Tochi Valley. In the formerlet in this series tend to confirm previous 934 of the 25,175 fighting men and 11,929 followits relative harmlessness
of
The active
experience regarding (so gun-shotlong as a bone is not struck) as compared with wounds, and of these 78 died or 8 3 per cent ofthe damage done by most other projectiles used the cases. In the Tochi Valley, where 6,017 fight-in modern warfare. ing-men and 3,902 followers were engaged, 1,188 On the other hand, the old-fashioned round admitted into
ers were
admitted with
were
with
hospital
gunshot-wounds,and
of these
28 died.
particular regions of the body which were by gunshot amongst the troops in Tirah
The
wounded were:?
Head
Shoulder
? ?
...
?
146
?
...
?
9
?
out
?
55
?
?
35
?
42
?
buttocks
...
?
?
G
?
?
...
...
...
were
admitted into
hopelessly dying condigeneral base-hospitals, however
hospitals
tion.
the
in
a
the results of treatment wound
?
37 147
?
of these wounded
the field
corded,
?
...
...
Lower extremities
as
,,
...
...
In
,,
72
...
Upper extremities Hip joint
Many
? ?
...
...
were
pysemia, hospital
diseases
were
"
the best
ever re-
all gangrene and their by
conspicuous
although the difficulties of transport there were excessive. From the Tirah Maidan 111 miles the wounded had to be
absence,"
transported
before
they
Shinawari,
could be entrained?40 of which to, were
done in field-dandies, and the
bullock-tongas to stage is over two high
remaining 72
in ambulance
Khushalgarh.
The
first
Effects of spherical bullets.?(1) Mostly lodged, requiring an operation for extraction; (2) sup-
3
33 cases
37
...
Arteries Parts not defined Other injuries
with
292
...
in
...
spine Perineum, groin,
contrast
?
...
Face and neck Abdomen Neck and
sharp
bruising of the tissues and the introduction of septic foreign bodies, hence sinuses and slow healing; (8) fractures and injuries of important structures common ; and (4) course of bullet tract often tortuous. Effects of Lee-Metforcl bullets.?(1) Did not lodge (except in the last case), hence much less subsequent manipulation of the wounds; (2) much less tissue injured, cloth, &c., not carried into the wound, hence rapid healing often with-
...
Chest
ball offers in its effects a the Lee-Metford projectile.
puration
usual from the
(3) bones escaped injury in a
suppuration
structures
;
and
important
wonderful way j
and
(4) course of bullet track usually straight. The Martini-Henry bullets, on the other hand, lodged in the tissues much more frequently than the Lee-Metford and much more deeply than the round balls. Consequently they were more difficult to find and also more difficult to extract, partly owing to their greater depth and partly their
being
owing
to
jagged
and flattened.
Henry was
a
more
Owing
deformed,
more
to the Martini-
being more deeply lodged, there greater tendency for them to shift their
bullets
THE INDIAN MEDICAL GAZETTE.
52
planes of the deep Major Beevor's of the greatest Roentgen-Ray apparatus proved in and of use in localising the site confirming the to wander in the
position,
muscles
or
inter-muscular septa.
in the tissues. In a presence or absence of bullets couple of instances men were received with only a single scar, that of the wound of entrance ; but there was no reliable information available as to whether the bullet had been extracted. With the X rays it matter to demonstrate that no
in the limb or part affected. to the introduction of foreign bodies or material, owing to the greater trauma
remained
Owing septic
subsequently a simple foreign body
was
lodged
tissues, or in consequence of increased manipulative interference in extracting deeplyto the
seated and
the wounds the common, and
encapsuled projectiles
suppurated, sinuses patients were longer in hospital. were
damage
done
wounded
to
were
There
was more
important structures,
disabled for
so
the
longer average
a
Wounds of the lower extremity in this series number double those of the upper. Case 70, in which a bullet travelled half way round
period. the
pelvis
without
to the
injury
is
viscera,
one
of considerable interest, as is also Case 193, in which a bullet perforated the chest, lung, and shoulder-joint and fractured the head of the humerus. Of the Snider bullet-wounds, of which there were 11 cases; the most noticeable thing was the of the effects produced, which greatly surpassed the results above described under the
severity
headings of Henry, and
wounds from
wounds recoveiy to
Lee-Metford, MartiniTil all of the Snider
round bullets.
suppuration
slow
was
and to
out of the total bones
imperfect owing
or
traumatism.
severe
In 9
fractured.
The Snider wounds gave the greatest proportion of fractures and also the most severe ones. The
spherical
were
bullet wounds had the next greatest
number of fractures and the Lee-Metford wounds the fewest. As regards the lodgment of
projec-
this occurred in 4 out of the 11 Snider cases, compared with 5 out of the 12
tiles, as
ties
greatly
13 bullets
Martini-Henry
in 12 of the 1G spherical bullet-wound cases. As in the MartiniHenry series, the wounds of the lower extremi-
wounds, and
lodged
outnumbered
those of
the upper
limbs. It is
interesting
to note
bullet-wound of the lung Lee-Metford case there was
that all 3 survived.
rapid
find
cases
In
of
the
complete
recovery in a fortnight, injured ; but the results the two other the the
was
glenoid angle
The
subsequent
very
similar.
bone
no
very different in
one
(Martini-Henry)
opened
was
and the head of
in the other
fractured, of the
been
having
were
In
cases.
shoulder-joint
the humerus
1899.
[Feb.
scapula
(Snider)
fractured.
was
progress of these two cases was They were both received at
Rawal Pindi on the same day, having been b2 and 55 days 011 the lines of communication after
they
for 68 and 69
hospital both
and
wounded;
were
cases
remained at the
The
days.
much
was
they
the
same;
prognosis one
in
was sent
invaliding board as permanently unfit, and the other was given a chance of six months' sick leave in case he might recover sufficiently before
an
to be fit for further service.
I11
of the
proportion
large
a
cases
which
reached the General Hospital, 110 information was obtainable as to the kind of the bullet and which
firearm
at the
inflicted
the wound.
front and
Medical
the lines of
comofficers munication have their hands full; but still, as
Moir
Captain
suggests,
on
it would
not increase
their work much, while it would add ver}7 much to the interest of the cases,
which they
in
supplied following
printed forms might jot down the were
data while events were fresh in their forms proposed by Captain Moir
The
minds.
might contain
such
headings
at which wound
as
(1) place
or
received ; (2) nature of weapon or projectile; (3) nature of injury ; (4) approximate distance at which the shot was
action
fired,
also
the
was
direction,
from in
front, behind, &c.; (5) attitude of patient at the time he was struck, whether he was running, standing, lying down, &c.; and (6) any other facts of
above,
Of course, such information could not be obtained in all instances, but it would be forthcoming in many, and would afford useful
interest.
indications
regarding at varying
for treatment
as
well
as
information
the effects of the different ranges.
projectiles
