Reports on the extent and nature of the materials available for the preparation of a medical and surgical history of the Rebellion.

Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Reports on the extent and nature of the materials available for the preparation of a medical and surgical history of the Rebellion. Source: Wellcome Collection.

    15/192 (page 9)
    ON SPECIAL WOUNDS AND INJURIES. It is now proposed to review briefly the records of special wounds and injuries, of some of their complications, and of the operations which they have rendered necessary. GUNSHOT INJURIES OF THE HEAD. In this important class of injuries, the utmost pains has been taken to secure com- pleteness and accuracy in the records. The registers have been copied by experienced clerks, and have been supervised by a medical officer. Exclusive reliance has not been placed upon the field and hospital reports; but in a large proportion of cases, specific inquiries in regard to the extent and results of individual injuries have been made by letter. All, or nearly all, cases of gunshot injuries of the head that have been reported to the office from the commencement of the war to October 1st, 1864, have been entered in the records. They number 5046, and have been recorded in two classes; first, the gunshot fractures and injuries of the cranium, including the perforating and penetra- ting and depressed fractures, the fractures without known depression, and the contusions of the skull resulting in lesions of the encephalon; and, secondly, the simple contusions and flesh wounds of the scalp. It is quite possible now to establish subdivisions in the first class; but to have attempted this heretofore, would have been premature, and likely to produce confusion. In the first class 1104 cases are recorded. Of 604 of them, of which the results have been ascertained, 505 died and 199 recovered. In 107 of these terminated cases the operation of trephining was performed, of which 60 died and 47 recovered. In 114 cases fragments of bone or of foreign substances were removed by the elevator or forceps, without the use of the trephine; and of these 61 died and 53 recovered. When operative procedures were instituted, the recoveries were 45-3 per cent. But it must be apprehended that this favorable exhibit will be materially modified when a larger number of results are ascertained, and that a great proportion of the field operations of trephining, in which the results are stated to be undetermined, were lost sight of, and terminated fatally. In the 483 cases treated by expectancy, the ratio of recovery is only 20-5 per cent. But the latter group of cases includes nearly all of the penetrating and perforating fractures, and it would be unwise to base on these figures an argument in favor of operative interference. The gunshot contusions and wounds of the scalp that have been entered on the records number 3942, of which 103 terminated fatally. It is altogether probable that in all of these fatal cases some undiscovered injury was done to the cranium or its contents; or that the pericranium was removed, and death of bone ensued, with con- secutive lesions of the encephalon. The histories of many of these cases are now under investigation. So far as ascertained, the fatal results have depended upon concussion or compression of the brain, or upon the formation of abscesses in the liver or lungs, in