Wounds Of Various Parts Of The Body





1. =Of the Head.=--Wounds of the scalp are likely to be followed by (1)

erysipelatous inflammation; (2) inflammation of the tendinous

structures, with or without suppuration. A severe blow on the vertex may

cause fracture of the base of the skull. Injuries of the brain include

concussion, compression, wounds, contusion, and inflammation. Concussion

is a common effect of blows or violent shocks, and the symptoms follow

immediately on the accident, death sometimes taking place without

reaction. Compression may be caused by depressed bone or effused blood

(rupture of middle meningeal artery) and serum. The symptoms may come on

suddenly or gradually. Wounds of the brain present very great

difficulties, and vary greatly in their effect, very slight wounds

producing severe symptoms, and vice versâ. A person may receive an

injury to the head, recover from the first effects, and then die with

all the symptoms of compression from internal hæmorrhage. This is due to

the fact that the primary syncope arrests the hæmorrhage, which returns

during the subsequent reaction, or on the occurrence of any excitement.

Inflammation of the meninges or brain may follow injuries, not only to

the brain itself, but to the scalp and adjacent parts, as the orbit and

ear. Inflammation does not usually come on at once, but after variable

periods.



2. =Injuries to the Spinal Cord= may be due to concussion, compression

(fracture-dislocation), or wounds. That the wound has penetrated the

meninges is shown by the escape of cerebro-spinal fluid. The cord and

nerves may be injured (1) by the puncture; (2) by extravasation of blood

and the formation of a clot; and (3) by subsequent septic inflammation.

Division or complete compression of the cord at or above the level of

the fourth cervical vertebra is immediately fatal (as happens in

judicial hanging). When the injury is below the fourth, the diaphragm

continues forcibly in action, but the lungs are imperfectly expanded,

and life will not be maintained for more than a day or two. When the

injury is in the dorsal region, there is paralysis of the legs and of

the sphincters of the bladder and rectum, but power is retained in the

arms and the upper intercostal muscles act, the extent of paralysis

depending on the level of the lesion. In injuries to the lumbar region

the legs may be partly paralysed, and the rectal and bladder sphincters

may be involved.



Railway spine, or traumatic neurasthenia, may be set up by concussion

of the cord as a result of blows or falls. Passengers after railway

accidents, or miners, often suffer from this affection.



3. =Of the Face.=--These produce great disfigurement and inconvenience,

and there is a risk of injury to the brain. The seventh nerve may be

involved, giving rise to facial paralysis. Punctured wounds of the orbit

are especially dangerous. Wounds apparently confined to the external

parts often conceal deep-seated mischief.



4. =Of the Eye.=--The iris may be injured by sharp blows, as from the

cork of a soda-water bottle. It is usually followed by hæmorrhage into

the anterior chamber, and there may be separation of the iris from its

ciliary border. Wounds at the edge of the cornea are often followed by

prolapse of the iris. Acute traumatic iritis or irido-cyclitis may

supervene four or five days after the injury. The lens is frequently

wounded in addition to the cornea and iris. In dislocation of the lens

into the anterior chamber as the result of a blow, the lens appears like

a large drop of oil lying at the back of the cornea, the margin

exhibiting a brilliant yellow reflex. Partial dislocations of the lens

as the result of severe blows generally terminate in cataract.



5. =Of the Throat.=--Very frequently inflicted by suicides. Division of

the carotid artery is fatal, and of the internal jugular vein very

dangerous on account of entrance of air. Wounds of the larynx and

trachea are not necessarily or immediately dangerous, but septic

pneumonia is very apt to follow. Wounds of the throat inflicted by

suicides are commonly situated at the upper part, involving the hyoid

bone and the thyroid and cricoid cartilages. The larynx is opened, but

the large vessels often escape. In most suicidal wounds of the throat

the direction is from left to right, the incision being slightly

inclined from above downwards. At the termination of a suicidal

cut-throat the skin is the last structure divided, the wound being

shallower as it reaches its termination; the wounds often show

parallelism. The weapon is often firmly grasped in the hand. Inquiry

should be made as to whether the patient is right or left handed, or

ambidextrous.



Homicidal cut throat is usually very severe and situated low down in the

neck or far to the side.



6. =Of the Chest.=--Incised wounds of the walls are not of necessity

dangerous; but severe blows, by causing fracture of the bones and

internal injuries, are often fatal. The symptoms of penetrating wounds

of the chest are--(1) The passage of blood and air through the wound;

(2) hæmoptysis; (3) pneumothorax; and (4) protrusion of the lung forming

a tumour covered with pleura. Fracture of the ribs may be due to direct

violence, as from a blow, when the ends are driven inwards, or to

indirect violence, as from a squeeze in a crowd, when the ends are

driven outwards.



7. =Of the Lungs.=--These usually cause hæmorrhage, and are frequently

followed by pleurisy, either dry or with effusion, and by pneumonia.



8. =Of the Heart.=--Penetrating wounds are fatal from hæmorrhage, of the

base more speedily than of the apex; but life may be prolonged for some

time even after a severe wound to the heart. Injury to the right

ventricle is the most fatal injury and the most frequent. Rupture from

disease usually occurs in the left ventricle; rupture from a crush is

usually towards the base and on the right side.



9. =Of the Aorta and Pulmonary Artery.=--Fatal.



10. =Of the Diaphragm.=--Generally fatal, owing to the severe injury of

the other abdominal organs. If the diaphragm be ruptured, hernia of the

organs may result.



11. =Of the Abdomen.=--Of the walls, may be dangerous from division of

the epigastric artery; ventral hernia may follow, internal hæmorrhage,

etc. Blows on the abdomen are prone to cause death from cardiac

inhibition.



12. =Of the Liver.=--May divide the large vessels. Venous blood flows

profusely from a punctured wound of the liver. Wounds of the

gall-bladder cause effusion of bile and peritoneal inflammation.

Laceration of the liver may result from external violence without

leaving any outward sign of the injury; it is commonly fatal. There is

rapid and acute anæmia from the pouring out of blood into the abdominal

cavity. This may also occur with injuries of other organs in the

abdomen.



13. =Of the Spleen.=--Fatal hæmorrhage may result from penetrating

wounds or from rupture due to kicks, blows, crushes, especially if the

spleen be enlarged.



14. =Of the Stomach.=--May be fatal from shock, from hæmorrhage, from

extravasation of contents, or from inflammation. The danger is

materially lessened by prompt surgical intervention.



15. =Of the Intestines.=--May be fatal in the same way as those of the

stomach. More dangerous in the small than in the large intestines.



16. =Of the Kidneys.=--May prove fatal from hæmorrhage, extravasation of

urine, or inflammation.



17. =Of the Bladder.=--Dangerous from extravasation of urine. In

fracture of the pelvis the bladder is often injured, and extraperitoneal

infiltration of urine occurs, with frequently a fatal issue.



18. =Of Genital Organs.=--Incised wounds of penis may produce fatal

hæmorrhage. Removal of testicles may prove fatal from shock to nervous

system. Wounds of the spermatic cord may be dangerous from hæmorrhage.

Wounds to the vulva are dangerous, owing to hæmorrhage from the large

plexus of veins without valves.





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