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
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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