Bullet Wounds

IHE simple and common type of bullet wound shovs an cntrance and exit wound; but it is well knowin that a bullet often re-enters the body an(d a second pair of wounds results. Suppose, however, that the first exit w,Nound and the second entrance wound are so close togetlher that they form only one wound. The patient would then have three woun1ds an(1 nio lodged bullet. Tlhe second exit wound may, of course, be absenit, leaving two wounds and a bullet lodge(d in a distant part of the body. I have knownv a case of this type wvhere the bullet entered the deltoid region and left the body in the concavity of the neck above the clavicle, and re-entering immediately, lodged on the opposite side of the neck. The bullet in this case was discovered after twenty years, and an examination of the scars showed how the original error had been made. Where a patient has a single wound, the bullet is often found under the skin. It would appear that the strong andl elastic skinl can hold up a bullet that has passed through and shattered a bone a few inches away. The diagram (fig. 1) shows ten possible varieties of entranice and exit wounds wNhere the bullet passed once or twice through the body. This diagram may appear somewhat complicated; but it is quite inadequate when we consider wounds of the intestine. The lumen of the bowel might be regarded as the exterior of the body, and an entrance wound on the anterior-abdominal wall may be associated with an opening in the bowel lumen, and this wound could be described as an exit wound. If a wound is discovered in the bowel, a search will be made for a second wound, but it is obviously of great importance that a bullet may cause a single wound in the bowel. I do not refer to wounds of the boxvel in this strictly correct sense, I regard the wound of the bowel as seen at operation from the peritoneal aspect, and while I admit that such a wound is an exit wound of the body, I prefer to call it an entrance wound of the bowel. The possible types of bowel injury caused by a bullet are described in fig. 2. In these five types of injury the peritoneum and muscle retract and the wound is larger in these layers …