Shot in abdomen - how long until infection obvious?

BarbaraKE · May 21, 2008

Hi everyone - My WIP is set in 1870 Europe (so antibiotics are unknown). One of the main characters is shot in the abdomen. Even though a doctor is there, I assume that this is pretty much a death sentence because of infection. So my question is three-fold...

What would be the signs of infection and would they show up in any particular order?

How long until the infection is obvious and they know he is going to die?

How long would it take him to die?

Any help would be appreciated (and rep points will be given

).

Thanks!!

FinbarReilly · May 21, 2008

In the 1870's, an abdomen shot was a death sentence (usually within 24-48 hours), but not necessarily due to infection. Admittedly, it would be determined by what kind of shot (cannons are a probability, after all), but you would be dealing with blood loss (transfusions would still be virtually unknown) as well as organs being destroyed (such as the liver and kidneys).

As for the sepsis itself, the only sign that's pretty much guaranteed is a sharp pain and possible fatigue; due to the structure of the abdomen, it's possible to not see any other signs of the infection...

FR

sheadakota · May 21, 2008

boy, that really depends on what the bullet hit on its way through- as the previous poster said- they are going to die before sepsis has a chance to set in- blood loss, shock, fever, pain- lots of pain- most likely the bullet would rupture the intestines and cause peritinitis-a condition where the contents of the bowel spill into the abdominal cavitiy- not a good thing-Death would be slow and agonizing- 24-48 hours sounds right to me.

Where's Colorado Guy- he could tell you for sure- I'm just a nurse.

johnnysannie · May 21, 2008

Signs of an infected wound would include:

Redness or excessive swelling in the wound area
Throbbing pain or tenderness in the wound area
Red streaks in the skin around the wound or progressing away from the wound
Pus or watery discharge collected beneath the skin or draining from the wound
Tender lumps or swelling in your armpit, groin or neck
Foul odor from the wound
Generalized chills or fever

Onset would be two days or less but it's likely that shock would kill the patient long before infection.

During the Civil War, there was about an 80% death rate from abdominal wounds, so it would probably be about the same just a few years later in 1870.

BarbaraKE · May 21, 2008

Boy, that was fast!! Thanks for the quick responses.

Let me clarify a bit. He is shot once by a bullet. I'd rather he didn't bleed to death but an infection that kills him within a couple of days would be perfect. Sepsis setting in from bowel perforation would work assuming that death wouldn't take too long. Lots of pain is also good. The doctor does have opium and chloroform available but he's young, doesn't have much experience and has never dealt with something like this.

I assume fever would be a good sign of infection. How long until it showed up? Would it be spiky or simply stay high? How about red streaks? Pus? General pain/tenderness could be caused by the wound itself, not necessarily infection. How about delirium?

If he's in lots of pain, he would be pale and sweaty, right? How about his breathing? (I'm thinking short, shallow pants/gasps.)

Sheadakota - I have six more months until I graduate from nursing school. I tried checking my books but they haven't been much help with this.

wickeddj · May 21, 2008

Barbara,
A fever would show within 24 hours--how high it would be can be highly individual, but fevers due to bacterial infection tend to be on the higher side. The wound itself would be red, (red streaks may or may not show up, though they would be a later sign of blood infection), and foul smelling pus would also show within 24-48 hours with a really good infection. Delirium could result from a high enough fever, especially combined with the drugs the dr. has on hand and the possibility of inept administration of said drugs.

You're right on about the breathing, shallow to keep the abdomen from moving much...he would be pale and sweaty with the possibility of flushed cheeks standing out in contrast to the paleness of the rest of his face, but that might also depend on blood loss--he might just be sheet white.

Pup · May 21, 2008

BarbaraKE said:
Let me clarify a bit. He is shot once by a bullet. I'd rather he didn't bleed to death but an infection that kills him within a couple of days would be perfect.

Here is a detailed hour-by-hour description of a man who was shot in the abdomen in 1872, was treated by doctors, and lived for a day or so. Don't know if there might be anything helpful there.

The author, writing in 1874, also discusses penetrating gunshot wounds of the abdomen in general later in the monograph here.

tallus83 · May 21, 2008

The bullets in 1870 were still of the mini-ball variety.

Unlike todays bullets, which will remain pretty much in shape. The mini-ball is soft lead and flattens as it goes through the air. It will cause a large amount of damage to the internal organs. Hence all the amputations during the US Civil War when a bone was hit.

As for the other items, better sources have already answered you.

ColoradoGuy · May 21, 2008

I don't have much to add what others have said. If he survived the initial wound by not having major vessel damage, he would most likely die of peritonitis. The time course of that can be variable and you could easily manipulate circumstances to fit your plot needs. For example, major shredding of the colon (large intestine) would cause fairly rapid death--say 24 hours or so. On the other hand, a smaller hole (or holes) upstream in the small intestine could easily take a week to kill. So you have a lot of lattitude. A low velocity, soft lead bullet, such as the Civil War-era Minie ball, did quite a bit of direct tissue damage. Much of the damage from more modern, high velocity bullets is from blast injury.

Tsu Dho Nimh · May 21, 2008

BarbaraKE said:
Hi everyone - My WIP is set in 1870 Europe (so antibiotics are unknown). One of the main characters is shot in the abdomen. Even though a doctor is there, I assume that this is pretty much a death sentence because of infection. So my question is three-fold...

What would be the signs of infection and would they show up in any particular order?

How long until the infection is obvious and they know he is going to die?

How long would it take him to die?

Any help would be appreciated (and rep points will be given ).

Thanks!!

Abdominal wounds with intestinal damage and peritonitis, none of the usual signs you see in a wound of the limbs, but there will be swelling, distension, fever and pain. Patient's belly will look quickly like they have been inflated by an air hose, the fever is high, they are deleroius and in severe pain. Then their other organs start to fail ... they will eventually die of septicemia-induced heart failure because nothing else is working.

And they stink ... it's a rotten-meat, sickly sweet stench coming from their breath, their sweat, and even the wound.

sheadakota · May 21, 2008

BarbaraKE said:
Sheadakota - I have six more months until I graduate from nursing school. I tried checking my books but they haven't been much help with this.

Ooo welcome to the trenches- I have worked in in ICU for 23 years at a level one trama center- trust me- there is a lot you aren't going to find in books.

BarbaraKE · May 22, 2008

You have all been extremely helpful. Thanks.

GeorgeK · May 23, 2008

It would depend upon a lot of things. Death in under 2 days is not likely to be from infection, but rather blood loss. Death from sepsis from a perforated viscus in a hospice patient (generally no antibiotics depending) today is usually 3-7 days. It is a slow painful way to go. They usually don't get disoriented until the last day or so.

1870's munitions were low velocity and so caused significantly less internal damage than today's high velocity rounds. Also, that was the start of cartridges and if the person was shot with a musket, especially by someone who was not military, there would be a reasonable chance that they spilled some of the powder and it was undercharged. I've seen musket balls that were slow enough that a person could dodge them (some of the powder got squished into the grease in the posterior of the miniball and so it effectively became a tracer round).

HeronW · May 26, 2008

An old test for detecting hidden abdominal wounds was to have the pt. drink a broth of onions and garlic. If you could smell that coming from the wound shortly after consumption, you wouldn't need to bother with making many more meals.

Shot in abdomen - how long until infection obvious?

BarbaraKE

FinbarReilly

sheadakota

part of the human equation

johnnysannie

BarbaraKE

wickeddj

Wicked is as wicked does

Pup

.

tallus83

ColoradoGuy

I've seen worse.

Tsu Dho Nimh

sheadakota

part of the human equation

BarbaraKE

GeorgeK

ever seeking

HeronW

Down Under Fan