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View Full Version : gunshot wound to ribs/liver - late 19th cent.



CWatts
03-29-2016, 03:32 AM
Hopefully I've researched this enough for medically-knowledgeable people not to throw the book across the room, even found period sources with people (rarely) surviving similar injuries, but I might as well check here.

The unfortunate victim is a young woman, reasonably healthy, who is shot with a black-powder military rifle at fairly close range (mass firing squad). I have the bullet hitting a little below her right breast around the 8th rib or so, maybe the costal cartilage, which would put it at liver. That would cause a lot of bleeding - I assume it would take a while to be fatal? Would the bullet go through? She is wearing ordinary working-class clothing so probably a corset but not tight-lacing. I could have it deflected toward her side by one of the stays (spring steel), would that be more likely to cause it to lodge rather than exit?

Result I want is to have her be left for dead (the soldiers get attacked just after so they don't have time to double-tap/bayonet), be found some time later and barely survive. She's cared for by an experienced war nurse but there's no access to a doctor for at least several days. Antiseptics had been discovered only a few years prior so the nurse be sort of experimenting...maybe using vinegar or some other weak acid if they don't have phenol on hand? I would like her to eventually recover, though it would like take a while.

Anyway, I need to go ahead and write the damn thing and use what works for the story, but I want to keep things in the realm of plausibility.

Katharine Tree
03-29-2016, 04:00 AM
Exactly this injury happens in the eighth book of a particular wildly popular historical fiction series. I'd tell you to read it, but it's about 1500 pages long...

So let me sum up. The woman is shot by a blackpowder musket or rifle (not known which) while wearing typical late-18th century clothing including stays--which did not have steel in them at that time. Bullet misses major vessels and lodges in her liver. A doctor extracts the bullet, and the only problem left at that point is infection. She packs it with blue cheese, the mold prevents infection, and half a page later she's walking around again just fine.

Don't use the blue cheese plot point in your story. That was the Special Sauce in that particular book. Also, I assume guns would be higher-powered a century later. You will need some kind of explanation for why the shot doesn't blow a hole in her. Maybe steel stays are good enough; or maybe speculate about a misfire.

King Neptune
03-29-2016, 05:03 AM
That's great! You could even use the fromage bleu, if that seems to fit. The mold would be able to kill many bacteria, if it were living mold.

Twick
03-29-2016, 05:13 AM
Alcohol is an easily accessible germicide.

blacbird
03-29-2016, 05:15 AM
Any wound to the liver is really, really serious. Automatically life-threatening, in a major way. The rib matters a lot less than the liver does. Without modern medical treatment, this is a very likely fatal wound.

And I'm waaaaaay less than convinced that the mold in fromage bleu is suitable an an anti-infection agent.

For your story, why do you need such a severe wound?

Addendum: This is important. In the 18th century, nobody knew about infection or germs. Even well into the 19th century, this ignorance persisted. A doctor probed Abraham Lincoln's head wound with an unwashed finger, trying to locate the bullet that ultimately killed him. Twenty years later, James Garfield was similarly examined, with the resultant infection that led to his death many weeks after he was shot. Garfield's death would almost certainly not have occurred under modern medical treatment; it was quite similar to the wounding of Ronald Reagan almost exactly a century later. The concept of using blue cheese to stem an infection is historically absurd.

caw

Chris P
03-29-2016, 05:22 AM
It also sounds like President Garfield's injury. He was shot with a handgun, so not as powerful, but he would have survived if some careless doctor hadn't puctured his liver trying to work the bullet out.

But for your disinfectant, you could look into some herbal wash that might have been used at the time. Or make one up. Infusion of Jerusalem artichoke root or something like that. If someone wanted to get technical you could argue that washing with sterilized water from boiling the herbal wash would have been better than nothing. And people then did survive some horrific wounds. The army even cataloged a lot of them from the Civil War.

CWatts
03-29-2016, 05:39 AM
Oh crap, I should probably do something else then. No bleu cheese or time travel ;) Guns would be more powerful and so it should go through. I could be evil and have the bullet go in between the stays in front, but hit one in the back which traps the bullet or makes it bounce around.

I had something far less tasty in mind for the secret sauce. The place had a serious fly infestation (what do you expect when there's corpses left rotting in the summer heat?) so maggots could get into the wound and start munching on infected tissue. There's also the fact she's an uncooperative patient - I'd imagine getting drunk would be very bad?

I actually got the idea from Army case records from the Wild West, where the survivors were treated with carbolic acid which is what Lister used. So they could use that. I could have them try to get to a hospital - unfortunately it's the one where the army came through and killed everybody, but there should be supplies to salvage.

This character is in a life-threatening situation regardless. A less-serious wound could easily turn bad if I need it to, especially given a temporary breakdown of civilization.

Chris P
03-29-2016, 05:58 AM
Two thoughts on the fly route. One, there are things called "surgical maggots" that only eat necrotic flesh and leave the heathly behind. This is an old parctice that is lately getting more attention. However, I don't think they would work for a gunshot wound to the gut for all kinds of juicy reasons.

The other would be lots more relevant to your setting. Do some research on "myiasis." This is when flies lay eggs in wounds and the maggots eat all the flesh, living and dead. It used to be a really big deal for livestock here in the US by infesting newborn animals' navels. The screworm, which was the worst offender, was eradicated from the US in the 1960s but would have been a big concern 100 years earlier.

Just something for you to chew on

Katharine Tree
03-29-2016, 06:14 AM
Yes yes, do read about flesh-eating worms and maggots. Don't report what you find.

While you're at it, you might want to read up on the case of Alexis St. Martin, who survived a gunshot wound to the abdomen and lived for many years with an open hole to his stomach. Dr. William Beaumont treated him and kept a journal about it.

cmhbob
03-29-2016, 07:16 AM
There's a scene in one of the Aubrey-Maturin novel - HMS Surprise, I think, where Dr Maturin performs surgery on himself. This would be 1799-1800 vintage medicine.

ColoradoGuy
03-29-2016, 08:25 AM
As an ICU doc I deal with a lot of liver injuries, generally from blunt trauma after motor vehicle accidents and the like. The bleeding from fractured livers is actually quite variable. These days only about 10% even get an operation, even for grade IV (the worst) injuries. Today a penetrating injury like your character's would be explored in the operating room, but even then the bleeding is variable. You could have it nick the liver and your scenario would be plausible enough to use. Believe me, weird stuff happens with trauma. Your main issue is that bullets cause blast injury to internal organs and tend to shatter things. But still, I think your scenario is fine. As long as the intestines aren't punctured the infection risk would be much less.

FWIW, these days we tend to leave bullets where they end up if digging them out would cause more injury. Back then they thought it was important to get the bullet out, which it isn't. Bullets are sterile by themselves -- infection comes from bits of clothing and such that get dragged into the wound.

And yes, the famous case of Dr. Beaumont that Katharine notes involved a guy getting shot in the stomach. Beaumont spent the winter looking into the guy's stomach and studying digestion -- seminal work on the subject. He wrote a big book about it.

nemaara
03-29-2016, 09:35 AM
She packs it with blue cheese, the mold prevents infection, and half a page later she's walking around again just fine.

ಠ_ಠ

That's... erm... creative.

CWatts
03-29-2016, 02:43 PM
As an ICU doc I deal with a lot of liver injuries, generally from blunt trauma after motor vehicle accidents and the like. The bleeding from fractured livers is actually quite variable. These days only about 10% even get an operation, even for grade IV (the worst) injuries. Today a penetrating injury like your character's would be explored in the operating room, but even then the bleeding is variable. You could have it nick the liver and your scenario would be plausible enough to use. Believe me, weird stuff happens with trauma. Your main issue is that bullets cause blast injury to internal organs and tend to shatter things. But still, I think your scenario is fine. As long as the intestines aren't punctured the infection risk would be much less.

FWIW, these days we tend to leave bullets where they end up if digging them out would cause more injury. Back then they thought it was important to get the bullet out, which it isn't. Bullets are sterile by themselves -- infection comes from bits of clothing and such that get dragged into the wound.

Thanks. How would the same injury be different if it was a stab wound instead of a gunshot? No blast issues but probably more infection - esp. for a bayonet that had been used on other people.

ColoradoGuy
03-29-2016, 05:58 PM
Thanks. How would the same injury be different if it was a stab wound instead of a gunshot? No blast issues but probably more infection - esp. for a bayonet that had been used on other people.

I expect that's correct. But you could still have her survive. The stab may or may not hit large vessels, such as the portal vein or hepatic artery.

Overall I tend to think people overthink these medical questions when writing novels. If a scenario is plausible, even rare, readers will suspend disbelief if your story and writing are good. I do, even though I'm an expert on severe injuries. I've been doing this for 35 years or so and I see amazing things all the time. My physician father passed on to me what his physician father said: medicine is equal parts science, near science, intuition, guesswork, and blind luck.

Katharine Tree
03-29-2016, 06:59 PM
ಠ_ಠ

That's... erm... creative.

Not endorsing it. Just summing up.

nemaara
03-29-2016, 08:03 PM
Not endorsing it. Just summing up.

Mhmm, I know, I know. It's just that I got this vivid image of someone stuffing blue cheese into a hole in her body and thought it was really funny.

c.e.lawson
03-29-2016, 09:30 PM
...The concept of using blue cheese to stem an infection is historically absurd.

caw

If the particular series is the one I think it is, then the main character is a war nurse from WW2 who travels back in time, so she knows about more modern medical treatments.

blacbird
03-29-2016, 09:35 PM
If the particular series is the one I think it is, then the main character is a war nurse from WW2 who travels back in time, so she knows about more modern medical treatments.

Is it? The only reference I saw to an extant historical series was in Post #2, not the OP. I was responding to the OP.

caw

Marlys
03-29-2016, 10:55 PM
Go to Google Books and read actual accounts by 19th-century doctors--I learned a ton there when I was researching my MC's battle wounds, most from the Civil War. I found discussions of various types of torso wounds, approximate survival percentages, individual cases and how the doctors treated them, whether the soldiers were taken directly for treatment or lay on the battlefield for a while, etc. etc.

Try search terms gunshot wound liver and set it to return only results from the 19th century. You can tinker with the search to narrow the time period down or to investigate other possibilities, but that should give you a good start. Seriously fascinating stuff.

CWatts
03-30-2016, 05:03 PM
Go to Google Books and read actual accounts by 19th-century doctors--I learned a ton there when I was researching my MC's battle wounds, most from the Civil War. I found discussions of various types of torso wounds, approximate survival percentages, individual cases and how the doctors treated them, whether the soldiers were taken directly for treatment or lay on the battlefield for a while, etc. etc.

Try search terms gunshot wound liver and set it to return only results from the 19th century. You can tinker with the search to narrow the time period down or to investigate other possibilities, but that should give you a good start. Seriously fascinating stuff.

The Internet Archive also has a medical history library online, where I found this resource (browsing through it gave me the idea that this could be survivable, actually): https://archive.org/details/reportofsurgical00unituoft

It looks like the U.S. Army took to using carbolic acid as an antiseptic right after the Civil War - think of how many lives could have been saved if it had been discovered just a few years earlier. Note that there are sections on all kinds of injuries and operations, not just combat wounds (the STD section is downright horrifying), plus there's a whole section on arrow wounds that could be helpful for a lot of periods.

Thanks to all who responded.