Gunshot Wound to the Abdomen - Female Character

What time period and level of medical care is available?

She's shot with a flintlock pistol. If this dates the story to when flintlocks where state of the art a wound to the abdomen would likely be a death sentence due to infection. (Not to mention blood loss. There was no real surgical way to repair internal damage back then).

If it's a modern setting, and she just happens to be shot with an antique gun, then we can probably come up with something that works.

What was the path of the ball? If it just hit her hip and stopped, then she'd have a chance, but if it passed through her intestines, then she should say her prayers. If it went through her uterus without touching intestines, then she might also have a chance of survival, and that could make her sterile.

Take a look at some drawings of internal anatomy and see what looks possible.

Wanderingauthor said:

"What was the path of the ball?" Is pretty much the question I'd like answered. It's the one thing that's not explicit, so if we can come up with a path that works, it'd be awesome.
On another note, Ive been looking up anatomy and abdominal wounds witn diagrams and you would think, from the medical text books, that it was only ever guys who were injured!

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You're the one writing it. You must have some idea where the ball lodged and where the entry was. Those two items and any internal injuries do not have to line up. A flintlock pistol ball didn't move very fast; it did not have much energy. It might have entered by her navel and gotten all of six inches through flesh to lodge by the upper edge of the ilium without having actually entered the abdominal cavity. Or it could have entered on her right side, missed the large intestine, gone through her uterus, and lodged below and to the left of her ovary; that could easily make her sterile, but it would also be a very dangerous injury before antibiotics.

In that day and age, pretty much any injury that leaves her unable to have children is going to leave her dead as well. Most people shot with a flint lock did not die from the injury, but from sepsis. If you want her to listen e I would suggest the entry wound being low left abdomen. Nothing there to hit. In and out. She will have an infection, unable to avoid that, but if she's young and strong she could survive. Not a lot of blood loss either ,no major vessels there.

One thing to think about is that she might not be sterile, but depending on the damage it could cause concerns about her ability to safely deliver a child. Childbirth was pretty damn deadly at the time anyway. It's difficult enough for a modern woman to get a doctor to attempt VBAC, and a C-section in her era would be Russian roulette at best.

Wait, wait, wait. You do understand 'being taken on a horse' ie- riding, would be excrucriating to anyone shot in the hip or abdomen, right? Go sit on an exercise ball and move your hips in a figure 8. Now imagine a point of injury and pain and keep doing figure 8s. Sound fun? Now imagine the ball is a 1,000 lb animal walking under you with a lot more side to side movement. And don't even think of trotting.

This is why people were sometimes carried in stretchers, or on pole drags, or wagons. Very bumpy, but at least they could be on their backs. Much better than sitting.

Also, as a vet- there is no realistic way of hitting the uterus or cervix without hitting many loops of intestines. As pointed out, a broken hip might cause concern for giving birth, but you'd want to read accounts of people living with broken hips. There is a large variability in how a certain type of break affects a person.

Well my post about childbirth complications was more about scar tissue and muscle damage than actually hitting reproductive organs. But any concerns about delivery might be more a nervous doctor than reality. I was thinking of VBAC (vaginal birth after caesarian) because it is certainly possible but it's still controversial in the medical community. However your character probably hasn't had any damage to her uterus so it may not be an issue at all, more like if she'd had an appendectomy or something that would unrelated to her reproductive system other than close proximity.

Something else to consider is her clothing, especially a corset. Now that would not be armor by any means but its location and materials may change the bullet's trajectory, also whalebone could break or steel could dent in and either one could stab into her.

You may not want her to go unconscious from the injury itself (though she could faint) as that means serious blood loss and/or shock. Instead you may want have someone give her laudanum, so she's high on opium and drunk. Then you can always let her get addicted.... Hard core narcotics were pretty damn commonplace in the late 19th century, with a popular wine having cocaine in it (this inspired Coca-Cola when parts of Georgia went dry) and people using opiates as everyday painkillers/"little helpers".

'Unresponsive' is actually worse than 'unconscious.' In either case it's a very serious sign, especially if it occurs several hours after the initial injury, and even more if it lasts. If it's happening due to internal hemorrhaging, she's dead.

Depending on your world, it would be very reasonable to carry painkillers/narcotics while traveling. Or someone else is addicted and instructed to hand some over

And however you manage to get her 'knocked out', she is likely going to wake up, unless she is in fact on deaths door. So you're close to having written yourself into a corner. Perhaps step back and figure out what you really want from the scene. Perhaps struggling to get her back with a pole drag could be a big part of the story?

Wanderingauthor said:

I am hoping that somebody, preferably with some medical knowledge could help me.
I have a character, 24, of slight build but extremely physically fit. She is shot with an flintlock pistol and the bullet lodges to the side of her belly, possibly near the hip.

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People pretty much weren't using flintlocks anymore then. That would be an antique weapon.

What do you mean by to the side of her belly? Do you mean laterally from a head on view, or do you mean being struck from the side?

Wanderingauthor said:

I've assumed the shot has, miraculously, missed her vital organs. (This is allowed to be fairly miraculous as it only happens once in the novel).

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Flintlocks used a large caliber (generally) but produce a low velocity bullet. If struck from the side or laterally enough from a front on view it's entirely possible for the bullet to get stopped by bone particularly in a young fit person.

Wanderingauthor said:

After that, she is carried to safety and taken on horseback, though she is forced to move herself over short distances.
At first she is in a lot of pain, but the bleeding seems to slow fairly soon after the injury and she is lucid. Half an hour to an hour later though she starts to show signs of blood loss.

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What do you mean signs of blood loss? Is she bleeding externally again or does she just faint? It was very common in the late 1800's for women particularly and even gentlemen to wear tight corsets which can easily produce the effect of fainting during exertion.

Wanderingauthor said:

I was imagining internal damage and bleeding possibly from the discharge of the weapon's energy through her body. Would this work?

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What do you mean by throughout her body? Low velocity bullets do not produce a shockwave effect in the target.

Wanderingauthor said:

After about an hour she becomes becomes unresponsive / unconscious, but it's a further two hours before I can get her medical attention.
Aaah, this is all in the story now, so i'd appreciate it if someone could identify an injury that would work for! I have researched abdominal injuries and know that it's a dangerous place to be shot for all manner of reasons, so I don't need the list - just an idea of what possible injury could come closest to these results.

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In the beginning of your post you said it missed vital organs. Have you changed your mind? A hip shot with a low velocity round in someone wearing a corset (all reasonable for the period) would accomplish this.

Wanderingauthor said:

Here's the other part of the question:
In a follow up story I was considering having it revealed that she couldn't bear children because of this injury.
Is this possible?

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It's very possible that she and the generally relatively ignorant doctors of the day might think so without it actually being the case. Even today patients fall prey to the coincidence of timing and attribute all manner of irrelevant things as causative. I knew one patient who was drinking orange juice when she happened to get renal colic and insisted that orange juice caused her kidney stone. There are soooo many things wrong with that assumption that I won't get into it. Suffice it to say that people often make horribly wrong assumptions about medicine. She can be infertile or subfertile for many other reasons but that won't stop someone from blaming it on the hip bullet.

Wanderingauthor said:

What would cause this? (Without of course killing her).
And would she have any other permanent symptoms / visible or apparent damage / pain?

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As much or as little as you want

Wanderingauthor said:

Probably a laymen's idea of blood loss, but becoming weak and dizzy and eventually losing consciousness.

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If you write it like that, you've killed your character. Loss of consciousness is a late sign of uncompensated shock; it means you've lost so much blood that your brain's not getting enough oxygen. It means death is imminent. 19th century medicine has no way to fix this, so if your character passes out from losing blood, she will die.

Pain.

Of course she could pass out for other reasons, if you absolutely want that to happen.

People are pretty dang tough, I mean, she could be carried off on horseback and just have to deal with excruciating pain. Historically, women have had to ride horses while in labor due to bad circumstances. People had to do hard painful things all the time just because that's the way life was (and still is sometimes).

If you want this to make her sterile and not puncture any organs, I'd have it just graze through some flesh and her get a bad infection afterward.

Infection killed a lot of people back then, but a few people did manage to power through it. True story, my 3x great grandfather was gutted by a mini ball during the civil war. He literally picked his guts off the ground, rinsed them with canteen water, put them back in and bound his abdomen to keep them in place. Then on his way back to camp, he found a confederate kid in the same condition, did the same thing to the kid, and brought the kid back with him.

They both lived. I don't know if they avoided getting an infection (did he have booze in his canteen? haha) or if they just managed to recover from it. They're not the only folks in history to beat abdominal gunshot either, it's just very very likely to be fatal.

Anyway, an abdominal infection could cause her to become sterile without having to puncture anything. If it spread to her reproductive organs and caused scarring in the fallopian tubes or even in her uterus that would definitely hinder getting pregnant.

Or she could just be sterile from other natural causes, and people blame it on the gunshot because they don't know any better.

For what it's worth, a character getting gut shot and having a harrowing near death battle to overcome infection is a lot more believable to me than a character getting a "lucky" gut shot that just temporarily incapacitates them but bleeds dramatically all over the place.