Gunshot

This paper is based on four years of active service as a surgeon in the past war. It seems appropriate to discuss and perhaps apply some of the principles of management of gunshot in war to civilian gunshot which will regrettably remain an occasional part of surgical practice. Active prophylaxis against anaerobic infection in our war gunshot is such a strict program that there remained the rare necessity of removal of most foreign bodies and even drainage of wounds. The same may not be true in civilian gunshot except when prophylaxis is immediate and efficient. Metallic foreign bodies are well tolerated in the liver as shown by clinical and experimental studies. Survivors of thoracic gunshot are seldom subjected to surgical repair, while abdominal gunshot victims are seldom denied celiotomy. The relief of shock and stay of intra-abdominal hemorrhage with repair of lacerations is paramount. External and internal drainage with suction and an active chemotherapy seem important. Blood and plasma, and in addition, fluids containing an appropriate amount of proteins, carbohydrates and vitamins given intravenously are essential in the postoperative regimen.