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CHAPTER 7 Staffing Essentials

7.1 LEARNING OUTCOMES

1. Explain why effective recruitment is important.
2. Describe the basic process of doing a job analysis, job specification, and job description.
3. Explain why both internal and external recruiting are important.
4. Describe several strategies for external recruiting.
5. Identify five sources of data used to make selection decisions.

7.2 CHAPTER OUTLINE

Forecasting Staffing Needs
Recruitment
Why Recruit?
Job Analysis
Job Description
Job Specification
Preparing the Job Analysis, Specification, and Description
Job Analysis and Specification
Job Description
Recruitment Strategies
Internal Recruiting
External Recruiting
Recruiting for Diversity
Realistic Job Preview
Best Strategies
The Selection Process
Criteria for Decision Making
Data Collection

7.3 CHAPTER TEACHING TIPS

To teach the material covered in Chapter 7 of the text, use the Comprehensive Lecture Outline
(see section 7.4 below). Supplement the Comprehensive Lecture Outline with some of the
following instructor’s resources:
 PowerPoint® slide presentation PowerPoint slides can be used for review purposes by
both instructors and students. Each presentation provides a basic framework for the

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 1
 chapter. Instructors can access them on the instructor's companion website and on the
Instructor’s Resource CD. Students can access the slides on the CourseMate website for this
book.
 Knowledge to Action (text) Chapter 7 includes two Knowledge to Action features that
help students:
* Examine external postings for employment positions. (p. 145)
* Examine diversity strategy. (p. 146)
(Note: See the Comprehensive Lecture Outline below for suggested answers to the
questions.)
 Videos (CourseMate) The authors have selected and recommend the following video clips
from for Chapter 7:
* Allstate: In Good Hands
* Whirlpool
 Opening Vignette—Straight Talk from the Field (text) Martha Scott Smith, director of
public affairs/foundations at AT&T-Southeast, introduces students to the importance of
diversity and how to attract and retain a talented, diverse workforce. Consider using the
opener as an alternative to the icebreaker included in the Comprehensive Lecture Outline.
 Leveraging Technology (text) Human Resources departments use applicant tracking
systems. It is important for students to understand how applicant tracking systems work to
enhance their career opportunities.
 Questions for Reflection (text and section 7.5 below for suggested responses) Consider
using the questions for out-of-class assignments or to start in-class discussions to assess
student understanding and application of the most important concepts in the chapter.
Consider also using some of the questions as part of your tests or quizzes.
 Hands-on Activities (text and section 7.6 below for suggested responses) This section
includes three activities that may require students to do individual and/or group research
beyond the text. Consider using either or both of these activities after the completion of the
lecture for this chapter. For Chapter 7 the three activities are:
* Job Description
* Best Hiring Practices
* Interview Questions
 You Decide Case Study (text and section 7.7 below for suggested responses) This case
covers Improving Diversity and gives students an opportunity to apply the concepts
covered in the chapter through answering questions about a hypothetical, yet realistic,
scenario. Students practice critical thinking, problem solving, and other skills as part of a
classroom discussion or as a graded assignment. This is a helpful case to begin the study of
diversity in the workplace and ways to enhance diversity recruiting.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 2
 The Manager’s Toolkit (text and section 7.8 below for suggested responses) This
provides students with a structured opportunity to analyze the basic job description for
their ideal job. Assign Manager’s Toolkit activities at the end of each chapter occasionally or
consider assigning all or most of them to help students create a Management Portfolio for
use in the workplace or interviews.
 Soft Skills for Success (text and section 7.9 below for suggested responses) This activity
focuses on multicultural or diversity skills and gives students an opportunity for self-
assessment of their strengths and weaknesses as a member of a diverse multicultural team.
The instructor may want to inform the students that this self-assessment is private and will
not be seen by anyone else.
 Miscellaneous Activity (Instructor’s Manual, section 7.10) Consider using this activity as
an individual or team assignment near the end of this chapter, after students have had a
chance to absorb the material in the chapter.
 Learn It On the Web (Instructor’s Manual, section 7.11) Consider assigning this activity to
teams at the beginning of the chapter and again near the end to allow them to refine their
answers. Have teams meet with another team toward the end of the chapter to compare
answers, and then have teams report to you on each other’s answers.

7.4 COMPREHENSIVE LECTURE OUTLINE

ICEBREAKER ACTIVITY
Ask students: “How does your employer recruit new employees? What is your turnover rate?
What reasons do employees give for leaving the organization? Is there anything management
can do to retain those workers?”
I. Forecasting Staffing Needs Right-sizing—having no more or no fewer than the number of
employees needed—is critical to an organization. First-line or office managers are in the
best position to analyze the needs for right-sizing.
II. Recruitment This refers to efforts by an organization to find and hire qualified employees.
A. Why Recruit? A company recruits to replace an employee, to add staff, and to fill new
jobs.
B. Job Analysis This identifies the tasks and skill requirements for a specific job. This
should be done for all new positions, with a review for all existing positions.
C. Job Description This is a document that outlines expectations, tasks, responsibilities,
education, and skill requirements for a specific job. This is needed for all new jobs, with
review and updates of existing jobs.
D. Job Specification This is a written summary of the qualifications needed to successfully
perform a particular job.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 3
III. Preparing the Job Analysis, Specification, and Description This section describes the
process of completing the job analysis and writing the job specifications and description.
A. Job Analysis and Specifications A job analysis identifies the job tasks and skills
required to do the job. It also specifies the knowledge, technical skills, behavioral skills,
and personal attributes required to do the job successfully.
a. Technical Skills Technical skills needed, such as computer skills, depend on the job.
Technical skills should be listed on the job analysis and specifications.
b. Behavioral Skills Behavioral skills, such as having a professional manner, that are
desired for a person in the position should be listed in the job analysis and
specifications.
c. Personal Attributes Personal attributes, such as being friendly and helpful, that are
desired for a person in the position should be listed in the job analysis and
specifications.
B. Job Description This provides specific information about the responsibilities and duties
for the position. It also includes essential skills and desired qualifications, along with
information about the organization and its culture.
a. Job Title This should be concise and descriptive, giving others a clear idea of what
the employee does.
b. Position Description This is a brief narrative description of the position, the
employee’s goals and responsibilities, and major job functions.
c. Reporting and Organizational Structure This shows where the employee fits into
the organizational hierarchy.
d. Organizational Values and Culture This section specifies the characteristics of the
organization and expected behaviors, attitudes, and values.
e. Desired Qualifications Specific qualifications for performing the job are listed here.
f. Requirements Listed here are the physical and mental requirements for the job.
IV. Recruitment Strategies When hiring, managers need to match employees’ talents with the
tasks and responsibilities.
A. Internal Recruiting This is posting or advertising a job within the organization and
encouraging qualified employees to apply.
B. External Recruiting This is posting or advertising a job with sources outside the
organization.
______________________________________________________________________________
KNOWLEDGE TO ACTION
1. What would you think if you worked for an organization that had a position open for
which you believed you were well qualified and the organization only posted it
externally?

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 4
 Answers will vary. Students will either think companies should open job opportunities to
employees or they will think outside recruitment adds new blood to an organization.
2. How might you handle the situation?
Answers will vary depending on student’s view. Students who believe job opportunities
should be open internally might say they would approach the Human Resources
Department.
______________________________________________________________________________

a. Employment Agencies These agencies screen candidates for organizations for a

fee.
b. Placement Services of Educational Institutions Organizations not in need of
extensive experience use these free services of colleges, universities, and some high
schools to find candidates among graduating seniors.
c. Print and Online Advertisements Theses sites may be linked to print advertising.
Online recruiting websites include Monster or CareerBuilders. Social media such as
LinkedIn are also used to post advertisements.
d. Word-of-Mouth Referrals These are effective and inexpensive. Referrals come
from current employees, college faculty and alumni, and clients.
C. Recruiting for Diversity Recruiting a diverse workforce and preventing job
discrimination are major responsibilities of managers and supervisors.
______________________________________________________________________________
KNOWLEDGE TO ACTION
Do you think it is necessary and appropriate for companies to form alliances and partnerships
with diversity organizations as a key strategy to enhance diversity recruiting? Why or why
not?
Answers will either be yes or no. A student might say yes because diversity organizations are a
good source for finding and recruiting people of different cultural backgrounds. A student might
say no because hiring should be open for all qualified people regardless of heritage.
______________________________________________________________________________

D. Realistic Job Preview During an interview, provide a job applicant with the day-to-day
preview of the job including job acceptance, turnover rate, and job satisfaction.
E. Best Strategies A strategy is needed to generate a pool of qualified applicants.

V. The Selection Process This is often compared to a hurdle race because it can become
complex and drawn out.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 5
______________________________________________________________________________
DISCUSSION QUESTION
Why do human resources experts commonly compare the selection process to a hurdle race?
How do large organizations handle the selection process differently from small and medium-
size companies? What are the first two steps a company should take when seeking new
employees to ensure fair and unprejudiced consideration for all job applicants? Why are these
two steps important?
______________________________________________________________________________

A. Criteria for Decision Making Most companies use the multiple-hurdle or a

compensatory approach to making hiring decisions. With the multiple-hurdle approach,
applicants must pass a series of procedures (or hurdles) that apply to a specific job. The
applicant must clear each hurdle before continuing. With a compensatory approach, an
applicant can progress through all the procedures without being screened out and is
evaluated using a composite score.
B. Data Collection To select the best-qualified candidate, use the job analysis,
description, and specifications.
a. Résumé and/or Application Data can be collected by requesting a résumé or
having applicants fill out an application form.
b. Pre-employment Testing Job candidates may be asked to take different types of
tests that assess skills and personality, or check for drug use or a criminal
background, for example.
c. Work Samples of Portfolios These can provide useful information about
candidates and their abilities.
d. Interviewing Only the best candidates should be interviewed, which can take place
in person, on the telephone, or virtually using Internet tools.

7.5 QUESTIONS FOR REFLECTION

1. Why is effective recruitment and selection important?
Recruitment is important because employees need to find qualified employees and
companies need to select the right employee for the job.
2. Describe how you would complete the following:
a. Job analysis
Job analysis is the process of identifying the task and skill requirements for a specific
job, determined by studying superior performers in related jobs.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 6
 b. Job description
Job description is a document that outlines expectations, tasks, responsibilities,
education, and skill requirements for a specific job.
c. Job specification
Job specification is a written summary of the qualifications needed to successfully
perform a particular job.
3. Describe how you would do the following types of recruiting:
a. Internal
You would post positions within the company and encourage qualified employees to
apply for them.
b. External
You would advertise the position through employment agencies, placement services of
educational institutions, in print and online media, and through word-of-mouth.
4. Why should you give both positive and negative information in a job preview?
You want the candidate to have a realistic understanding of what the job entails.
5. Why is recruiting for diversity important?
The ultimate goal of recruiting is to generate a pool of qualified applicants for new and
existing jobs. One of the challenges is creating an applicant pool that is demographically
representative of the population at large if diversity is to be achieved.
6. What criteria would you use for selection if you were hiring for the job you now have or
would like to have?
You would want to review data on education, experience, professionalism, communication
skills, technical skills, organization and time management, overall impression of candidate’s
performance, overall job knowledge and skills, meeting management skills, self-
management skills, and emotional intelligence.
7. Why are those criteria important?
You want the candidate with the best skills for the job and the one who best fits in with
your organization.

7.6 HANDS-ON ACTIVITIES

1. Job Description—The instructor may want to bring sample copies of good job description
into class. This activity in which students are to find a job description and answer questions
about it is best completed individually.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 7
2. Best Hiring Practice Questions—This assignment may be either completed as a team or
individually. Teams are to answer a series of questions, using them to build a list of best
hiring practices. Have teams or groups of students get together to compare answers and
add helpful suggestions to each other’s work. This assignment should be given at the end of
the chapter.
3. Interview Questions—Students are to write a list of questions they would ask if they were
hiring, and then evaluate their list. Have students write their interview questions
individually, and then work with a partner to use the questions to interview each other. The
person being interviewed should then provide constructive feedback to the interviewer.
Have partners switch with another duo and repeat the process.

7.7 YOU DECIDE: CASE STUDY Improving Diversity

1. What could Jessica do to enhance diversity recruiting?
Answers will vary. Students might say that Jessica could contact organizations or
employment agencies that specialize in placement of diverse candidates or she could
contact colleges or universities with a strongly diverse graduating class.
2. What should she do about current employees who may be interested in the new and
vacant positions?
Answers will vary. She may want to be honest and tell the employees that diversity is good
for the company so they are looking externally.

7.8 MANAGER’S TOOLKIT

The Chapter 7 Manager’s Toolkit asks students to do a job analysis for their dream job. Suggest
that after they complete the job description and matrix, they put the material away for a few
days, and then return to it with a fresh mind, making changes at that time.

7.9 SOFT SKILLS FOR SUCCESS

Chapter 7 focuses on multicultural and diversity skills. Students are asked to analyze their
ability to work on a diverse team. Assign this as an individual project that is to be done outside
of class. Assure students that their answers will not be read by anyone else, so they want to
provide an honest appraisal of themselves. This is an opportunity for students to look at
themselves, and possibly find areas in need of growth.

7.10 MISCELLANEOUS ACTIVITY

Application Search
Purpose: Students review a number of applications and determine key characteristics of a well-
prepared application.
Time: Allow 10 minutes to review and 10 minutes to debrief the activity.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 8
Procedure:
1. Prior to this class, ask students to bring an application form from work or download
applications from various websites. Well-written applications include Safeway, Starbucks,
and Renaissance Hotels among others.
2. Organize students into teams of three and hand each team an application.
3. Ask the students to review the application paying attention to style, the type of questions
asked (legal/illegal), readability, and anything unique about the application.
4. Call time after 5 minutes and have students switch their applications with another team.
5. Repeat step 3.
6. At the end of the activity, debrief the students with the following questions:
* What were two things you liked about each of the applications?
* What were two things you would change about your team's application? How?
* How is the eye appeal of the application? Does it represent the company in a positive
manner?
* Was there anything unique on the application? What made it different?

7.11 LEARN IT ON THE WEB

The purpose of this activity is to learn more about the Americans with Disabilities Act. Students
should review the following sites to answer the questions.
http://www.samhsa.gov/
http://www.eeoc.gov/facts/fs-ada.html
http://www.lowvision.org/american_disabilities_act.htm
http://consumerlawpage.com/brochure/disab.shtml
a. Who is protected under the ADA? What is “a physical or mental impairment that limits
one of life’s major activities”? List five examples of a physical impairments and five
examples of a mental impairment.
The ADA protects qualified individuals with disabilities. An individual with a disability is a
person who has a physical or mental impairment that substantially limits major life
activities; has a record of such impairment as documented by a physician; or is regarded as
having such impairment. Major life activities are functions such as caring for one's self,
performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and
working. Under the ADA, a qualified individual with a disability is an individual with a
disability who meets the essential eligibility requirements for receipt of services or
participation in programs or activities. Whether a particular condition constitutes a
disability within the meaning of the ADA requires a case-by-case determination.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 9
 Physical impairments include, but are not limited to: visual, speech, and hearing
impairments; cerebral palsy; epilepsy; muscular dystrophy; autoimmune diseases such as
multiple sclerosis, lupus, or scleroderma; orthopedic conditions; paralysis; cancer; heart
disease; diabetes; and contagious and non-contagious diseases such as tuberculosis and HIV
disease (whether symptomatic or asymptomatic). Mental impairments include, but are not
limited to: mental retardation, emotional illness, ADD, ADHD, and related learning
disabilities.
b. The text discusses the employer obligations to the ADA but the ADA also covers
accessibility of the business/public entity to the disabled individual. Discuss Title II and list
three ways an employer can increase accessibility to a client with disabilities.
Title II of the ADA prohibits discrimination against qualified individuals with disabilities on
the basis of disability in all programs, activities, and services of public entities. Public
entities include state and local governments and their departments and agencies. Title II
applies to all activities, services, and programs of a public entity. Employers can increase
accessibility by:
 Providing services, programs, and activities in the most integrated setting appropriate to
the needs of qualified individuals with disabilities.
 Making reasonable modifications in their policies, practices, and procedures to avoid
discrimination on the basis of disability unless they can demonstrate that a modification
would fundamentally alter the nature of their service, program, or activity.
 Ensuring that individuals with disabilities are not excluded from services, programs and
activities because buildings are inaccessible.
 Providing auxiliary aids to individuals with disabilities, at no additional cost, where
necessary to ensure effective communication with individuals with hearing, vision, or
speech impairments. (Auxiliary aids include such services or devices as: qualified
interpreters, assistive listening headsets, television captioning and decoders,
telecommunications devices for the deaf [TDDs], videotext displays, readers, taped
texts, brailed materials, and large print materials.)
c. Assume that your business was recently cited by your county as not disabled friendly. You
are asked to make your entrance wheelchair accessible. What do you do?
Work with your local county officials and learn what the wheelchair accessibility
requirements are because slope and angle vary from state-to-state. Meet with a contractor
and review options about ramp and handrail placement. Check with the IRS tax code as
some of the expenses may be tax deductible.
d. The county also cited you on your lack of disabled parking. You currently have 100 parking
spaces for your business; subsequently, by law, how many parking spaces must be
marked “handicapped?”
The business must provide a minimum of four handicapped spaces.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 10
e. True or False. Employees that currently abuse drugs or alcohol are covered under the
ADA. Please explain your answer in detail.
Employees who abuse drugs are not covered under the ADA and are specifically excluded.
An employer may take action against this employee as she/he is not a “qualified individual
with a disability.” Do note that the ADA is the minimum requirement and employers may
offer to cover substance abuse under their employee assistance programs. Although drug
users are not covered, alcoholics are protected if the employer acts on the basis of such
use. Employers may be required to provide accommodation to the employee (time off to
attend AA meetings); however, they may discipline or terminate the employee if she/he
continues to drink on the job or abandons their assistance programs.

Instructor's Manual for Administrative Management © 2015 Cengage Learning. All Rights Reserved. 11
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a small column of air, which, exercising an expansive force,
produces more or less explosive effect, that may be seen along the
bullet track or at the point of exit. These explosive effects are
proportionate to the size of the bullet, its bluntness, and its velocity.
This theory was more tenable in the days of large and blunt
projectiles than today, for in time past experiments have shown that
when a bullet is dropped into water from a height there is forced into
the water along with it a certain amount of air, estimated by
Longmore at twenty times the actual volume of the bullet itself. It
may be doubted, however, whether the rifle projectiles of today can
produce sufficient air pressure to cause the destructive effects thus
attributed to it.
 Fig. 47

a, completely shattered after perforating a horse’s thigh-bone at 220

yards; steel mantle stripped; b, ball with mantle torn off and rolled up, core
deformed, after shattering human tibia at 60 yards; c, wholly disorganized
ball, which destroyed middle metatarsal bone of horse at 660 yards, steel-
mantled; d, ball which shattered a human femur at about 750 yards, steel-
mantled; e, remains of steel mantle and part of core lodged in human
femur, wound inflicted at about 1100 yards; f, g, fragments of mantle found
near the orifice of the wound of exit at about 1100 yards’ range, steel-
mantled; h, piece of steel mantle split off by striking a dried horse’s
metatarsal at over 1300 yards; i, steel-mantled ball which perforated the
internal femoral condyle and lodged beneath the skin at nearly 2200
yards. (Recent foreign report.) (De Nancrède.)

Another method of accounting for shattering effects noted in many

of these wounds is hydrodynamic pressure, depending upon the
incompressibility of fluid and of tissue containing it, and the
narrowing of the space occupied by fluid as a result of the transfer of
pressure in all directions. Other things being equal, the most marked
effects would be manifest in organs containing the most fluid, the
effect increasing with the amount of fluid, the speed of the bullet, its
size, and any alteration of shape which it has undergone in transit. It
has been shown that the hydrodynamic pressure of steel-jacketed
modern bullets varies from six to eight atmospheres. This theory
accounts for the peculiar destructive effects seen in the brain, the
heart, the stomach, and intestines when struck at short range.
Another method of accounting for the results of a bullet wound
takes account of the peculiar effect due to the rapid rotation of the
bullet, the movement given it by the rifling of the barrel from which it
is fired. It appears that a bullet travelling at the rate of 620 meters
per second will average about four rotations per meter. Even in
passing through a human body this would scarcely give it but two
rotations in transit, while in passing through any given bone the force
would be too slight to be appreciable.
While the theories mentioned above, the hydraulic and
hydrodynamic, are attractive, yet they are unsatisfactory; we can do
little more than sum up the damage done by a rifle ball as due to
arrest and divergence of its energy, penetration depending upon its
remaining velocity, its preservation of its original shape, and the
resistance offered by the part injured. If the latter be great, and its
shape be but slightly changed, there are pronounced explosive
effects. Moreover, one end of the bullet is a little heavier than the
other, and this will tend to produce a certain amount of tilting, by
which a key-hole wound may be also produced. Fig. 47, from De
Nancrède, shows the many alterations in shape which may be
produced under various circumstances. Again, hard-metal jackets or
mantles may be stripped off bullets before the latter reach the body,
or in passing through it, as has been shown.
Bruns has shown that with the ordinary small arms the size of the
wounds of entrance and exit diminishes with the decrease in velocity
or increase of the distance, although allowance should be made for
the manner and angle at which the bullet strikes the surface, the
wound being circular or oval according to these conditions. The
wound of exit will depend upon the direction of the axis of the bullet
at the instant it leaves it; thus it may be oval or irregular. When the
bullet in transit shatters or comminutes a bone the wound of exit may
be made much larger and more ragged than otherwise. In a general
way Bruns makes the statement that, other things being equal, the
damage inflicted by the escape of a projectile from the body varies
according to distance from the weapon. Thus up to fifty meters a
considerable amount of destruction of muscle, etc., may be
produced. The area is small and the track of the bullet is smooth and
little larger than the caliber of the projectile. Between 100 and 300
meters there is little destruction of muscle, and the wound of exit is
smooth and may contain some bone debris. Thus Bruns would make
it appear that the distinguishable characteristics of near and distant
shots appear in the variations to be noted between the wounds of
entrance and exit.
After a careful study of the alterations in the shape of the bullets
themselves, Coler and Schjerning reported at the Twelfth
International Medical Congress that only in 4.5 per cent. of all hits
does deforming of the bullet occur; if hits in the bones only are
considered, the percentage would be much greater. In wounds of the
other parts alone there is rarely any deforming effect upon the
projectile. They also show that careful distinction must be made
between the deformity of the bullet caused by the body and that
resulting from impact upon some object before reaching the body.
Thus if a bullet have first struck a branch of a tree, or some object
upon the ground, it may have become so altered in shape as to
correspond almost to a Dumdum bullet. The harm done by such a
ricochet shot depends upon its unexpended energy and its altered
shape, but will always be greater than if it had struck in the direction
of its long axis.
The question of the heat imparted to a projectile in its course and
the possibility of its being sterilized by such heating are questions
which have been carefully investigated. The heat of a bullet
produced by penetration into a hard material will depend upon the
striking distance and the density of the material. In the human
tissues the heat attained by a bullet, even when penetrating a bone
at short range, is rarely 100°C., while at long range it will scarcely
amount to half of that. There is no accurate measure of the heat that
may be engendered in its passage through the atmosphere, but the
question is one of interest, in that it brings up the possible
sterilization of the bullet and its capacity for destroying such septic
material as it may carry in with it. A series of experiments made in
Baltimore and elsewhere permit the following conclusions to be
drawn:
1. The majority of cartridges in their original packages are free
from septic germs, this freedom being due to the precautions
observed during their manufacture.
2. As a result of this cleanliness the majority of gunshot wounds
are not septic.
3. Such resistant germs as those of anthrax, when applied to the
small bullet of a hand weapon, are rarely completely destroyed by
the act of firing, and it is possible to infect an experimental animal
with such a projectile.
4. The ordinary germs of suppuration are not always destroyed,
and may also cause infection.
These conclusions may be epitomized in these two statements:
that bullets from small hand weapons are not necessarily sterilized
by the act of firing, and that they also may infect.
The principal features to be noted in a case of gunshot wound are
the following:
1. Hemorrhage.
2. Shock.
3. Pain.
4. Powder burn.
5. Localizing symptoms.
6. Multiplicity of wounds.
7. Entrance of foreign material.
8. Explosive effects.
9. Perforation of large vessels and the viscera.
1. Hemorrhage.—Hemorrhage may be internal or external. When
internal it is rarely so accessible as to permit of
the saving of life, yet the effort should be made to ascertain the
source of the hemorrhage, as only in this way can life be saved. For
example: A patient may bleed to death from injury to an intercostal
artery, an epigastric, etc., while in either case a very simple
expedient would tend to save life. External hemorrhage is generally
due to injury of main vessels, and may end fatally unless first help be
instantly rendered. Since the introduction into the army of a trained
hospital corps, and a widespread diffusion of a knowledge of “first-
aid dressings,” this is much less likely to occur than in the days
previous to the use of the emergency packet. Recent military
experiences have been that hemorrhages from limb vessels are
much more likely to subside spontaneously than those of the viscera.
2. Shock.—Shock is present in a large proportion of gunshot
injuries, especially those of the viscera and the region of
the spine. Experienced army surgeons speak of the peculiar facial
expression in those cases of shock which demand immediate
attention.
3. Pain.—The symptom of pain is exceedingly variable. It is rarely
complained of at the time of infliction, especially when the
individual is laboring under stress of excitement. The pain of a
wound will be increased by every movement of the body. When
momentary pain is followed by local anesthesia, and especially if the
latter be permanent, it will indicate the division of a nerve trunk,
which will justify an operation for exposure of the site of the injury
and nerve suture.
4. Powder Burn.—Powder burn is met with only as one of the
complications of a short range and injury of an
exposed part. Its degree is modified by the distance of the injured
part from the muzzle, by the character of the powder, and the
dimensions of the barrel. Fish has shown that in a pistol wound at
short range the burning or scorching effects, which he calls the
“brand,” are always found on the hammer side of the weapon which
inflicted the wound, i. e., if the hammer were held up the brand would
be above the entrance wound. The bullet wound in such a case
shows the direction of the aim, but the recoil will so far change the
direction of the barrel as to divert the stream of gases of combustion,
so that they follow the new direction of the barrel, which is always
toward the side of the hammer. This is a point in medical
jurisprudence which has been testified to in the courts. The use of
smokeless powder minimizes any effect of this kind. It has been
claimed that a homicide has been recognized in the dark by the flash
of the old-fashioned gunpowder used in the weapon, but the use of
smokeless powder would obviate this possibility. The most distinctive
part of a powder burn is the appearance of the tattooing caused by
the lodgement under the skin of grains of unconsumed powder. Such
grains, when accidentally or purposely contaminated with germs, are
not purified by the act of firing. This is less true of certain brands of
smokeless powder. Nevertheless the opinion prevails that
gunpowder may serve for conveyance of infection. The so-called
smokeless powders are of secret composition, although it is known
that in a general way they are composed of gun-cotton, dynamite
(i. e., nitroglycerin), or picric acid. Melinite is composed of picric acid
and collodium—i. e., gun-cotton. There are many of the modern
explosives which depend for their final effect upon the combination
of two or more substances. In the smokeless powers there is usually
enough nitroglycerin to have a very noticeable effect should they be
touched to the tongue, while even the fumes might be disagreeable
or disabling.
5. Localizing Symptoms Due to the Presence of the Bullet.—
The
greater the distance and the smaller the velocity the more likely is a
bullet to lodge within some portion of the body instead of passing
through it. In the Cuban campaign the proportion of cases of
lodgement was less than 10 per cent. of the entire number of bullet
wounds. A bullet which rests within the body either will or will not
produce disturbances which may be more or less lasting. In a large
proportion of cases the latter will prevail. The number of pensioned
soldiers who are carrying unremoved bullets in some portions of their
body is by no means small. A rifle bullet may remain in certain
portions of the cranium without producing much disturbance. Bullets
which cause no trouble are best left undisturbed. Those which
produce serious symptoms should be removed. To Esmarch is
attributed the dictum that the harm produced by a bullet is usually
done during its passage, and after it has found lodgement it ceases
to be a source of trouble. While not invariably true, this is so
generally the case that acceptance of this statement has
revolutionized the previously prevailing view, i. e., that a bullet should
be always removed if it be possible to locate and extract it. In some
instances it may be located by a study of the symptoms; as, for
instance, in certain areas of the brain, or when lying in close
proximity to joint surfaces it interferes with their function; although a
bullet embedded in bone often does not seriously interfere with the
use of the affected part. The bullet which divides a nerve trunk rarely
lodges in such position as to be considered when the repair of the
nerve injury is undertaken; such wounds will generally be found to be
perforating.
 Fig. 48

Multiple shot wounds of arms and back. The ulcer over the spine was produced by
pressure, not by the ball (case in Cincinnati Hospital, 1884). (Conner, Dennis’
System of Surgery.)

6. Multiple Wounds.—The same bullet may sometimes inflict

multiple wounds, and, with modern
projectiles, these are now more common, as many as six wounds
having been made by one missile in its passage, e. g., wounds of the
arm and body. Thus multiplicity of wounds may not indicate that the
patient has really been shot more than once. In cases of perforation,
for each wound of entrance there should be found one of exit, and at
the first examination of the patient the discovery and consideration of
each of these injuries should be part of the routine. If on examination
but one wound be discovered, then the inference is natural and
unavoidable that the bullet is still within the patient’s body (Fig. 48).
7. Entrance of Foreign Material.—The entrance of fragments of
cloth or other extraneous matter
is now less frequent, for bullets of tremendous velocity rarely carry in
any perceptible material, their diameter being small and their
surfaces polished. A ricochet bullet may carry tetanus or other
spores from the earth, and lockjaw may be the result. In other words,
gunshot wounds now are less likely to become infected wounds than
they were years ago.
8. Explosive Effects.—The shattering and explosive effects of the
impact of bullets upon certain of the viscera
are sometimes disastrous, and yet not easily seen from the outside.
This is especially true in the brain, heart, liver, spleen, kidneys, and
bones. Almost complete pulpification of the semisolid viscera may
occur as the result of perforation by a small missile, and the general
condition of the patient should be relied upon to indicate this fact.
9. Perforation of the Large Cavities of the Body usually implies
perforation of at
least a portion of their contained viscera. Thus if a man be shot
through the chest it may be assumed that perforation of the lung has
occurred, while in a case of bullet wound of the abdomen it will rarely
be found that the viscera, especially the intestines, have escaped
perforation. Still, remarkable cases are occasionally recorded. Thus I
have seen a man who had been shot through the abdomen from
front to back, the bullet entering just above the pubis and escaping
near the lumbar spine, who never seemed to have suffered seriously
from his injury, although the bullet was a large soft one from the old
Springfield musket.
Diagnosis.—More or less characteristic appearances pertain to
most wounds of entrance and of exit, which render
them reasonably distinct and recognizable, even though no history
be obtained. Nevertheless much depends upon distance, velocity,
and any deformation of the bullet due to its impact upon some other
substance previous to its entering the body. An elongated wound
may suggest that the direction of the bullet was at an angle with the
surface struck. Such wounds are known as “key-hole” wounds. A
bullet already deformed may inflict a wound that will baffle
speculation. The wound of exit is usually a little larger than that of
entrance. When much larger a bone lesion should be expected.
Trifling punctures, perhaps made by particles of the bullet, may be
found around the principal wound or in the bone which it has
shattered.
Diagnosis may include a recognition not merely of the general
character of the injury, but whether it was inflicted by one or more
bullets; whether these bullets have escaped; and if not, in what part
they are probably lodged. In the preantiseptic days much of this
information was gathered by the use of the probe, and the porcelain-
tipped probe devised by Nélaton was relied on for much more than it
could possibly safely tell. In those days probing was indiscriminately
practised, and accomplished more harm than good. Now the probe
is rarely used, at least at first, and when used, it is connected with
some electrical device by which results are attained with a minimum
of handling. For this purpose the telephone probe of Girdner was
formerly a popular and ingenious device, which has been more
recently supplanted by a simpler mechanism by which, when the end
of the probe comes in contact with metal, a little bell, or buzzer, is
rung. No probe or other instrument should be introduced into a
gunshot wound, for diagnostic or other purposes, without observing
aseptic precautions.
The most valuable expedient for the detection and location of
bullets, as of other foreign bodies, is the Röntgen ray. With a suitable
apparatus of this kind the surgeon can not only decide as to the
location of the missile, but whether it is best to attempt an operation
for its removal.
Prognosis.—In gunshot wounds not speedily fatal the prognosis
depends upon the part injured, the size and shape of
the missile, its velocity, the distance from the weapon, the amount of
blood lost before attention was given, the character of the attention
first received, and the absence of such complications as exposure,
rough handling, etc. The dictum that the fate of a wounded man is in
the hands of the surgeon who first attends him made its author,
Esmarch, famous. The patient having escaped the dangers of
hemorrhage and shock is to be carefully guarded from sepsis, and if
thus guarded can be protected against most of the other visible
dangers save those due to perforations of large cavities. If, therefore,
a gunshot wound can be promptly provided with a primary aseptic or
antiseptic dressing, and in other respects be let alone, the outlook for
the patient will be encouraging. The prognosis often depends upon
how completely the patient is let alone after the application of
occlusive dressing.
Treatment.—Hemorrhage is the first consideration, and should be
the first care of the surgeon. Digital pressure may be
resorted to, which may suffice until a temporary expedient has been
supplied. Next in importance is disinfection of the area surrounding
the wound and the application of a sterilized absorbent dressing,
with pressure to prevent loss of blood. The use of the probe, or any
attempt to at once ascertain the location of the bullet, is not
advisable. The question is not, “Where is the bullet?” but, “How
much harm has it already done?” And the first attention should be
addressed to atoning for any harm that may have been done. Even
though the intestines have been perforated, or the heart wounded,
there is no need in doing anything more than meeting the immediate
emergency. If shock be extreme it may be atoned for in some
measure by lowering the head and bandaging the extremities; while
in extreme cases hypodermoclysis or venous infusion of saline
solution, often with the addition of a little adrenalin, will be of service.
Again, physiological rest of the part injured, i. e., immobilization, as
well as absolute rest of the patient’s body and mind, must not be
neglected.
Primary laparotomy has been done upon the battle-field, and is of
itself a testimony to the intrepidity and zeal of those who have done
it; yet, as a practice, it is to be condemned. All operations upon
gunshot wounds should be done in a well-equipped hospital.
 Fig. 49

Gunshot wound of forearm. Bullet in situ in bone.

The probing of bullet wounds is so unwise that it may be well to

state the reasons for its general condemnation:
1. As it used to be practised, neither probe nor skin nor the
operator’s hands were sterilized.
2. Even when carefully done it is often absolutely disappointing,
the probe failing to reveal the presence of the bullet.
3. By the time the probe is introduced the wound will be usually
more or less filled with blood clot. To stir this with a probe is to invite
a secondary hemorrhage or annoying oozing.
4. Even when properly used the probe may carry in infectious
material from the surface.
 5. Most wounds made by modern bullets, even pistol bullets, are
of such a character that it is difficult to follow their track without using
force.
6. I have known a wound on the anterior surface of the body to be
probed for a bullet that had escaped, as shown by an examination of
the other side of the body, which the attendants had failed to search.
7. If there be good reason for exploration of a wound let it be
postponed until the surgeon is prepared to follow a bullet and extract
it. When it does not call for extraction, it does not call for probing.
8. The best probe is the surgeon’s finger, and for its use the
patient generally requires an anesthetic and free incision.
When muscle is torn and needs suturing, or when tendons or
nerves are divided and need the same resource; when bones are
shattered and fragments need to be removed; when the skull has
been fractured and portions of bone driven into or upon the brain;
when the intestines have been perforated; when even the heart has
been wounded and the pericardium is filling with blood so that the
heart’s action is becoming impeded; in any or all of these
emergencies the patient needs surgical relief. But this should be of a
kind that, save in an emergency, should be postponed until suitable
preparation can be afforded.
 Fig. 50 Fig. 51

Wound inflicted at 1300 Shattering of humerus at long range with modern

yards by steel-mantled projectile; fusible metal cast showing extent and
ball (from a recent character of laceration of soft parts (from a recent foreign
foreign report). (De report).
Nancrède.)
 In regard to regional indications in the treatment of gunshot
wounds it will only be possible here to give some brief general hints,
the reader being referred to the chapters on Regional Surgery for
more specific instructions. Nearly all gunshot wounds of bones are
compound fractures, and are comminuted as well. The best
treatment is primary aseptic occlusion and immobilization, without
effort in the direction of exploration. In an open wound the vessels
should be secured, loose pieces of bone removed, and jagged bone
ends trimmed; while in some instances a wire suture or other
mechanical expedient may be resorted to with advantage. Provision
should also be made for drainage.
In the regions of the large joints the same general principles are
applicable. Under the old regime a gunshot wound of the knee would
condemn a person to amputation in the middle of the thigh. Now, if
such a limb be promptly provided with suitable antiseptic dressing,
and placed at rest, the patient may save not only the limb, but the
use of the joint. Extensive comminution may call for excision.
Amputation is seldom necessary, except when important
bloodvessels have been divided.
 Fig. 52

Perforating bullet wound of head, wound of exit showing brain protrusion.

Sloughing pressure-sore of scalp. Complete paralysis of motion and loss of
speech. Battle of Mukden. (Major Charles Lynch.)
 Fig. 53

Perforating bullet wound of head, with prolapse of brain at wound of entrance.

Operation done in Russian Red Cross Hospital at Mukden. Left hemiplegia; mind
clear. (Major Charles Lynch.)
 PLATE XIII

Radiograph of Head viewed from the Left Side,

showing Mauser Bullet Lodged in Brain. (Surgeon-
General’s Report on Use of Röntgen Ray, 1900.)
 Fig. 54

Perforating gunshot wound of head; two wounds converted into one by removal of
comminuted bone. From Russian Red Cross Hospital, Mukden. (Major Charles
Lynch.)