A practical treatise on fractures and dislocations / by Lewis A. Stimson.
- Lewis Atterbury Stimson
- Date:
- 1905
Licence: Public Domain Mark
Credit: A practical treatise on fractures and dislocations / by Lewis A. Stimson. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![or disease by its prompt appearance. In the less severe cases some- thing may be gained by massage, electricity, and persistent eiForts to straighten the lingers. Suppuration in simple fractures is very rare, and when it occurs it appears to be due to auto-infection, by germs carried by the blood and possibly brought from some suppurating focus in a distant portion of the body, as a furuncle; rough handling of the broken limb and neglect of proper care apparently favor its occurrence. It promptly makes the fracture compound by spontaneous or surgical opening, and the course and prognosis are then those of an open infected fracture. Suppuration in compound fractures can generally be prevented or restricted to the superficial layers when the wound is small and its edges not contused, as is ordinarily the case in fractures by indirect violence. The later its appearance, the less likely is it to sjjread widely amono^ the muscles and endaus^er life. In compound fracture with bruising and extensive laceration, sup- puration may remain as a local complication, the pus escaping freely to the exterior and the infection not spreading; the graver cases will be considered in the following section. Early General Complications. Septicasmia. This grave complication occurs in compound fractures and in simple ones followed by gangrene of the limb or suppuration at the seat of fracture. The most prompt, rapid, and fatal forms are seen in compound fractures accompanied by much bruising and lacera- tion of the soft parts and in those patients whose vitality has been lowered by alcoholism, disease, or age. A dusky-brown tinge discolors the skin about the wound and spreads rapidly upward, especially on the sides and back of the limb; the torn muscles become gray and less moist, an offensive odor appears and grows rapidly more marked, and a thin offensive discharge escapes at the surface of the wound and can be pressed out from its recesses. The limb swells far above the fracture, the temperature rises, the patient becomes apathetic and slightly delirious. Occasionally pressure with the fingers upon the discolored skin ])rovokes the slight crackle of emphysema, evidence of decomposition with production of gas, and, if well marked, strongly suggestive of the presence of one of the most rapidly fatal infections known, that of the vibrion septique of Pasteur, or the bacillus capsulatus aerogenes (Welch), the germ of acute gangrenous septiceemia. Amputation alone, with vigorous disinfection of the stump and of the subcutaneous tissue throughout the discolored area, can save life, and that only in so small a proportion of the cases that no one can be blamed for declining to resort to it. The peroxide of hydrogen appears to be a valuable antiseptic in these cases; it can be forced under the skin with a syringe or through incisions which will serve also for drainage. I have never known a case in which the septic vibrio was present to recover, although I have heard of one or two; in a few cases in which the early symptoms indicated its presence I have changed the diagnosis because the patient did not fail so rapidly as I anticipated,](https://iiif.wellcomecollection.org/image/b2120648x_0088.jp2/full/800%2C/0/default.jpg)
