Resection of the shoulder joint : remarks upon the cases of six invalids, admitted during the year 1864, at the Royal Victoria Hospital, upon whom resection of the shoulder-joint had been performed in New Zealand for gunshot injuries / by T. Longmore.

  • Longmore, Sir Thomas, 1816-1895.
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Resection of the shoulder joint : remarks upon the cases of six invalids, admitted during the year 1864, at the Royal Victoria Hospital, upon whom resection of the shoulder-joint had been performed in New Zealand for gunshot injuries / by T. Longmore. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    subsequently, was a mistake ; the supposed foreign body may, perhaps, have been a fragment of bone. Dr. Melladew writes from the Queen's Redoubt Hospital, on February the 24th, 1864:— The subsequent progress of this case has been satisfactory on the whole, though there have been, from time to time, abscesses and constitutional disturbance, owing to the detach- ment of small splinters and comminuted pieces of bone due to the original injury. The operation wound has gradually filled up and is now closed, excepting a part not more than one inch and a half in extent corresponding with the situation of the wound of entrance. From this opening there still exudes a Uttle healthy pus, and as the edges are fungoid, it is probable that more splinters are yet to come away. A second opening exists in the anterior boundary of the axilla from which a little pus comes away ; it was made with the knife in searching for the bullet which was thought to be pre- senting there. The man's general health is at present very good. The con- dition of the long head of the biceps muscle is not mentioned in any of the reports of this case. When this patient was admitted into the Royal Victoria Hospital on July the 20th, 1864, he was suffering greatly from pain and swelling of the injured arm, and from much constitutional disturbance. On examination, a large collection of matter was found to be occupying the situation of the cavity left by the resection and its neighbourhood. This was due to a fall he had on board ship about three weeks before he landed. He had slipped and fallen on his left side, and the weight of his body was brought to bear upon the elbow of the injured arm as it lay secured against the side of his chest. As soon as the patient had been put to bed and had properly rested, the abcess was opened, and ten ounces of pus were evacuated. This was rapidly followed by relief of all the patient's general symptoms. Shortly after admission also the wound of entrance of the bullet reopened, and the probe detected a sinus extending downwards and backwards with some rough bone at its extremity. No loosened sequestra were, however, found. The bullet still remained lodged, and careful exanination for a long time led to no discovery of the site of lodgment. It was ascertained that the man's left arm was elevated iu the act of supporting his rifle whilst he was aiming, when he was struck by the bullet, which was fired from above and in front of the position where he was standing. According to the patient's statement the exploratory incision made on the pectoral wall of the axillary triangle was employed to evacuate an abscess and not to search for the ball, as stated in the abstract sent from New Zealand. This opening was not yet closed when the patient arrived at Netley, but had left a sinus whose orifice was on the inner wall of the chest two inches below the apex of the axillary space. When a probe was passed along this sinus, its progress seemed to be arrested by contact with indurated cellular and muscular tissues at a few inches distance from the orifice. The direction in which it passed most easily was backwards and downwards. Between the papilla at the opening of the sinus, and the axillary border of the scapula an extensively diffused swelling was found to exist over the wall of the chest, and, judging from the direction from which the ball was fired, the situation of the wound of entrance, the position of the patient's arm when he was struck, with the fact that the ball could not be discovered at the time of operation, there seemed no doubt but that this swelling was in some way due to the presence of the projectile. Occasional efforts were therefore made in this direction for the discovery of the projectile, and, at last, in September, a probe came into contact with it lying beneath the scapula on its pectoral aspect, and at a short distance above its inferior angle. A scale of lead was at first brought away by a pair of bullet forceps along the sinus, and through the opening at the margin of the axilla. The bullet itself was then grasped, but could not be extracted. Various kinds of extractors were employed, but with no success ; the bullet appeared to be brought forward for a limited distance, and then to meet with some obstaclOj which could not be overcome without using an unjustifiable amount of violence. The attempts at withdrawing it by the sinus were then abandoned ; and sub- sequently an incision was made immediately below the lower angle of the scapula, and by passing the finger upwards, after some little effort it was removed. The difficulty which had been previously experienced was at onco
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