On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer.
- Louis Stromeyer
- Date:
- 1860
Licence: Public Domain Mark
Credit: On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![suppuration and moderate its severity so much by the strictest antiphlogistica, that, at first, the progress of such a case, may appear to give the best promise, but, Uttle by little, the process extends to the whole joint; the suppuration breaks tlirough the capsule above and belowj the thigh and leg are traversed by purulent sinuses, and even amputation, undertaken at this late period, affords little hope of saving life. Larry, indeed, Chirm-gische Klinik, states that, he healed numerous cases, even when the bone was injured, by means of quiet position, strict antiphlogistic treatment, pressing out and drawing out by a syringe [?] the fluid from the joint, complete closure of the wound, &c. However, he remarks in the same work, In wounds of the knee-joint, with comminution of the femur, amputation must be performed. In the same way, Guthrie states— Gun-shot Wounds of the Extremilies :—Every gun- shot wound of the knee-joint, when one or both epiphyses are struck, require immediate amputation. He has not seen a single case recover without removal of the limb. Further on he says— In slight wounds of the patella, the attempt may be made to save the limb, so, also, if only the capsule is injm'ed, and this to a slight degree. In such cases, the wound of the capsule some- times heals quickly, and yet amputation is later demanded. He considers the strongest antiphlogistics required in all such cases, and poultices the surest means to obviate the necessity of amputation. We can well subscribe to the opinions of this excellent author. We have also observed that injuries of the patella may give good hope of presei-ving the limb. In the year 1848, a Prussian soldier recovered with anchylosis of the knee-joint, in a Flensburg hospital, in whom tbe bullet had entirely comminuted the patella, and who expressed himself with the strongest determination against amputation of the thigh. In the year 1850, we had a remarkable case of injury of the patella, in which life and limb were similarly preserved. A conical bullet had struck the anterior surface of the patella obhquely, and caused a prolonged lacerated wound, as that of a grazing-shot. The surgeon in attendance, judging from the appearance of the wound, had made no special examination, and the external wound soon healed by simple cold-water dressing. Little by little, however, chronic inflammation came on, with dropsical distension of the joint, and gradual weakening of its ligamen- tous structures, so that, at last, by contraction of the flexor muscles, incom- plete luxation of the tibia flexed on the thigh took place backwards. It was later found that a piece of the bullet was lodging in the patella, it was removed with some difficulty by incision. The bullet had evidently been split, after it had penetrated the patella, the larger portion had then passed on, as often observed in the cranial bones. The flexion, with partial luxation of the knee was gradually removed by Stromeyer's Extension-machine. Hennen, also, relates, in liis Principles of Military Surgery, two cases of recovery after comminution of the patella. In one of them he had bled the patient, in all, to 235 ounces of blood, and had ordered him so little diet, that he thinks, in comparison, Valsalva's dietary was immoderate. Amputation of the thigh was so fatal in our campaigns, that, latterly we were most unwilling to perform this operation. Of 128 patients, in .whom the thigh was amputated, in the three campaigns, 77 died, but 51 recovered. Almost all those operations proved fatal, in which a considerable infiltration of the soft parts was already present at the operation,—the number of these was not small, as the wounded were, partly, brought to the hospital by long](https://iiif.wellcomecollection.org/image/b21079432_0113.jp2/full/800%2C/0/default.jpg)
