On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer.

  • Louis Stromeyer
Date:
1860
Catalogue details

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.

    21/144 (page 5)
    easier to recognise than simple iractiires. However experience has taught me that in this respect more errors than right diagnoses are made. The cause of this is, that the majority of surgeons employ for the examination of gun-shot wounds— not their fingers— but the probe, with which in fact nothing can ba properly felt. It would be by no means improper, to deprive military surgeons of their probes in the commencement of the campaign, in order to lead them to use their fingers for probing womids. I do notremember having used any other,probe than the director [ German, grooved probe ] during the whole cam- paign. Another difficulty exists in the character itself of these fi'actures,—for while in ordinary fractures a complete division of the periosteum takes place, tills is frequently preserved in its greater extent in gim-shot wounds, and often hinds together the fragments so thoroughly, that no displacement of them fol- lows and the form of tlie bone is retained. Thus I have seen complete crushing of the upper end of the ulna into the joint, in wliich no deformity occurred and the patient could perform all the usual movements. Even in examination by the finger it is easy to be deceived, if the examination is not conducted in the very spot where the shot had entered, and from the bullet changing its course after striking the bone, the finger may follow the track formed in the soft parts without attending to the injured bone. The longer the track is, the more dif- ficult are these examinations, hence many injixries of the bones are fii'st known by their consequences. Prognosis in Gun-shol lajmies of Bones. It cannot be forgotten that gun-shot wounds accompanied with injury to the bone, are much more dangerous than those not complicated in this manner. Indeed the first effect of the wound is much more severe if the bone has been struck,— for when a bullet merely pierces the soft parts, very often the flowing blood first shows the patient that ho is wounded,— should however a bone be struck, the patient is thrown to the ground, as it were torn away from the place or carried round in a circle; while the usual phcenomena appear of a shock to the whole nervous system viz; syncope, coldness, pallor and a small, quick pulse persisting for a longer or shorter timo after the reception of the injury. This shock is probably not without influence on the fm-ther course of the case. By a greater size of the injured bone, the more extensive is its injury and the nearer this is to the ti-unk, so much the more guarded must be the progno- sis. The irritation of the soft parts by the broken ends of the bone is of the greatest influence on the subsequent inflammation, so that there is an important difference in the course of the case should one bone be broken or both of them, — while in the latter the moat serious inflammatory symptoms occur— the for- mer runs its coiu-se with merely local sjonptoms, except in such cases where the sphntcring extends very far. These observations are of the utmost importance for the treatment of such cases, as we sec that the injury to the bone is not the cause of the violent inflammation, but that this arises from the initation of the soft parts by the sharp fragments of bone thrust out of their position either by external violence or by the muscles of the Mmb. For treatment of individual cases of this kind, these remarks remain in their full force, but in hospitals where the pysemic contagion developcs itself, the in- jured bones experience a far greater danger— one entirely independent of the irritation caused by the fragments. Experience has taught me,'that it is espe- cially those gun-shot wounds with injury to the bone which end fatally by pyse- mia. The nearer to the trunk the bones of the extremities are injui-ed so much