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.

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    application of leeches oi' by an incision piercing the fascia. As regards such incisions most modern surgeons are sufficiently enterprising; yet as regards the allowing matter to be discharged, I have found the most prejudicial ■timidity is the fashion. Instead of favoring the escape of pus by a.suitable position of the part, and incisions and bandages to correspond, the wound is shut up immediately with a pledget of smooth charpie and strips of adhe- sive plaster, above this a compress and bandage, so that frequently notliing can flow away, and on the dressing being removed in twenty-four hours, a full stream of matter rushes out. Now comes the pressing and squeezing around to force out the last drop of matter,—many taking the limb between their hands and squeezing it as they would a lemon. Let this treatment be con- tinued only some days, and the pus, at first mild, scentless and yellow, becomes acrid, greenish and f&tid. As usual, one fault introduces another; a com- pressing bandage is now made use of; from this I have never seen the least use, but often the greatest disadvantage, as it retains the' pus rather than forces it out. Wlien this also proves useless, the next step is to use in- .jections, generally of lunar caustic, sometimes of camomile tea, chlorine water or decoction of cinchona, on purpose to improve the quality of the discharge; this is only become acrid because its escape was not free, and it becomes no better from, the presence- of such injections, a part of which always remains behind in the wound,—the most harmless indeed are warm water injections, without, however, attaining the desired object. It is heartily to be wished that the German surgeon should at last free himself from such quack-pro- ceedings, for which the patients thank him but little, as the daily-repeated expression of the matter is far more painful and oiFensive than a suitable incision; I have often heard the patient say, the cutting is nothing, but the squeezing is unbearable. When an obstinate discharge is treated by dilatation or by fresh incisions wjiere, through improper treatment, the suppm'ation is become profuse and of bad quality, the quantity becomes instantly less, the quahty improves, and the general state rises in tone. The fearful Sinking of matter can alone be preven- ted by the means I have mentioned. I have had opportunity to observe during the campaign that there are two forms of sinking of matter of which one alone merits this name though both are so entitled. The true sinking of matter [Burrowing of matter] consists in the pus formed in one spot sinking according to gravity in the cellular tissue, usually under the fascia— partly in- filtrating the cellular tissue,—partly forcing it aside and thus forming large cavities. The second kind consists of new inflammatory processes wherein the part s^\ ells, hardens but later fluctuates, if this be opened early no pus is visi- ble but serum or a gelatinous mass, yet these cavities filled with serum stand in connection with the chief focus of suppuration so that occasionally the finger may be passed from the serous into the suppurating cavity. It seems that in these cases the pus-serum had infiltrated under the fascia, causing an acute inflammatory process excited through the acridity of the secretion, while in the true sinking of matter the pus extends itself without causing inflammatory swell- ings in its path. Only after some days, and after the application of poultices, the incision iji the serum-filled cavity commences to yield pus, and to serve as issue for the chief collection. In practice, the difiference of the two kinds of burrowing of pus is a matter of importance,—the true one requires imme- diately a sufiicient counter-opening; in the inflammatory form, however, leeches are sometimes able to prevent the further formation of purulent foci.