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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    The Diet of such -wounded must of course correspond to 'tlie antiphlogistic treatment, consisting of cooling drinks, water-soup [a kind of thin gruel], and a little bread, perhaps for many weeks. Possibly it is superfluous to mention this, but I have unfortunately found that many medical men do not trouble themselves in the least about what their patients eat and drink, or consider it of no impoi-tance. I have seen numberless times that the patients received roast or broiled meat, as soon as tliey had the least appetite again. Fre<juently the patients think that they must have something nourishing throughout to support their strength, they eat therefore what is given them without having appetite for it. It was well worthy of remark, that this unsuitable diet seldom caused indigestion, but it certainly contributed to keeping up the suppuration and in- flammatory accidents, as in many patients a diminution of the suppuration at once followed, after I had put them upon vegetable diet. I recommend there- fore in the most urgent manner a greater severity in dieting, and so much the more as later — the dangers of the first week being happily passed by — a more nutritious diet affords so much the better service. Further Progress of Gun-shot Wounds. In favorable cases the inflammatory accidents are not severe, or become rapidly milder. Suppuration lessens, sequestra, which through sticking pain in the vfound, and by slight bleeding of the granulations, are known to be entirely free, are sought for and removed,—with the matter the fragments of clothes which had been driven before the bullet are discharged, and are care- fully collected by the patient, who thus reckons what may remain. The last piece having come to sight, the suppuration lessens decidedly, yet the wound still remains open, as tertiary sequestra have to be separated in many cases. Many surgeons, if they feel necrosed bone with the probe, now commit the fault of forcibly attempting to keep the wound open, until the sequestra are loose. Fortunately sponge-tents were not at hand, but in their place I found many plugs of considerable length forced into the wound. Their action is entirely prejudicial, they hinder the escape of matter, keep up the inflammation, cause unnecessary pain and generally fail in their object, as the dilatation of the wound by the knife for the extraction of large fragments, still cannot be dispensed with, and small ones escape of their own accord. I have frequently seen that the track of the wound closed shortly after the removal of the tent, although necrosed bone could be felt, — this is explained by the necrosis affect- ing but a very thin layer, which escapes in minute particles. Among the dangers threatening the patient labouring under gun-shot in- juries of the bones, pyaemia stands foremost. It occurs especially—lat, in such wounded who must be transported far; 2nd, in those who with fresh wounds have been admitted into hospitals, which had been filled with wounded from previous battles, and still contain patients with suppurating wounds. It also seemed that more pysemic cases occurred in hospitals, which, besides having been employed for cases of other internal disease, had also received typhus pa- tients. 3rd, Surgical operations, in which the medullary canal of the bone is exposed to the influences of air and matter, seem to favour the disposition to pyaemia. Hence it has been very frequent after resection of bones in their continuity in 1848, and after amputation as well in the present, as in the past year. In many cases this began, as it were in an acute form, for it appeared on the fifth or sixth day by shivering fits, jaundice, retching and bilious vomit- ing anA soon ended fatally. Generally, however, it occurred first after many