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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    become lax, the local symptoms improved, but the patient died from abscesses in the hmga. Gun-shot Injuries of the Hand. Injuries of the second row of carpal bones are far less dangerous than those of the first range, yet by negligent treatment they may have equally unfavora- ble consequences. My pupils at Freiburg will remember the fortunate cure of a Russian tailor, who having fought in the squadron of Herwegh, received a bullet through the second row of carpal bones and yet recovered without the least interference with the motion of the hand. Still less dangerous are the injuries of the metacarpal bones, whether one or many are shattered. I have met with a case where a bullet had transversely traversed and broken the metacarpal bones of the four fingers, where neverthe- less the hand was preserved and in completely useful condition. The healing occurs with some shortening of the metacarpal bones, the slight discharge of sequestra being very striking; all operative interference should be unthought of. Gun-shot injuries of the fingers are very frequently met with;—in many cases exarticulation of the injured finger was at once performed with good re- sult,—on the other hand all exarticulation of the fingers which were performed after an interval of forty-eight hours, were followed by very violent inflamma- tion, obstinate suppuration and not unfrequently by stiffness of many fingers or of the whole hand. In accordance with my formerly expressed principles [If the operation cannot be performed before inflammation has set in, the full de- velopment of suppuration must be waited for. ] I have not performed or encou- raged the performance of exarticulation of the fingers in the field, and have thus avoided the inflammatoiy accidents which are consequent upon operations of this kind when performed too late. I have never seen tetanus arise in theso injuries. In all injuries of the hand a splint must be employed, and poultices are earli- er indicated and must be longer continued, than in other parts of the body. Local baths may be very readily applied and with great advantage in these cases, as well as in injuries of the fore-arm,— they may be employed sooner in the hand than in the arm. Gun-shot Injuries of the Pemur. Among these the most dangerous are the injuries of the head, the neck and the neighbourhood of the trochanters. In one such case, death followed rapid- ly with symptoms of pyaemia, in two others— after protracted suffering. In a fourth case I)r H. Schwartz performed resection under my direction,—the bul- let had penetrated anterior to the trochanter major and passed obliquely in- wards, the sufferings of the patient were excessive and the suppuration so free, that it was probable that the hip-joint was involved. The operation consisted in making even the lower fragment with the saw and in exarticulating the upper one,—it was neither difficult of execution nor attended by haemorrhage, jet after some days the patient died of pyaemia and on the autopsy it M'as found that a part of the iscliium had been shattered by the bullet. I could never decide in favour of exarticulation of the hip in these cases, expecting indeed nothing from it, as the result of amputation of the thigh had already proved so unfavorable. I should in any case, as Oppeuheim, give the preference to resection, and that aftpr the occurrence of suppuration, because