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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    more especially in our hedge and ditch country, to give proper attendance to individuals, at the same time that certain bodies of troops were compelled. to retreat. The phenomena accompanying comminution of a large bone are those of severe concussion of the limb. I have already explained how the soft parts are crushed by the violent flying apart of the pieces of bone. In consequence of this, more or less hfemorrhage occurs in the cellular tissue of the surrounding soft parts. The sheaths of the vessels and nerves are especially the seat ot hsemorrhagic effusion. Lessened sensibility [benumbing] is the next result from contusion and compression of the nervous trunks, and the same cause acting on the veins, the circulation is slackened and passive congestion arises, shortly followed by copious serous infiltration in the tissues. This Serous Infiltration forms a white, doughy, painless swelling, which at first only occurs opposite the injured part of the bone. A bandage quickly and well applied and by which the whole limb is enveloped, and the applica- tion of splints or straw pads (straw splints) to check the motion of the fi'agments of bone as far as practicable, may contribute much to check or prevent this Berous infiltration. If such a bandage cannot be applied, the transport of the wounded exerts the most hurtful agency on these injm'ies. Eveiy jolt of the waggon causes severe pain, the muscles are thrown into spasmodic action, so as to drive the sharp points of bone again and again into the soft parts. It is especially hurtful if a careless surgeon has applied a single or a few turns of a bandage or indeed a tourniquet firmly around the injured spot for fear of haemorrhage. The congestion and effusion increases more and more, so that on arrival at the hospital, the bandage may be buried in the swollen limb. Such a mistake is stiU worse should lai'ge vessels, especially veins, be wounded, the hjemorrhage is aided, not checked, and distends the whole limb, as the outer wound is closed; it forms a firm swelling, the skin over which is at first pale and cool but soon becomes of a spotted, dirty, brownish color in the course of the veins, later blebs appear on these spots, containing dark red scrum. This Bloody Infiltration generally results in mortification, if it is impossible to remove a portion of the stagnant fluids by suitable treatment, and thus to restore the circulation. On dissection of such limbs, thick layers of black, coagulated blood are found in the cellular tissue, under the skin, between the muscles and within the sheaths of the vessels and nerves. Of course where no blood is found the distension has been due to serous efiusion. b. Influence of Hospital Air on the Wound. It is well known that in hospitals where suppurating wounds Lave been long imder treatment^ and where ventilation has not been properly attended to— that miasma developes itself and exerts a noxious agency on the wounds. Those wounds complicated with injuries to bone are especially subject to this influence, and in such cases phlebitis resulting in pyaemia with generally a fatal termination may readily occur in wounds of apparently a slight character. If the hospital air is very foul, hospital gangrene is set up, it is contagious, aff'feeting the merest wound and often proving rapidly fatal. In the Schleswig- Holstein campaigns we have happily never experienced this evil,— pyaemia, however, was very fatal, especially in those sick-houses which had been re-