On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer.
- Louis Stromeyer
- Date:
- 1860
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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![took place. If the pus was retained, or formed gravitating abscesses in the arm or back, tbese were opened or the wound dilated, and thus frequently flmall splinters could be withdrawn from the now-necrosed, sawn surface ; wo must never attempt to press the pus out of the wound at the time of dressing, but merely cleanse it, by trickling over, or syringing it with warm water. Passive motion, very limited at first, gradually increasing in strength, was begun directly cicatrization commenced, and we were able to preserve con- siderable power of motion in all the cases that recovered. Gfradually the muscles of the patient began to develop their activity, and in many cases so quickly that the hand could bo raised to the mouth before the wound was quite cicatrized. Of 19 resections of the shoulder, 7 only were fatal, most of them from pyaemia. In 5 of them before death active ha3morrhage set in, caused by obstruction in the veins and was not to be stopped by ligature of the artery; as shown by one case, in which the axillary and subclavian vessels were suc- cessively tied. In such cases, either foul suppuration in the medullary canal, or phlebitis of the axillary vein, or both were always present. Tlie length of interval between the injury and operation seemed to exert an influence on the result. Of 6 performed in the first twenty-four hours, but 2 were fatal. In the stage of commencing suppuration, hence in that of the highest inflammation, on the third or fourth day, 3 resections were per- formed, of these 2 proved fatal. Secondary operations, that is, after the full occurrence of suppuration;were efiocted 10 times, with fatal result in 3 cases; which is somewhat more favorable than in primary resection. Hence, I be- lieve, it would be better to resect earlier, directly after the reception of the injury, or at least within the first twenty-four hours. If the injury is first discovered on the third or fourth day, or one is prevented from operating sooner, than it is advisable to wait till suppuration is fully set in, and until that time, to moderate the inflammation by strong antiphlogistics. It is curious that the operation on the left side seems to give less favorable results than on the right, 6 of 12 died of those resected on the left; 1 out of 7 of those resected in the shoulder on the right side. A similar proportion held good in resection of the elbow, in whom, of those operated upon on the left 4 in 19, on the right, 2 in 20, resections proved fatal. From this, the fatality attending operations on the left arm to that on the right, is as three to one ; but of course further observations are required to enable conclusions to be deducted. To enable the reader to form his own judgment on the principles here laid down, there follows here short histories of such cases as I have been able to collect, and at the end, a tabular appendix of them. [Of the nineteen cases eight are translated.] Case I.—Shot in the left Shoulder-joint, with Comminution of the Head of the Humerus. Ee?ection on the 17th day. Kecovery.—The Prussian Grenadier, Carl O , aged 24, was wounded, 24th April, 1848, at Schleswig, in the left shoulder by a bullet, the head of the humerus being shattered. The bullet had entered near the coraooid process, could not be found and first appeared superficially U\o years later, near the inferior angle of the scapula. Th« general state was at first good, the severe pain being relieved by ice.](https://iiif.wellcomecollection.org/image/b21079432_0084.jp2/full/800%2C/0/default.jpg)
