A report on excisions of the head of the femur for gunshot injury / War Department, Surgeon General's Office.

Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: A report on excisions of the head of the femur for gunshot injury / War Department, Surgeon General's Office. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    mination of one of the most important questions of modern military surgery. Indeed, when it is considered that most of the abstracts of this great array of cases furnish all essential particulars respecting the nature of the injury, the date and mode of operation, the after treatment, progress, and termination, that the condition of each of the survivors of the operation has been traced for years, and that the aggregate results are compared with those of the only remaining alternatives in the treatment of such injuries, viz: temporization and amputation, it must be admitted that this report comprizes the elements for solving the grave problem of the appropriate treatment of gunshot injuries involving the hip-joint. I describe the operations in three categories: primary, intermediate, and secondary excisions. This classification, adopted by this Office in discussing all the major amputa- tions and excisions, has been criticised by students of the closet and by surgeons in civil life, but by no military surgeons of practical experience. If a study of the histories of over twenty thousand major amputations, and of more than four thousand excisions of the larger joints, performed during the late war, may permit me to speak authoritatively on this point, I would say that no doctrine in military surgery is supported by more ample evidence than that which teaches that in operations for traumatic causes, there is a wide difference in the results of those performed immediately after the reception of the injury, those performed during the existence of inflammatory action, and those done after the symptomatic fever and inflammatory symptoms have abated. Boucher was the first to formally define these periods, in a memoir addressed to the French Academy of Surgery in 1752. His divisionvwas adopted by Guthrie, and commands the approval of the vast majority of modern military surgeons. It has been well said by Rutherford Alcock, that the mode in which authors define the periods and circumstances which constitute primary and secondary operations is one of the main causes of erroneous estimates of the compara- tive value of primary and secondary operations, and of the discrepancy of opinion on the subject. It is notorious that some authors limit the designation of primary operations to those performed within ten or twelve hours from the reception of the injury, while others extend the period to three or four days. M. Legouest has well observed that more exact definitions on this subject are among the desiderata of modern surgical science. That the operations done in the intermediate period must be separated, in estimating results, from those performed in the primary and secondary stages, and must be looked upon as com- pulsory operations, may henceforward be assumed. Critics may cavil at the scientific accuracy * of such classification, but when the facts are at hand to demonstrate its utility, their strictures are of little value.f * See The British and Foreign Medico-Chirurgical Eeview, No. LXXIII, p. 173, July, 1868. tThose not weary of a thread-hare argument may consult: Guthrie, Treatise on Gunshot Wounds, 3d ed. London, 1827, p. 230; Alcock, Notes on the Medical History and Statistics of the British Legion in Spain, London, 1838, p. 66; Sedillot, Traitede Medecine Operatoire, T. 1, p. 316; LEGOUEST, Diet. Encycloped. des. Sci. Med. Paris, 1865, Art. Amputations; Bern- HARD Beck, Kriegs-Chirurgische Erfahrungen wahrend des Feldzuges 1866 in Siiddeutschland, Freiburg, 1867, p. 268. [Dr. Beck agrees with M. Legouest, that instead of three divisions only, the intermediary period should be sub-divided.] Dr. S. Fknwick, of Newcastle-on-Tyne, Monthly Journal of Medical Science, and Archives Generates de Medecine, 4e Serie, T. XVI, p. 362; Nelaton, Elemens de Pathologie Chirurgicale, T. 1, p. 224; Pitha and Billroth, Allgemeinen und Speciellen Chirurgie, Erlangen, 1865, Erster Band, Zweiter Abt., 5, 369; NeudGrfer, Handbueh der Eriegschirurgie, Erste Halfte, Allgemeiner Theil, Seite 345; Ballingall, Outlines of Military Surgery, 5th ed., p. 424; W. Fergusson, F. E. S. A System of Practical Surgery, London, 1857, p. 197; Berard, Denonviixiers, and Gosselin, Compendium de Chirurgie Pratique, T. II, p. 504 The latter authors, and Sir William Fergusson and M. Nelaton, are among the prominent surgeons in civil life who recognize the distinction sought to be established by the military surgeons.