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Show arrnnmx. FRACTUEES ex cox-snow. well, with but common care ; nor is the combination of a shat~ I know that a man has been shot in a duel, or on the highway, and has received a pistol-ball in the bones near the kneejoint; I have been consulted on a pistol-ball lodging about the knee; and a case has been communicated to me of a pistolshot through the head of the tibia ; and in all these cases the limb was saved. But this only shews the propriety of the vlfl‘s'": . ,..... .1, ‘, "1?": at, .q-v .. - .. . 270 tered radius and a torn radial artery a case for amputation. V. In all cases of the ball entering the heads of bones it does not follow that they pierce or lodge. I have specimens of all kinds of fractures by gun-shot, and amongst them the head of the humerus shattered to pieces. In Haslar hospital there lay three men with the heads of the humerus shattered by balls; there lay many too struck about the shoulder joint. If a man be struck on the top of the shoulder, and upon laying the hand over the joint, and moving the arm, the bones are felt jarring, and the bone be not merely fractured, but we discover by the finger in the shot-hole that they are crushed, it is a case for amputation at the shoulder joint. i l raw-VI»? o‘vgxm‘fo-fil-r-Mu--- "'1‘ i VI. When the ball enters into the lower head of the femur, and lodges, we may be long in suspense. By and bye the whole limb inllaming, and becoming greatly Swelled, an abscess forms, perhaps, in the calf of the leg; we are then tempted to think that the ball has fallen down to that place, and that the abscess being opened the ball will be found. But I have twice found this to be a great mistake ; the ball has stuck in the bone; it is a source of great irritation ; that irritation is not immediately shown by its effects on the bone, but on the surrounding soft part of the limb, and, as I have said, on the part of the limb below the seat of the ball. This swelling and great abscess in the leg, on diS‘? section, shows not the cavity of the abscess formed in the cellular membrane, but the inflammation goes so high that the very texture of the muscle is destroyed. Besides this consequence of the injury to the bone there is another effect to be taken into consideration, the swelling of ‘the knee joint; although the capsule of the joint be not opened, yet the ball being socketted in the head of the femur, or tibia, the eifusion of the joint will be converted into purulent matter; on dis~ section, after amputation from such a cause, I have seen six ounces of pus from the knee joint. The ball immersed in the lower head of the femur followed by these consequences of violent inflammation, makes a case for amputation. 2371 distinction I have made, that it is not merely the lodging of the ball, or the transpiercing of the bones by the ball, but this followed by the circumstances described, which makes the necessity for amputation. The case will be essentially changed if the wound is by a pistol-bullet, not by a musketball. The features of the case will be still more essentially changed if instead of the soldier being thrown into a naggon, or transport, without medical attendance, he be laid in quiet and rest, and bled, and kept low, and the inflammation sub- dued by cold applications. But I return to my position by saying, that I have seen the same case in all important circumstances, and the same necessity of amputation, from the ball lodging in the head of the tibia, that I have described as proceeding from a ball piercing the femur. VII. It must be. remembered, that when inflammation has arisen, and the whole constitution has sympathized with the injury of the part, it is more difficult to controul it than it is to ward off inflammation, and save the limb, when we receive the patient before it has commenced. If in such a case as I have described above, We are enabled by bleeding and cold to keep down the rising inflammation, yet the constitution is alive to this impression of injury, and the patient may suffer from severe and threatening spasm ; but after the full and repeated evacuation an aromatic and an opiate have the most soothing and agreeable effect. VIII. In the examples which I have of balls that have entered the heads of bones, and the body of the vertebrae, there are none of them changed in figure. I know this does not absolutely follow, yet when we have to extract a ball from the center of a bone, we may expect it to be still a ball. whereas if ,_.Vl"."_'r. Mi |
