A Treatise on Gunshot WoundsLongmore, T. (Thomas), Sir
History
A Treatise on Gunshot Wounds
Longmore, T. (Thomas), Sir
Gunshot wounds
on the 21st and one on the 22d September—and all these lived to be
carried on board ship on the latter–named day, and two, as before
stated, lived several weeks. The absence of increased shock from
pain during the amputation very probably enabled these patients to
withstand the fatigue of removal to the coast and embarkation on board
ship. With regard to the objection of occasional bad results, a recent
estimate has shown that the probable proportion of all the deaths
which have occurred from chloroform to the operations performed under
its influence, exclusive of its use in midwifery, dental surgery, and
private practice, has been one in 16,000; and as these accidents may
equally occur during “minor operations,” in army practice as in civil
life, it should be used or not at the option of the patient.
In respect to the danger of anesthetics in the secondary operations
connected with gunshot wounds, Dr. Scrive’s experience has led him
to remark: “When consecutive amputation is rendered necessary by
the gradually increasing debility of a wounded man from purulent
discharges, chloroformization takes place with the most perfect
calm on the part of the patient;” and he classes its use under
“chloroformization de nécessité.” The general rules followed in civil
surgery must be equally applicable in these cases.
It must frequently happen in military practice that several operations
have to be performed in rapid succession on the same person, from
necessity of a speedy removal of the wounded; and, moreover, from the
number of cases which are suddenly thrown on the care of the army
surgeons after a general engagement, it must frequently occur that the
diagnosis of a case is more or less doubtful. In such instances, the
use of chloroform, by diminishing pain and preventing shock, and thus
giving the opportunity of more accurate examination of parts, becomes
particularly valuable in army practice. After the battles of Alma and
Inkerman, when orders were given to remove the wounded as speedily
as possible, the first–named consideration frequently occurred. The
case of Sir T. Trowbridge is quoted by Mr. Guthrie. This officer had
both feet completely destroyed by round shot at Inkerman, and it was
necessary to amputate, on one side at the ankle–joint, on the other
in the leg: the use of chloroform enabled the two operations to be
performed within a few minutes of each other with perfect success. The
amputations were done by the late Director–General of the Army Medical
Department. In illustration of the second casualty, the following,
which happened to the writer at Alma, may be named. A man of the
Grenadier company of the 19th Regiment had a leg smashed by round
shot. It was a question whether the fracture of bone extended into the
knee–joint. Two superior staff–surgeons were near; a hasty consultation
was held, and it was decided that the probabilities were in favor of
the joint being intact. Amputation was performed, and the tibia sawn
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