Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands: from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.Guthrie, G. J. (George James)
History
Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands: from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.
Guthrie, G. J. (George James)
Crimean War, 1853-1856 -- Medical care; Napoleonic Wars, 1800-1815 -- Medical care; Surgery, Military -- Europe -- History; War wounds -- Europe -- History
18. In examining a wound, a finger should be gently introduced, if
possible, in the course of the ball, to its utmost extent; in parts
connected with life, or liable to be seriously injured, it is the only
sound usually admissible. While this examination is taking place, the
hand of the surgeon should be carefully pressed upon the part opposite
where the ball may be expected to lie, by which means it may perhaps be
brought within reach of the finger, and for want of which precaution,
it may be missed by a very trifling distance. While the finger is in
the wound the limb may be thrown as nearly as possible into that action
which was about to be performed on the receipt of the injury, when
the contraction of the muscles and the relative change of the parts
will more readily allow the course of the ball to be followed. If this
should fail, attention should be paid to the various actions of the
limb, the attendant symptoms arising from parts affected, and what may
be called the general anatomy of the whole circle of injury. A muscle,
in the act of contraction, may oppose an obstacle to the passage of an
instrument in the direction the ball has taken, especially if it should
have passed between tendons or surfaces loosely connected by cellular
membrane; as by the side of, or between the great blood-vessels, which
by their elasticity may make way for the ball, and yet impede the
progress of a sound. When the ball is ascertained to have passed beyond
the reach of the finger, a blunt silver sound or elastic bougie may be
used, and the opposite side of the limb should be carefully examined,
and pressure made on the wounded side, when it will probably be found
more or less deeply seated. If the ball should not be discoverable by
these means, the surgeon should consider every symptom, and every part
of anatomy connected with the wound, before he decides on leaving the
ball to the operations of nature.
19. It is unnecessary to dilate a wound without a precise object
in view, which might render an additional opening requisite. This
dilatation or opening, when made, should always be carried through
the fascia of the limb. A wound ought not to be dilated because such
operation may at a more distant period become necessary. The necessity
should first be seen, when the operation follows of course.
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