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
The patient is aware of having received a severe blow on the part
affected, which does not show much external sign of injury, the skin
being often apparently unhurt or only grazed; the power of moving the
part is lost, and it is insensible. The bone or bones may or may not
be broken, but in either case the sufferer, if the injury be in the
leg, is incapable of putting it to the ground. After a short time the
limb changes color in the same manner as when severely bruised, and the
necessary changes rapidly go on to gangrene. The limb swells, but not
to any extent, and more from extravasation between the muscles and the
bones than from inflammation, which, although it is attempted to be set
up, never attains to any height. The mortification which ensues tends
to a state between the humid and the dry, and rather more to the latter
than the former. These cases are not of frequent occurrence, and are
not commonly observed until after the blackness of the skin, and the
want of sensibility and motion attract attention; for the patient is
generally stupefied at first by the blow, and the part or parts about
the injury feel benumbed. I made these cases an object of particular
research after the battle of Waterloo, but could find only one among
the British wounded. The man stated that he had received a blow on the
back part of the leg, he believed from a cannon-shot, which brought him
to the ground, and stunned him considerably. On endeavoring to move,
he found himself incapable of stirring, and the sensibility and power
of motion in the limb were lost. The leg gradually changed to a black
color, in which state he was carried to Brussels. When I saw it, the
limb was black, apparently mortified, and cold to the touch; the skin
was not abraded; the leg was not so much swollen as in cases of humid
gangrene; the mortification had extended nearly as high as the knee;
there was no appearance of a line of separation; and the signs of
inflammation were so slight that amputation was performed immediately
above the knee. On dissecting the limb, I found that a considerable
extravasation of bloody fluid had taken place below the calf of the
leg, and in the cavity thus formed some ineffectual attempts at
suppuration had commenced. The periosteum was separated from the tibia
and fibula; the popliteal artery was, on examination, found closed
in the lower part of the ham by coagulated lymph, proceeding from a
rupture of the internal coat of the vessel. Two inches below this the
posterior tibial and fibular arteries were completely torn across, and
gave rise, in all probability, to the extravasation. The operation was
successful. The proper surgical practice in such cases is to amputate
as soon as the extent of the injury can be ascertained, in order
that a joint may not be lost, as the knee was in this instance. It
is hardly necessary to give a caution not to mistake a simple bruise
or ecchymosis for mortification. To prevent such an error leading to
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