When a patient is brought to our military hospitals, who has had his
foot, leg, hand or arm shattered by a ball, or any other violent cause,
whether the parts are intirely carried off, or adhere by a little
flesh and skin, but in such a manner that there is not any hope of a
re-union; in this last case, we begin by cutting through these slender
attachments which keep the part suspended, and thus intirely separate
it from the body. In both cases, when pieces of the extremities of the
bones jut out, and may prove hurtful, they must be sawed off with a
convenient saw, whether they be moveable or still firmly adhere to the
limb: When they are moveable, they must be held by an assistant. I hope
no man in this treatment, will pretend to see any thing like what is
properly called amputation, which I condemn.
After this first operation, I carefully examine if there be still any
small splinters left, and whether they are only held by the fleshy
parts, or still adhere to the bone; I remove all those, with the
fingers, or with instruments, that can be separated without violence
or a fresh effusion of blood.
After removing as many splinters as I can, I slightly compress the limb
between my hands, gently stroking it lengthways, from above downwards,
endeavouring, at the same time, to restore, as much as possible, its
natural shape; I dress the sore with a digestive, to which I add a
little essence of myrrh, or solution of mastic: I cover the whole with
dry lint; applying the same bandage as after artificial amputation,
sufficiently tight, without, however, running the risque of causing
pain or increasing the inflammation: Afterwards I moisten the whole
with as much spirit of wine as may penetrate to the parts affected;
taking care to keep the limb extended in a right line, and laid soft.
The first days, till the suppuration becomes plentiful, I only dress
it once every twenty-four hours, sometimes seldomer; but when the
suppuration is begun, I renew the dressings twice a day; and such of
them as immediately touch the bone, or fleshy parts of the wound, I
cover with lint dipt in solution of mastic, balsam of Fioraventi, or
some other balsamic essence, in order, by that means, to prevent too
large a suppuration. I likewise remove, each dressing, all the little
shivers of bone which do not reunite, and which, though they could not
be separated at the first dressing, may in the succeeding ones.
With respect to the larger fragments, which must form the stump of the
bone, I not only take care not to loosen them, but even, as I already
remarked, endeavour to promote their coalition, by light compression
with the hands, and binding the bandage somewhat tighter than I would
otherwise do. If, at the expiration of a month, a fragment of this
kind is not coalesced, but on the contrary, is become more loose,
without however being intirely so; in that case, by shaking it gently,
moving it upwards and downwards, and loosening the fleshy parts that
hold it, I endeavour to bring it away intirely. If there are some of
them cracked as high as the articulation, I give myself no concern
about them, but leave them to nature[21]. But as to the small, short,
pointed shivers which do not re-unite with the bone, I take care, as
I have already observed, to remove them as soon as possible, commonly
in the first seven or eight dressings; and at each dressing, I gently
stroke down the muscular flesh towards the end of the stump; I keep
the whole firm, by giving a proper degree of tightness to the bandage;
moistening it, as long as the dressings are necessary, two or three
times a day with spirit of wine. By these means, such kind of patients,
at the end of four or five months, are as compleatly cured as the
nature of the accidents will admit of.