The external applications for a contused limb should vary, according
to circumstances, or according as the contusion has caused a mortified
slough, or has not. If it has not, but nevertheless the bone is
fractured, the applications should be of a very mild nature. In such
a case I make no incisions, but I endeavour to bring the two ends
of the bone together, to place them in their natural position, and
to keep them in it, by means of compresses and bandages, as in the
common simple fractures: I constantly stupe the whole dressings with
discutient and vulnerary fomentations[40], and exactly follow the plan
laid down § XIV. by which means I have almost always happily cured
contusions of this kind.
If the contusion has caused a mortified slough, and has at the same
time shattered the bone, we must begin by separating the dead slough
from the sound parts, with a scalpel; we must make deep incisions, and
neglect no means proper for promoting the discussion or suppuration;
and the fracture of the bone must be treated agreeably to the method
recommended § XXIV. This case requires great vigilance in the care of
it, and we find ourselves amply recompensed for our labour, by the
pleasure of accomplishing the cure of these unfortunate patients,
either compleat, or at least as much so, as can possibly be obtained in
their situation.
There is at present at the hospital at Torgau, a soldier who had been
grievously wounded; the shoulder and arm were very bad, from the
extravasation the contusion had occasioned; the scapula and clavicle
were entirely shattered; the head of the os humeri dislodged from the
glenoid cavity, and pushed downwards; the ligaments having been too
violently stretched, now hung loose; and the neighbouring parts, deeply
bruised, were covered with a black slough, like a mortification. The
contusion and double fracture of the shoulder blade and clavicle are
compleatly cured, the head of the os humeri never could be kept in its
articulation, on account of the relaxation of the ligaments; the other
symptoms are happily removed, but he has a cough, and almost constant
fever, with its concomitant symptoms; whence we may conclude that
matter is formed in some bowel, probably in the lungs, a consequence
resulting from the contusion of the internal parts.