I shall here add that with regard to those who have had the thigh or
arm carried off by a cannon ball, I do not recollect that any of the
first have been brought to our hospital; they doubtless died instantly
in the field of battle, in consequence of the hemorrhage. Several of
those who had the arm carried off were brought, but the camp surgeons
had previously stopt the bleeding, and applied the dressings commonly
used after amputation, and we cured them afterwards by the method
mentioned in § XXXI. The men wounded in this manner afford me an
opportunity of inserting in this place, what I had to say with respect
to the necessity of amputation in consequence of an hemorrhage; but
I shall be very brief, as in these times, when surgery makes such
progress, there is no artist but knows, and is familiarly acquainted
with the different methods of stopping a bleeding. Therefore,
although the interosseous, the brachial and crural arteries, near the
articulations of the elbow or knee, or any other branches of arteries
when divided, may give the surgeon a good deal of trouble, he is not
obliged on that account to take off the limb; for in whatever situation
we suppose the artery to be injured, the surgeon may always, by proper
dilations, come at the wound, and stop the bleeding by the application
of astringents, among which agaric and spirit of turpentine has, with
us, very often succeeded, or by compression or ligatures, or lastly by
all these means united; thus amputation ought never to be performed
on account of an hemorrhage. It is even astonishing to conceive
how surgeons should think of such an expedient, as frequently the
difficulty of stopping the bleeding after amputation is greater than on
any other occasion, especially if it be performed below the knee[41].
I therefore persist in my opinion, whether the wound of the arteries
be only accompanied with one in the soft parts, or whether at the same
time the bone be fractured or shattered: In this last case, I should
join the treatment mentioned in this section to that of § XXIV.
It will here perhaps be objected, that all these means would be to no
purpose, if the brachial or crural arteries are wounded at a certain
height, because, in such a case, the limb must waste away for want of
nourishment. I shall return an answer in a few words, with respect
to the crural artery at the upper part of the thigh, which is, that
whether my method can, or cannot be adopted in this case, there is no
alternative; no surgeon as far as I know having ventured to perform
amputation at this part, because every body would dread the patient's
expiring during the operation[42]: Neither would the wounds of the
brachial artery induce me to take off the arm at its upper part,
although it be practicable, because I think every expedient is to
be tried before we have recourse to this; and as from several cases
we learn, that after the operation for the aneurism the member has
recovered its heat, motion, and strength[43], even when the trunk of
the brachial artery has been cut through; I think when it is wounded,
we ought to tie it without fear, and afterwards provide for the
preservation of the limb, by aperient spirituous fomentations and
by gentle frictions, which contribute to open and enlarge the small
vessels, and by that means to restore heat and life to the parts[44].
If we observe, the first or second day after the operation, a little
swelling or heat below the wound, we may conceive great hopes that the
whole limb will revive: If, on the contrary, whatever is below the
wound shrivels, grows cold and dry, then we may think of amputation,
without, however, being precipitate; as a mortification in this case is
always slow, and sometimes the limb recovers heat and motion very late.
But I am convinced this case will very rarely require amputation. In
conformity to the plan I have proposed, I should now mention the two
last circumstances wherein amputation is deemed necessary, a caries of
the bone, and a cancerous disposition of the part; but I imagine it
will be better first to relate some instances of cures effected without
amputation, wherein this operation to many surgeons would have appeared
indispensable.
The first case I shall relate is very remarkable, of a soldier in
his royal highness prince Henry's regiment, whom my friend M.
Kretchmer, an able artist, and principal surgeon of the hospital, and
Mr. Sterneman one of the ordinary surgeons, had the care of under my
direction, and cured compleatly to the surprize of every body. The left
arm was terribly shattered by four different pieces of iron shot, the
os humeri was broke through the middle, and the arm pierced with eight
holes, and at the joint of the elbow there was a true aneurism, of the
bigness of a large fist. Mr. Kretchmer began by applying the tourniquet
at the armpit in order to stop the bleeding; then of the eight wounds
or apertures, he chose two nearest to the fracture, and dilated them
in such a manner as to lay the bone bare; he likewise dilated a
little the six others; after these dilatations he extracted several
large splinters, he then brought the two ends of the bone together,
placed them in their proper position, in which he made them be kept
by assistants, while he moistened all the wounds with equal parts of
spirit of wine and arquebusade water, and covered them with lint; he
wrapped up the whole arm in linnen cloth, and fastened the bandage
moderately tight: he next applied gradual compresses to the aneurism,
and bound it up with a roller by itself; after which he moistened
the whole with the same mixture of spirit of wine and arquebusade
water, and as much martial ball as he could dissolve in it, and
applied over the bandage for the aneurism the fomentation which I have
already mentioned, made with the species for the black decoction[45].
He slackened the tourniquet every two hours, drawing it tight again
immediately; he removed it altogether at the end of a few days,
contenting himself with compressing the artery under the armpit with
bolsters and a bandage which did not hinder the dressing of the wounds.
He dressed them every day, but the bandage for the aneurism he renewed
only every other day, although two of the openings lay under it. In
this manner he persevered with great assiduity for a considerable time.
All this while he made the hand and fore arm be secured in a cylinder
of strong pasteboard, and suspended in a sling. He bled the patient
frequently, gave him vinegar and water for his drink, and made him take
from time to time the powders which I mentioned before, consisting
of nitre, Epsom salt, cream of tartar, and true Armenian bole[46].
By these means only, he restored this arm, which was so bad that it
could not even be taken off, to such a state, that in the course of
three months, after having removed some splinters, the aneurism was
dispersed, and the fracture and wounds were perfectly cured.
We cured another soldier belonging to the regiment of Brandenburgh
Bareith, whose elbow was miserably torn by five pieces of iron shot,
some of which stuck fast in the part, and where both bones of the fore
arm were shattered.
After having dilated the wounds, we extracted some splinters, sawed off
a piece of the cubital bone about four inches long, and in dressing the
wounds endeavoured to avoid too large a suppuration.
In the ordinary method amputation would certainly have been performed,
as the fore-arm was shattered, and the upper arm which was untouched
could admit of the operation, but we saved the arm and made a perfect
cure without having recourse to such an expedient, which are so many
evidences that give their testimony in favour of our method, which we
can produce to the partisans of amputation.
M. de Sass, colonel commandant of a regiment belonging to the garrison
of Lattorf, and who is at present commandant at Brieg, received at the
battle fought near Czeslau, a musket shot in the leg, which shivered
the two bones into several fragments, of which some of four or five
inches in length were extracted. The surgeons thought amputation
necessary, and pressed him to submit to it; he refused however and
recovered; although the limb is bent outwards he can walk and go about
his business with ease.
A soldier of the regiment of Cuirassiers of Gessler, called Lukrafka,
was wounded in the going through the exercise with the regiment, in
such a manner that the two bones were fractured in the middle, with
several fissures lengthways. After having laid the fissures of the
bone bare, I sawed through a piece of the tibia about five inches in
length, which I removed together with the marrow; I separated with a
pair of forceps the useless parts of the fibula which jutted out, then
I placed the bones in their natural position, and at the expiration of
four months the patient was cured. This limb was somewhat shorter than
the other, he could nevertheless walk and leap with ease.
M. de Franckenberg, a captain in Hulsen's regiment of foot, was
terribly wounded by a musket ball at the battle of Loboschitz; all the
bones of the tarsus were broke and shattered in such a manner that it
seemed almost necessary to take away the whole number; which being
done, and the parts of the foot brought close together, it recovered
so far that this gallant officer, with the help of a double heel, can
walk conveniently, and is able to do duty along with his regiment in
garrison at Alt-Sydow.
M. de Alvensleben, ensign in the guards, received at Torgau a wound
above the foot which shattered the tibia and fibula, and the splinters
forced by the violence of the shot formed three distinct layers; I
was obliged to make a great many deep incisions, and in a little time
he was so much better, that I could venture to entrust the remainder
of the cure to the surgeon of the regiment. A soldier of Sybourg's
regiment of foot, named Mieke, seventy years of age, received near
Miessen in 1759, a musket shot which shattered the shoulder bone two
fingers breadth below the articulation; a splinter was taken out five
inches long; he was nevertheless perfectly cured at the end of nine
months, and left Wittemberg to go to the hospital of Invalids at Berlin.
M. de Stabenwol, captain lieutenant of Grabow's regiment of foot, at
the battle of Kunnersdorf, received a musket shot which shattered the
head of the os humeri close to its articulation with the scapula; he
was perfectly cured in the space of eight months, and went from Stettin
to Berlin[47].
M. de Rottkirk, commandant of the margrave Charles's regiment, and
M. de Krockow, captain in Schlabrendorf's regiment of Cuirassiers,
received each of them a wound through the joint of the shoulder, and
were both compleatly cured at the expiration of about ten months.
M. de Britzke, commandant of Knobloch's regiment of foot, was wounded,
near Dresden, by a musket ball which pierced the articulation at the
elbow, and shattered the three bones which join at that place. Several
splinters were extracted; this officer nevertheless in about two years
was compleatly cured, and at present does his duty gloriously at the
head of his regiment.
I shall finish the account of these cases with that of a prince
wounded at the battle of Kunnersdorf. A musket ball wounded him very
badly, passing through his foot at the articulation of the tarsus and
metatarsus in such a manner, that all the metatarsal bones excepting
one were shattered. Proper incisions and the other remedies already
mentioned effected his cure, and restored him to the nation and the
army to their great joy, although the wound was of that kind, for which
surgeons were accustomed to amputate not above fifty years ago[48].