Secondary amputations not so successful after injuries as after
incurable disease; circumstances under which the operation is
performed in military surgery, and the consequences; secondary
hemorrhage; non-union of the stump; phlebitis and sloughing of the
stump; depositions of matter in the viscera; in secondary amputations
larger flaps required, or the bone to be cut shorter; directions for
sawing the bone; larger number of arteries to be tied; torsion of
arteries; bleeding from a small branch, cut short, above the ligature;
mode of avoiding this; use of the tourniquet; and its inconveniences;
in oozing of blood, the wound not to be finally closed for some
hours; treatment in cases of non-union; cat-gut or other animal
ligatures; hemorrhage from large veins to be controlled by pressure,
not by ligatures; if the bone be too long, a piece to be sawn off;
consequences of not doing so. COMPOUND FRACTURES: definition of;
comminuted; compound fracture of the arm or leg does not necessitate
amputation; of the thigh, amputation is requisite; difficulty of
treating a gunshot fracture, with extensive splintering of the bone;
consequences of the splintering; necrosis of the bone, and formation of
sequestra; case of Lieut. Timbrell, fracture of both femurs; recovery
without amputation: lodgment of a ball in, or its passage through, a
bone, without splintering; consequences; its removal requisite when
lodged in a bone; mere grazing a bone by a ball; simple transverse
fracture of a bone by a ball; flattening of a ball; its lodgment
between the broken portions of a bone; extensive shattering of the
femur, a case for immediate amputation; gunshot fractures of head
and neck of the femur; excision of the injured portions of bone-if
the upper third, or middle of the bone, amputation necessary; in
fractures of the lower third, not communicating with the knee-joint, an
attempt is to be made to save the limb; when the femur is splintered,
if the limb is to be saved, the principal splinters to be removed;
the necessary incisions often neglected; if the splinters cannot be
got at, amputation is requisite; secondary danger from the smaller
splinters; a careful examination to be made for them when suppuration
is established, and incisions made if requisite for their removal;
consequences of their retention; proper bedsteads for the wounded
should form a part of military stores; position of the patient in
gunshot fractures of the leg or thigh; splints, and their application;
gunshot wounds of the leg; limb rarely to be amputated; removal of
splinters; position of the limb; Mr. Luke’s the best apparatus for a
compound fracture of the leg; illustrated by wood-engraving; bearers
for wounded men; gunshot wounds of the arm; more probability of saving
the limb; if an artery ulcerate, it should be tied at each end; primary
amputation in such cases rare; secondary, only for mortification, or
when the strength gives way; in incisions at a late period, the nerves
and arteries to be avoided; splints for the arm. Hospital returns.
pp. 141-162