Memphis daily appeal. [volume] (Memphis, Tenn.) 1847-1886, 1862-07-10
BY MCLANAHAN & DILL.

are commonly used in the country for carryin
it, should be procured aud duly fl led.
,. Bandages or rollers, applied on the field 0
battle are, in general, SO many things wasted
as they become dirty and stiff, and are usually
cut away and destroyed, without having beer
really useful; they are therefore not forth-com
inc when required, and would be of no use.
.. Simple gunshOt wounds require nothing
more for the first two or three days, than tht
application of a piece Of wet or oiled linen
fastened on with a strip Of sticking plaster, or i
possible, kept constantly wet and cold witt
water. When cold disagreeS wsTm water should
be substituted.
L. Wounds made by swords, ssbers or othel
cutting instruments, are 10 be treated principally
by position. Thus, a cut down to the bone
| across the thick part OF the arm, Immediately
below the shoulder is 10 be treated by raising
the arm 10 or above right angle with the body.
| in which position It is to be retained, however
| incOnyenient it may be Ligature5 may be in
serted. but through the skin only. If the throat
be cut across in 'front.' any great vessels should
| be tied, and Oozing stopped by a sponge. After
| a few hours, when the OOzing is arrested, re-
move the sponge, and the head brought down
toward the chest, and retained in that position
| without hgatUres if this is done too soon, the
sufferer may possibly be suhoeated by the infiL
tratiou OF bloc into the areolsg tissue parts ad-
| jacent
. If the cavity of tho chest is opened into by
| q sword or lance, it is Of the utmost Importance
that the wound in the skin should be effectively
| closed, and this can only be done by sewing it
up as a tailor OF a lady would sew up a seam,
skin only being included: compress list should
be applied over the st:ches, fastened on By stick
| ing plaster. The patient is then to be placed
on the wounded side, that the lung may fall
| down. if it can, upon, or apply itself to the
wounded part and adhere it, by which happy
and hoped for incident Life may in all probability
| be preserved. II the lung should be seen pro-
| truding in the wound, it should not be returned
beyond the level of the ribs, but be covered over
| by the external parts.
! 6. Il is advisable to encourage previously the
| discharge of blood from the cavity of the chest
| if any have fallen into it; but if the bleeding
! from within should continue so as to place the
life of the sufferer in danger the ex ernal weund
should be closed and events awaited.
:. When 1t is doubtful whether the bleeding
proceeds from the cavity Of the chest, or from
the inteTcostal artery "a surgical bugbear) an
iucision through the skin and the external inter
c0stal muscle viii expose the artery close to the
edge of the rib having the internal intereOstal
muscle behind it. The vessel thus exposed may
be tied, or the end pinched by the forceps until
it ceases to bleed. Tying q string round the
ribs is a destructive piece of cruelty, and the
sidered as surgical incongruities.
{. A gun-shOt wound in the chest cannot close
by adhesion, and must remain open. The posi-
ton Of the sufferer should therefore be that
which is most comfortable to him. A small hole
penetrating the cavity Is more dangerous than a
large one and the wound is less dangerous If the
ball goes through the body. The wounds
should be examined, and enlarged if necessary,
in order to remove all extraneous substances,
Il, h1 f,o
face of the lungs; the opening should be cover
ed with soft oiled or wet int-a bandage when
agreeable. The ear of the surgeon and the
ststhOseope are invaluable aids, and ought al
ways to be used indeed, no injury of the chest
eau be scientifically treated without them.
9. Incised and gun-shOt wounds of the abdo-
men are to be tfeatsd in nearly a similar man
ner; the position in both being that which is
most agreeable to the patient, the parts being re-
laxed.
IO In wounds of the bladder, an elastic cath
er IS generally necessary. Ifit cannot be passed,
an opening should be made in the periE@um for
the evacuation Of the urine, with as little delay
as possible.
H. In gun-shot fractures of the skull, the
loose, broken pieces Of bone, and all extTaneOUs
substances are to be removed as soon as possible,
and depressed fractures Of bone are to be raised.
deep cut made by heavy sword through the
bone, into the brain, generally causes a cOnsid-
erable depression OF the inner table Of bone,
whilst the outer may appear to be merely ii
yided
u. An arm is rarely to be amputsted, except
from the effects of 2 cannon shot. The head of
the bone is to be sawn OF, if necessary. The
elbow-o oint Is 10 be cut out if destroyed, and the
sufferer in either case, may have very useful
arm.
I3. In case of gun-shOt fracture of the upper
arm, in which the bone is much splinteged, incis
ions are 20 be made, for the removal of all the
broken pieces which it is feasible to take away.
The elbow is to be supported. The forearm is
to be treated in a similar manner; the splints
used should be solid.
"a. The hand is never to be amputated. unless
all or nearly all its parts are destroyed. Differ
ent bones Of it and Of the wrist to be removed
when irrecoverably injured with or without tho
metarcarpal bones and fingers or the thumb
bnt thumb and one finger should always be
preservd when possible.
ID. The head Of the thgh-bone should be sswn
Off when broken by q musket-bal Amputs-
ton at the hip joint should only be done when
the fracture extends some distance into the shaft,
OF the limb is destroyed by caunOn-shot.
l6. The knee Joint should be cut out when II
recoveTably injured; but the limb is not to be
anputated until it cannot be avoided.
i. guns fracture Of the middle Of the
thigh, attended by great splintering, is Q case
for ampUtGtion. Ia less difficult cases, the
splinter should be removed by incisions, par
ticularly when they can be made on the upper
and outer side Of the thigh. The limb should
be placed on q straight, 6rm splint. a broken
thigh does not admit ruuch, aud sometimes
Of no extension, With0ut;s -nsdvisable increase
Of suffering. An inch or tvs Of shortening the
thigh does not so materially interfere with pro-
4, hnrTi inn
escaped amputatOn.
I5. A leg injured below tie knee should rare
IL be amputated in the first instance, unless
from the effects Of caunon-shot. The splinters
Of bone are all to be Immediately removed, by
saw or foreers after due incisions. The limb
should be place. iron splints and hung on
permanent frame a. Gd0rding the greatest com
fort and probable chance of ultimate success.
Ig An snkle-joint is 10 be cut out, unless the
iendons around are too much injured, and so
are the taTsal and metatarsal bones and toes.
Incisions have hitherto been too little employed
in the early treatment Of these injuries OF he
foot for the removal Of the extraneous sub
stances.
20 A wound Of the principal artery OF the
thigh in addition 10 gun-shot fracture, renders
immediate smputation necessary. In no other
| part of the body is amputstOn to be done in the
first instance for such injury. LigatuTes are to
be placed on the wounded artery, one above, the
| other below the wound, snd events awaited.
81. The occurrence Of modification in any Of
these cases viii be known by the change Of
| color in the skin. 1t viii rarely occur in the
upper extremity, but will frequently do SO in
tie lower. When about to take place, the color
| of the skin Of the foot changes from the natural
/ aesh color, TO a taliowTy or mattled white. Am
putation should be performed Immediately above
| tba fractured mart Tie modification is yet
1 local
y. When tlis discOloration has not been OBJ
served, and the part shrinks, or gangTene has
set in with more marked appearances, but yet
seems to have stopped at the ankle, delay is
perhaps, admissible, but if it should again
spread. or its cessation be doubtful, amputatlon
should take place forthwith, although under less
! favorable circumstances. The modification IS
becoming, or has become, constitutional