Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

These splints are so portable that they may be carried into the field or upon the deck of a ship, to bring the patient to the surgeon.

In using the apparatus, the back of the leg and lower end of the thigh are to be evenly supported on a pad placed on the leg-rest; a splint is to be placed on each side of the leg, and the whole secured by straps carried around near the knee and ankle. The leg is then to be suspended by two straps from the bar of the cradle placed over the leg as represented, so as to swing without touching the folding board on which the cradle is placed. The foot should be secured to the foot-piece by a bandage.

Solid splints, and a firmly-fixed cradle, under which the leg may hang, may be said to be the sine qua non of the treatment of a gunshot fracture of the leg. The French in the Crimea have an apparatus called a GOUTTIÈRE, to be hereafter noticed.

158. Half-a-dozen pairs of long poles made light and of tough wood, which might always be replaced without difficulty, and a good thick ticking for each pair, having a case or pipe on each side in which the poles might run, ought to be a part of the surgical stores of every regiment on service in time of war. Two short irons, having at each end a ring through which the poles may run, will keep the ticking or sacking extended, and the patient flat and immovable unless shaken by accident. The sacking will roll up into little compass, if the poles should not be forthcoming or are not wanted, and, when the ground is damp, will make an excellent bedstead as well as a covering for the doctor. If four legs be added to each bearer, a great facility will be obtained on halting when the carriers are tired, the sufferer being raised from the ground, which in muddy or boggy places is very desirable.

159. The arm, when fractured by musket-shot, admits even of more strenuous efforts being made to save it; from its smaller size, and the more ready exposure of the bone or bones when badly broken, the danger is less. If an artery should yield by ulceration, it should be laid bare by operation, and a ligature placed on each bleeding end. An additional or second wound in the forearm only complicates the case, and the loss of a finger or two does not augment the danger. In fact, amputation should rarely take place in the first instance, and only in the second when mortification has commenced, or the strength and health of the patient will no longer bear the drain upon them. The head of the bone should be removed, with as much of the shaft as may be injured; the elbow-joint should be excised, if the condyles are destroyed and the joint injured; if the middle of the bone should be destroyed, the upper and lower ends of it should be approximated. A great advantage is derived from the facility with which the upper extremity can be supported as compared with the lower, and the aid to the general health which may be obtained from the locomotion sufferers with broken arms are capable of undergoing.

160. In making incisions for the removal of splinters of bone, both at an early and at a late period, particularly in the latter, when the soft parts are all impacted together, and nothing is gained beyond what is cut, the course of the trunks of nerves, as well as of the great arteries, should be carefully attended to, and those parts avoided; for a successful cure of the fracture will be much deteriorated in value, if accompanied by a loss of motion or of sensation in the hand or fingers.

161. Splints for the arm should be made of solid materials, although light; some a little hollowed, and at a right angle, to correspond with the bend of the arm, and to admit of a little motion of the radius and of the forearm and hand, which relieves the position, is more comfortable for the sufferer, and tends to prevent stiffness of the elbow. The pads of lining for the splints should be made of cleaned or carded wool, rather than of tow or old linen, protected by some one or other of the modern modifications of caoutchouc or gutta-percha.

162. The medical treatment of compound fractures should be directed to allay pain and to prevent as far as possible any excess of general irritation and fever; to sustain, at a subsequent period, the strength of the sufferer by appropriate medicines, good and sufficient diet, and a free circulation of air, without all which little can be expected, to say nothing of absolute rest and those ordinary attentions and comforts so necessary for the restoration of health.

163. The following returns are illustrative of the principles recommended with reference to primary and secondary amputations. The first two show the seats of injury in 1359 persons wounded and admitted into hospital after the battle of Toulouse. The fifth return should be considered rather as an approximation to the truth than as the exact truth, as it does not include those who died on the field of Waterloo, but those only who reached Brussels, and does not include those who were sent to Antwerp.

No. 1.—Return of Surgical Cases treated and Capital Operations performed in the General Hospital at Toulouse, from April 10th to June 28th, 1814.