On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer.

  • Stromeyer, Georg Friedrich Louis, 1804-1876.
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: On the fractures of bones occurring in gun-shot injuries / by Louis Stromeyer. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    Gun-shot Injuries of the Lower Jaw. These injuiies occur very frequently, and in the most fi'ightfiJ form. In many cases the bullet had traversed each lateral half of the lower jaAV, and on each side had caused comminuted fracture. In one case, all the teeth except- ing a pair of molar teeth, were struck out not only from the inferior—but from the superior maxillaiy bones. In another case a grenade shot caused the de- struction of those parts of the upper and lower jaws supporting the incisor and canine teeth. In most cases the bullet had broken the jaw-bone on the one side, and passed out again through the opposite cheek. An instance occurred of simple fracture of the lower jaw, anterior to the insertion of the masseter, the bullet not having entered; I first found tliis about eight days after the in- jury, it had been overlooked from the motion of the jaws being unaffected and no dislocation being present. The treatment of such cases was extremely simple. I merely removed those teeth and fragments of bone, which were either full)' loose or were hanging by thin shreds ; the discharge of the rest was expected from the suppurative pro- cess and they were only removed when this could be performed with ease. In no case was any resection undertaken of the injured jaw,nor any bandage ap- plied, the chief object was cleansing the mouth first by injection of cold—later of lukewarm water. This is positively essential, as the swallowing of matter leads not only to gastric irritation but also to typhous symptoms ; as I have twice seen, where, however, through careful cleansing of the mouth with solu- tion of chloride of lime an improvement was soon perceptible. The results of this simple manner of treatment was very favorable, as not only the majority of the patients recovered, but also the resulting deformities were but slight. The fragments united by bone, excepting in two cases in which there occurred ligamentous union; this circumstance I consider due to the fact that I left the discharge of the greater fragments of bone to the suppu- rative process and thus the periosteum remaining behind could form new boue. In the case, where the middle portion of the upper and lower maxillary bones were carried away by a grenade shot with considerable loss of substance of the under lip, no union in the middle line occurred either of the soft or of the hard parts. In this case, after a delay of four months, the soft parts which had united to the two halves of the lower jaw and ^vere much retracted, were loosened by me from the bone freely, and after the edges were pared were united in the middle line by the twisted suture. The parts healed, and the saliva could now be retained, however, the total failure of the under-jaw was a special disfiguration. Three cases of injuries of the lower jaw ended fatally; in the first, a Saxon soldier, the bullet entering near the chin had driven forwards the fragments of the shattered lower jaw under the tongue against the orifice of the laiynx. When I first saw the patient he was in imminent danger of sufiocation, from which I freed him by removing many sharp fi-agments from the neighbourhood of the glottis, by means of the left index finger introduced into the mouth; however, sudden death occurred on the fourth day from hjemorrhage;—the autopsy showed that this had taken place from the internal jugidar vein, which had been pierced by a sharp fragment of bone. In this case warm poultices had been immediately employed, and very improperly so: on representing this to the acting surgeon, he thought that secondary hsemorhage woidd have fol- lowed under any circumstances. However, the instance to be mentioned proves