MILITARY SURGERY AND MEDICINE. 



543 



Tie 15. 



Gait's Spiral Trephine. 



conservatism, in regard to amputation in gun- 

 shot fractures of the thigh, has been very 

 strong; amputation having been attempted in 

 not more than one-third of the cases brought 

 under treatment, and in not more than one- 

 half of those of gunshot injuries of the knee- 

 joint. Some of the most eminent surgeons, 

 Dr. F. H. Hamilton among the number, regard 

 this conservatism as excessive, believing that in 

 a considerable number of the cases life, easier 

 locomotion, and sounder health would have been 

 secured by amputation than by the attempt to 

 preserve the limb under the adverse circum- 

 stances of transportation to a distant hospital, 

 great comminution of the bones, spasms, or in- 

 tense and continued pain, great contusion or 

 laceration of the soft parts, or the participation 

 of the principal arteries or nerves in the injury. 

 Still this conservatism is more to the credit of 

 the surgeons than the reckless and indiscrimi- 

 nate resort to capital operations, so characteris- 

 tic of young and inexperienced surgeons, would 

 have been ; and it gives an incidental testimony 

 of great value to the ability and discretion of 

 the thousands of surgeons, called so suddenly 

 from civil life to the serious and unaccustomed 

 responsibilities of the camp and battle-field. 

 Of those cases of gunshot fractures of tho 

 femur or thigh bone in which amputation has 

 not been attempted, the proportion of recoveries 

 cannot be stated with certainty ; but judging 

 from the results .at several of the larger hospi- 

 tals, it may probably be safely reckoned as at 

 !east two-thirds. In some hospitals, as for in- 

 stance in the City General Hospital, U. S. A., 

 at St. Louis, it has approached three-fourths. 

 The apparatus adopted for the treatment of 

 these cases is entitled to a considerable share 

 of the credit for so satisfactory a result. 



The indications to be observed in the success- 

 ful treatment of a gunshot fracture of the femur, 

 without amputation, are, perfect quiet and rest 

 for the injured limb, without possibility of dis- 

 placement of the fractured portions of the bone, 

 gentle but continuous extension and counter 

 extension, to obviate the danger of any mate- 

 rial shortening of the limb, accessibility to the 

 wound in order to observe its condition, to pre- 

 vent hemorrhage or the secretion of foul and 

 irritating pus, and the removal of the necessary 

 evacuations and the change of the bed without 

 disturbing the patient. If the knee-joint be 

 involved in the injury, it is necessary to lay it 

 open ; and in theso cases a somewhat different 

 apparatus is required from that adopted in frac- 

 tures of the femur at a higher point. Although 

 the treatment of thece cases has generally taken 

 place in the larger post or general hospitals of 



the United States Army, yet they wore so nu 

 merous, and the labor devolving upon tho 

 dressers and assistant-surgeons was so inces- 

 sant and exhausting, that a resort to the com- 

 plicated operation and processes of the old 

 civil hospitals was impossible, and fortunately 

 it has been proved unnecessary. The first and 

 one of the most admirable of the inventions for 

 the treatment of these cases is Dr. Frank H. Ham- 

 ilton's canvas frame. This is simply a wooden 

 frame, a little longer and wider than the mat- 

 tress on which the patient reposes, covered with 

 firm canvas, and this reenforced a little above 

 (the side-rails extending perhaps six inches at 

 each end beyond the cross-rails), the centre by 

 a second piece two feet in width, stretched 

 across from one side-rail to the other, and firmly 

 stitched to the upper canvas ; through this 

 central portion, or a little above the centre of 

 the canvas, a hole one foot in diameter is cut, 

 and firmly bound with tape. In the foot cross- 

 rail is a broad slot into which an upright board 

 six or eight inches high, and having in it a spool 

 or other contrivance for a pulley, is inserted. 

 The patient is laid upon this frame, it having 

 been previously covered partially by two sheets, 

 folded in half, and laid one above and the other 

 below the central opening. The wounded limb 

 has a long wide strip of adhesive plaster ap- 

 plied to each side of it, and maintained in place 

 by a roller carefully applied to the leg below 

 the knee ; the ends of these adhesive straps are 

 firmly attached to a small piece of board Applied 

 to the sole of the foot, but wide enough to pre- 

 vent any pressure by the straps on the malleoli, 

 and the leg from the thigh downward is a little 

 elevated by being placed upon a thin cushion, 

 which should be filled with bran. Attached to 

 the board which is bound to the foot, is a 

 strong cord, which, passing through the pulley in 

 the upright board in the bottom rail, has at its 

 other end a bag of sand or a pail of the same, 

 not exceeding at first five or six pounds in 

 weight, but to be gradually increased afterward 

 as necessary. This constitutes the whole appa- 

 ratus for extension, and counter-extension is 

 made by raising the foot of the bed from three 

 to six inches by means of bricks, and thus 

 making the weight of the body the counter- 

 extending power. When it is desired to change 

 the bed, use the bedpan, or move the patient, 

 the canvas frame is lifted carefully with the 

 patient on it, and transferred to a couple of 

 movable stands or " horses," or laid on blocks 

 (figs. 16, 17 and 18). Another form of in- 

 valid bed adapted not only to these injuries 

 but to other cases, like severe typhoid or 

 yellow fevers, where it is difficult to move the 

 patient, is Dr. Josiah Crosby's invalid bed, re- 

 cently introduced by the Army Medical Board 

 into several of the U. S. general hospitals. It 

 is so constructed that while the patient lies sus- 

 pended upon broad and firm bands of webbing, 

 the bed can be lowered, one of the straps loos- 

 ened, and a bedpan used ; or the bed may bo 

 run out and aired or changed, or the wounds 



