WOUNDS. 



" Experience," fays M. Larrey, " has proved, both to the 

 army and navy furgeons, that the bad fymptoms which foon 

 follow fuch gun-fhot injuries as muft occafion the lofs of a 

 limb, are much more to be dreaded than thofe of immediate 

 amputation. Out of a vaft number of the wounded, who 

 fuffered amputation in the courfc of the firft four-and-twenty 

 Iiours after the memorable naval battle of the firft of June, 

 1794, a very few loft their lives." 



M. Larrey next acquaints us, that when he was fent to 

 the army of Italy in 1 796, he had alfo the pain of feeing in 

 the hofpitals great numbers of the wounded fall viftims to 

 the confidence which many of the furgeons of that army 

 placed in the principles of M. Faure. General Bonaparte 

 faw, that the ambulanci volante was the only thing that, in 

 the event of frefli hoftilitics, could prevent fuch accidents ; 

 and in confequence of his orders, M. Larrey formed the 

 three divifions d'arabulance, which are defcribed in his 

 Memoires de Chirurgie Militaire. 



Since this period, it has always been cuftomary in the 

 French armies, on the day of battle, to make every pre- 

 paration for performing amputation as fpeedily as poffible. 

 The mere fight of thefe ambulances, ( always attached to the 

 advanced guard,) fays M. Larrey, encourages the foldiers, 

 and infpires them with the greateft courage. 



M. Larrey defifes us to interrogate the invalids who have 

 loft one or two of their limbs, and nearly all will tell us, 

 that they fuffered amputation a few minutes after the acci- 

 dent, or in the firft four-and-twenty hours. 



" If M. Faure now retains any partifans," fays M. Larrey, 

 " I recommend them to repair to the field of battle the 

 day after an aftion ; they would then foon be convinced, 

 that without the prompt performance of amputation, great 

 numbers of foldiers muit inevitably lofe their hves. In 

 Egypt, this truth was particularly manifefted." 



Admitting, fays M. Larrey, that by a concurrence of 

 fortunate circumftances, which are not always to be calcu- 

 lated upon, fome patients efcape the danger of the firft 

 fymptoms, this proves nothing in favour of doing the 

 operation afterwards : it muft be feen what nature will do 

 towards the event of the cafe. 



If at the end of twenty or thirty days the prognoftic is 

 as bad as it was previoufly, amputation cannot be avoided. 

 Thus all the fufferings which the patient has endured have 

 been undergone for nothing, and the operation will now be 

 attended with confiderable rifti, inafmuch as the patient may 

 lie in a dangeroudy weakened ftate. 



If nature revives at all, no doubt the fuccefs of the 

 operation becomes more probable ; but in this cafe, the 

 furgeon, inftead of having recourfe to amputation, ftiould 

 redouble his efforts to preferve the limb. 



Cafes demanding Amputation tonfecutively — M. Larrey 

 gives us the annexed information upon this fubjeft. 



Firft safe. A fpreading Mortification — If the diforder 

 be owing to an internal and general caufe, it would then be 

 raftinefs in the furgeon to amputate before nature had put 

 limits to the difeafe. This kind of gangrene, according to 

 M. Larrey, is diftinguilhed from that which is named 

 traumatic, by the fymptoms which precede and accompany 

 it. Thefe fymptoms are fimilar to thofe which are obferved 

 in nervous ataxia, or adynamia. Here the operation 

 ought to be deferred, and endeavours made to combat the 

 general caufes with regimen and internal medicines. 



But when the gangrene is traumatic, the limb, fays 

 M. Larrey, fliould be immediately cut off above the dif- 

 organized part. Several fafts in fiipport of this advice are 

 related by this experienced furgeon in his Memoire fur la 

 Gangrene Traumatique. See Surgery. 



How contrary this advice to that inculcated by Sharp, 

 Pott, and nearly all eminent furgeons of the prefent time ! 



A particular cafe of gangrene has been pointed out by 

 Mr. Guthrie as demanding the early performance of am- 

 putation, and a deviation from the old rule of waiting till 

 the mortification has ceafed to fpread. It is when gan- 

 grene occurs after wounds of the large blood-veffels of a 

 hmb. See Guthrie on Gun-fliot Wounds of the Ex- 

 tremities, p. 63, &c. 



Second cafe. Convulfions of the wounded Limb. — Am- 1 

 putation of the member, performed immediately the firft ] 

 fymptoms of tetanus manifeft themfelves, more efpecially j 

 tliofe of chronic tetanus, was propofed and even praftifed ' 

 by Larrey with partial fuccefs. He iuppofed, that all 

 communication between the original injury, and the reft of 

 the body being thus cut off, the general diforder might 

 ceafe. 



Third cafe. Bad State of the Difcharge It often hap- 

 pens, that in gun-diot wounds, complicated with fraftures, 

 notwithftanding the moil fkilful treatment, the difcharge 

 becomes of a bad quahty ; the fragments of bone lie fur- 

 rounded with the matter, and have not the leaft tendency to 

 unite ; the patient is attacked with hetlic fever, and a 

 colliquative diarrhoea. Under thefe circumftances, life may 

 fometimes be prefervad by amputation. 



Fourth cafe. Bad State of the Stump. — ^^In hofpitals, fays 

 M. Larrey, the cure of amputations is fometimes prevented 

 by a fever of a bad charafter. The ftump fvvells, the in- 

 teguments become at firft retrafted, and then reverted and 

 difeafed a good way upward. The wound changes into a 

 fungous ulcer, the cicatrization of which is hindered by the 

 deep diforder of the bone, and the ulceration of the foft 

 parts. The extremity of the bone projefts. In order to 

 remedy this laft evil, it has been propofed to faw off the 

 projefting part of the bone, and with this even to ampu- 

 tate all the flefti beyond the level of the iltin. M. Larrey 

 condemns fuch praftice, as unneceffary and dangerous, and 

 he recommends giving nature time to effcft the exfoliation 

 of the difeafed projefting part of the bone, and heal the 

 wound. 



Of poifoned Wounds. — Thefe injuries are effentially dif- 

 ferent from every other defcription of wound, their great 

 particularity depending upon the introduftion of a venomous 

 matter into the wounded parts, or its depofition upon the 

 furface of the injury ; and, in general, the poifon is inferted 

 by the weapon with which the folution of continuity is pro- 

 duced. Sometimes, however, the contrary happens, when 

 previous cuts, or fcratches of the fingers, which are not 

 healed, become infefted with a virus, in the diffeftion of 

 bodies, or in the drefling of venereal ulcers. Nay, there 

 has lately been recorded in the public papers a remarkable 

 inftance, in which a nobleman's fervant died, as is alleged, 

 from the effefts of the poifon of a torpid viper, the fangs 

 and poifoned apparatus of which he had been handling and 

 exhibiting to fome vifitors, at a time when he happened to ' 

 have a flight cut upon one of his fingers. The cafe is ex- 

 traordinary, not only on account of the way in which the 

 infedlion was contrafted, but alfo on account of the fatal' 

 event, which is very uncommon in animals of the magnitude 

 of the human fubjeft, as we (hall hereafter notice. 



Pricks with the point of a diffcHing-lnife, when the inftru- 

 ment is covered with putrid, infectious, irritating matter, 

 may be confidered as a clafs of poifoned wounds. Some- 

 times, however, fuch accidents are followed by no injurious 

 effefts ; and when the lubjeft is ftrong and robuft, a little 

 inflamed tumour occurs in the Ctuation of the punclure, the 

 part fefters, burfts, and then heals up. But, as Richerand 



obfcrvcs, 



I 



