History of medical practice in Illinois - Bushnell Historical Society

202 History of Medical Practice in Illinois36 gunshot wounds of the thorax, including the lungs, 12 recovered. Allabdominal wounds were fatal. They stated: "It may be a question worthyof seriousthought, in view of the hopelessness of our present practice,whether we ought not to cut boldly into the abdominal cavity, wash outthe filth and, bringing the wounded intestine to the surface, endeavor toproduce an artificial anus." Certainly they were bold thinkers.Of the 109 wounds of the thigh, 90 were flesh wounds and 19 compoundfractures. Of the 90 flesh wounds, 76 recovered, 13 died and 1 1 were doubtful.Of the 19 open fractures, 5 were amputated at the upper third of thethigh, 1 recovered and 14 died. Of the three mid-thigh amputations, 2recovered and 1 died. One lower third amputation recovered. Nine weretreated without operative interference by using splints, position and suchincisions as were needed for drainage; 3 recovered, 6 died. From the report"it would seem that shots through the cancellous tissue, the superior onefifthof the femur, are much less dangerous than those in the compact boneof the shaft below." This was due to shattering caused by the soft Minniebullets(trench bombs) on the "ivory" bone.Twenty-six gunshot wounds of the knee were discussed:14 were fleshwounds; 12 recovered and 2 were uncertain in outcome. There were 12compound fractures of which 5 recovered, 4 died and 3 were doubtful.There were 10 gunshot fractures treated by amputation of the lower onethirdof the thigh; 6 recovered, 3 died and 1 remained doubtful. Oneresected knee recovered and one not operated upon died.Further reports "observed a considerable number of casesof gunshotfractures of the knee at the battle of Shiloh, very injudiciously treated asordinary fractures without any operation . . . but we never knew one torecover. . . . Let any young surgeon who is reluctant to sacrifice the limb orjoint in these cases take the trouble to dissect two or three of them, and hewill see at once why they all die, unless they are amputated or resected. Thebullet disorganizes the interior of the joint in a most surprising manner,filling it with 500 fragments of bone and cartilage and putting it in a conditionfrom which no human frame can recover without operative help."In the discussion of these war surgical operations it was stated that theoperations were for the most part executed by educated and skillful men,so that there was little occasion for criticism and the results compared wellwith those obtained in other armies.No hip joint amputations were performed. In 88 amputations of all partsof the body, 13 died and 67 recovered, 8 were doubtful. In 17 joint resections,12 recovered, 4 died and 1 was doubtful. There were 8 cases of ligationof large arteries and 1 was of the subclavian; 6 recovered, 2 died.The practical questions which arose were: (1) What cases require amputation?(2) What cases require resection? (3) What cases should be treated