History of medical practice in Illinois - Bushnell Historical Society

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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
General Surgery 203without operative interference, and (4) what variations from acceptedrules must be made in view of special military exigencies?Our records were compared to those of Esmarch's results in theSchleswig-Holstein campaign (19 resections with 12 recoveries) andGuthrie's series of 44 amputations in the British War with Napoleon, ofwhich number 17 died.In the report there is a long discussion of the results obtained by easternsurgeons in the Potomac Campaign plus a comparison with British statistics(which are the most extensive in the world) plus Stromyer's idea ofresection of the ragged end of a femur rather than a thigh amputation.This method was used in the Battle of Toulouse in Europe on 43 of themost favorable cases with a mortality of 60 per cent as compared with ourarmy's mortality of 55 per cent for all thigh amputations.Four conclusions were reached: (1) A large proportion of gunshot woundcomminuted fractures of the femur die within five days under any or alltreatments; there is no perfect reaction. (2) Shots through the spongytissues of the trochanter and neck of the femur are less fatal, since thereisnot so much splintering of ivory-like bone of the cortex and damage tothe soft parts. (3) Amputation above the middle of the femur should beperformed only in desperate circumstances. (4) If one can amputate belowthe middle of the thigh, do it promptly and thereby save 75 per cent of allpatients.It was also recorded that 10 to 15 per cent of deaths in military surgerywere due to erysipelas, diffusive phlebitis, pyemia and hospital gangrene.It was advised that the patients be kept dispersed in open tents in the field,never crowded together. "Men will lie in snow, on wet ground, or underopen sheds, and do well on bacon and hard bread; but in close hospitalsthey will die though they have all the luxuries of the world around them."The principal military hospitals in Illinois at that time were located atMound City, Cairo, Quincy, Alton, Camp Butler and Camp Douglas,Chicago. Most of the rebel sick (captured) were held at Camps Butler andDouglas. These men were usually considered inferior to northern men intheir recuperative powers. At Camp Douglas the mortality was twice thatof our own Union soldiers, although they were given the utmost care andattention.Cook County Hospital 6A brief supplementary resumed of the history of Cook County Hospitalmay well be added to this history of surgery in Illinois, consideringthat many of the great surgeons involved in the progress of the years1850 to 1900 worked in the hospital as staff members or interns. The•The writer has quoted freely from the Bulletin of35:255, September 1950.the American College of Surgeons
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HISTORY OFMEDICAL PRACTICEIN ILLINO
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PREFACEVARIOUS members of the Illin
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Prefaceixall of its local health de
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PrefacexiDr. E. A. Piszczek, Chicag
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THEEDITOR'S FOREWORDperiod 1850 to
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Editor's Forewordxvand 650 he comme
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xviiiXVIII.XIX.Medical Bacteriology
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CHAPTER IINTRODUCTIONBy DAVID J.DAV
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Introduction 5Smillie 3 wrote on ep
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CHAPTER IIMEDICAL GEOGRAPHY OF ILLI
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Medical Geography of Illinois 9geol
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12 History of Medical Practice in I
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Medical Geography of Illinois 15had
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Medical Geography of Illinois 17of
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Fig. i. Places and regions in Illin
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Medical Geography of Illinois 21ref
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Medical Geography of Illinois 23Cha
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i„r»-l ll'urlnllli• A i!.n»Ut
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CHAPTER IIITHE HARDY PIONEER:HOW HE
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CHAPTER IVORGANIZATION OF THE ILLIN
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CHAPTER VIIINTERNAL MEDICINEBy GEOR
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CHAPTER XIIIOTOLARYNGOLOGYBy ALFRED
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CHAPTER XIVDERMATOLOGYBy B.BARKER B
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CHAPTER XVNEUROPSYCHIATRYBy OSCAR H
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CHAPTER XXIVMEDICAL JOURNALISM IN I
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APPENDIXMISCELLANEOUS NOTESAddition
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5ioIndexAntifebrin, 138, 139Antipyr
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5 1 * Index159, 163, 190, 284; Amer
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5HCollege of Medicine, University o
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516 IndexEpidemics, 5, 507Epileptic
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15 i8 IndexHarris, Dr. J. O., 115Ha
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5 2 ° IndexJacobson, Dr. Daniel Si
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522Index456, 457; Privately Endowed
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