?wound. The flaps were dabbed over with a solution of one part of carbolic acid in eitrlit of linseed oil, and the same was injected into all parts of the wound, the opposed surfaces and edges of which were brought together by six points of interrupted suture, and supported by long stripes of adhesive plasters, the whole being covered by two layers of cloth saturated with carbolic acid and oil, and a small soft cushion was placed under the scapula. After the operation the patient was somewhat faint, and required the frequent administration of stimuli, which were gradually withdrawn as reaction set up. For the first few days the inner flap had a suspicious appearance, and small quantities of air kept bubbling from the wound ; but soon all anxiety was over, as the case progressed, and healthy granulations of the margins of the wound indicated its probable rapid healing. The needle over the axillary artery was removed on the 25th of March, and the patient discharged in the early part of the following month, with the entire wound all but cicatrized. Throughout the treatment a generous dietary, with anodynes, tonics, and stimulants were persevered with, and open air gestation for several hours morning and evening insisted upon. Locally, several layers of coarse calico, saturated with carbolic acid and oil, and covered over with sheet lead, were kept constantly applied. I saw this patient several months afterwards looking fat and lamenting much the loss of his arm.
Mussooiue,
AMPUTATION" AT THE SHOULDER-JOINT
FOlK
RAPIDLY SPREADING TRAUMATIC GANGRENE.
By Surgeon
F.
Odevaine,
in Medical
charge of
Mussoorie.
M. Sing, aged 18, a Sikh sowar in the service of H.H. the Begum of Bhopal, sustained a simple fracture of the right
radius at about its centre, in consequence of a fall from his horse wlien out in the district. He was taken to a village bone-setter, who bound up his arm very tightly, using thick rope in lieu of bandages for the purpose.
Two days afterwards lie returned to Bhopal, and remained for a week under the care of a native doetor at that place. He was then carried into Seliore, where I first saw him at the regimental hospital on the morning of the 13th March. I found the right forearm and band discoloured, vesicated, swollen, emitting great foetor, gangrenous, cold, and devoid of all sensation. The cellular tissue, up to within four inches of the shoulder, was infiltrated, swollen, and crepitating on pressure, there being no line of demarcation whatever. The patient presented an anxious, worn expression ; had not slept nor eaten much for days previously ; the pulse was weak and rapid. He begged me to save his life and not mind the limb. From his account, and the appearance of the parts, it was quite evident that the gangrene was quickly extending, and would soon invade the cellular tissue of the shoulder and chest; I therefore informed the patient and his friends that immediate amputation would be the only means of saving his life.
Having placed him on a firm fracture-bed in a separate ward having a large window, I brought him under the influence of chloroform, and proceeded to operate. The subclavian artery
it passes over the first rib was compressed, the limb abductand a long sharp-pointed knife passed backwards to the outside of the coracoid process, and its point made to come out at the upper part of the posterior fold of the axilla ; by cutting downwards and. outwards, the outer flap, about four inches in length, was formed, which, on being raised, exposed the capsular ligament of the joint and the small bleeding artery, (circumflex humeri) which was secured. With a catlin the joint was opened, and the head of the humerus forced out by abducting the limb across the patient's chest; resuming the long amputating knife, I divided the muscles attached to the large and small tuberosities, as also to the scapula, and the hospital assistant haying compressed the axillary artery between his thumb and fingers, the lower or inner flap was formed by carrying the knife downwards and inwards. The main artery and several smaller branches were tied; but fearing that the flup might take on grangrenous action and give rise to secondary hajinorrhage, I secured the axillary third method), as high up as po??ib'e, by acupressure (the leaving the eye-end of the long needle projecting from the as
ed,
18th
November, 1872.
Mussooiue,
AMPUTATION" AT THE SHOULDER-JOINT
FOlK
RAPIDLY SPREADING TRAUMATIC GANGRENE.
By Surgeon
F.
Odevaine,
in Medical
charge of
Mussoorie.
M. Sing, aged 18, a Sikh sowar in the service of H.H. the Begum of Bhopal, sustained a simple fracture of the right
radius at about its centre, in consequence of a fall from his horse wlien out in the district. He was taken to a village bone-setter, who bound up his arm very tightly, using thick rope in lieu of bandages for the purpose.
Two days afterwards lie returned to Bhopal, and remained for a week under the care of a native doetor at that place. He was then carried into Seliore, where I first saw him at the regimental hospital on the morning of the 13th March. I found the right forearm and band discoloured, vesicated, swollen, emitting great foetor, gangrenous, cold, and devoid of all sensation. The cellular tissue, up to within four inches of the shoulder, was infiltrated, swollen, and crepitating on pressure, there being no line of demarcation whatever. The patient presented an anxious, worn expression ; had not slept nor eaten much for days previously ; the pulse was weak and rapid. He begged me to save his life and not mind the limb. From his account, and the appearance of the parts, it was quite evident that the gangrene was quickly extending, and would soon invade the cellular tissue of the shoulder and chest; I therefore informed the patient and his friends that immediate amputation would be the only means of saving his life.
Having placed him on a firm fracture-bed in a separate ward having a large window, I brought him under the influence of chloroform, and proceeded to operate. The subclavian artery
it passes over the first rib was compressed, the limb abductand a long sharp-pointed knife passed backwards to the outside of the coracoid process, and its point made to come out at the upper part of the posterior fold of the axilla ; by cutting downwards and. outwards, the outer flap, about four inches in length, was formed, which, on being raised, exposed the capsular ligament of the joint and the small bleeding artery, (circumflex humeri) which was secured. With a catlin the joint was opened, and the head of the humerus forced out by abducting the limb across the patient's chest; resuming the long amputating knife, I divided the muscles attached to the large and small tuberosities, as also to the scapula, and the hospital assistant haying compressed the axillary artery between his thumb and fingers, the lower or inner flap was formed by carrying the knife downwards and inwards. The main artery and several smaller branches were tied; but fearing that the flup might take on grangrenous action and give rise to secondary hajinorrhage, I secured the axillary third method), as high up as po??ib'e, by acupressure (the leaving the eye-end of the long needle projecting from the as
ed,
18th
November, 1872.
