A case of amputation at the shoulder-joint / by E.R. Peaslee.

  • Peaslee, E. R. (Edmund Randolph), 1814-1878.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: A case of amputation at the shoulder-joint / by E.R. Peaslee. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    persons in good health, as the employes upon the roads are the most frequent victims; and yet subsequent accidents, es- pecially irritative fever, sloughing of stumps, and secondary hemorrhage, are very common. There is often in this class of accidents, a concussion of the whole body not common in gunshot injuries, and which indeed a musket ball can never produce. This induces a state of collapse from which the re- action is usually of a low grade, and the state which Travers calls prostration with excitement, (and which is better term- ed incomplete reaction,) ensues. This is a state most un- favorable for recovery from an operation, and the irritative fever accompanying it is well known to be in itself often pro- ductive of fatal effects even in cases where there is no local injury. But another cause of the doubtful success of amputations after railroad accidents, is to be found in the fact that the vast force and the rude violence which produce the local injury, render it altogether more extensive than it at first ap- pears to be. For example, the leg is crushed just above the ankle by the wheel of a railroad car, and two inches above the point where the force was applied, every thing appears perfect- ly sound. And yet, if the limb be amputated at that point, very likely the stump will slough because all the soft parts under the skin were, for a considerable extent, either killed or nearly deprived of their vitality, at first; or, very possibly, secondary hemorrhage will ensue from a similar unsuspected injury to the artery. Still neither of these conditions can be discovered by any external examination at the time; and the normal appearance of the skin, as it will usually be less ex- tensively injured, is well calculated to mislead us. Governed by these facts, in a case precisely like the one just supposed, I amputated at the place of election, as it is called ; and found on examination of the part removed that though the skin was uninjured for more than an inch above the injury of the bone, the muscles were dead and black to a point only an inch below that selected for amputation, in front; and behind two and a half inches below it. In another case, the anterior half of the foot was crushed in a similar manner, the remain- ing portion being apparently uninjured. Wishing to save the