A soldier of the 15th Infantry was shot at twenty-five yards in a night attack, entry, antero-interior aspect of left arm, two inches below the shoulder-joint- No exit. Remington 45-caliber. Enlarging the wound, I found a number of pieces of blue shirt and a very extensive comminution of the humerus. The bone was broken into twenty or thirty small fragments and there was only a small bridge of bone tissue left intact, on the posterior aspect, behind which the bullet was lodged, and whence it was removed with a good deal difficulty. The axillary vessels were uninjured. I removed the bone fragments and dressed the wound under a profuse gauze pack. I was gratified to find the case go on to convalescence with scarcely a symptom, and under a plaster splinter he had secured a fairly good arm when he left the hospital about two months afterwards. I do not think the case would have been uneventful, to say the least, had it been allowed to go on without such interference as it received. CASE V.-A private of the 37th Infantry was shot under rather unique circumstances, and I trust I may be pardoned, for reciting them rather fully. The soldier's company had been sent out to round up a "barrio " or village, supposed to harbor a number of insurgents. His sergeant investigated various houses, and where there was no cause to suspect much left one soldier in the house to search for rifles, etc., the rest of the squad moving on. The particular house to which this man was assigned, had no occupant, save an "old woman" who sat in a corner, betokening great fear. The soldier went about his search for contraband, and when his back was turned, the aged lady speedily developed into a very active Philippino "hombre " who fired a Remington 45-caliber bullet into the posterior aspect of the man's left leg, at about three paces. (It may be interesting to state that a long Tennessee soldier made a very pretty wing-shot on this "unsexed female" as he jumped from a window in the house, after his change of sex). The soldier's wound was dressed with a first aid packet and splint, and he was brought over thirty miles to Santa Cruz, arriving about forty-eight hours after the reception of his injury. Examination showed an absence of pulsation in the posterior tibial and a gangrenous state of affairs about the wound. I amputated below the knee-joint and therein made a mistake, seeing that I had to do a subsequent amputation through the lower third of thigh. This is the only case of gunshot wound in which I found amputation necessary. My excuse for narrating it, is found in the illustration it furnishes, of the intense insult, inflicted upon tissues by the large lead bullet, at close ranges. The tibia and fibula were literally ground into fragments, through the upper half of their extent and the laceration of the soft parts was so severe, that they were devitalized beyond anything I ever saw in gunshot wounds. I remember getting the impression when I saw this wound that it very much resembled the rail road accident cases, which we used to see in the City Hospital. I could not but contrast this case with the many clean punctures of the femur and humerus, which I saw follow in wounds from the smaller bullet. The ranges were all short; in fact we saw very few wounds in the Philippines which were not delivered within fifty yards, for the fighting we had to contend with, was almost altogether of the ambush variety wherein the assailing force shoots a volley from the under brush and then decamps, to put on white clothes and welcome you as the "mucho amigo," a few minutes after trying to "pot" you in the road. Generally speaking it was my observation that wounds. healed kindly in the tropics and that infection was the exception, following any attempt at asepsis. Discouraging as efforts to obtain this state in field surgery, may seem at first sight, we learned to look for it, following the use of the first aid package, with practically no interference with the wound, until it could be done under proper aseptic conditions. Provided the initial insult and immediate infection were not too great, we generally found clean wounds, and modern. surgery finds a steady and oft recurring triumph in those gunshot wounds, which heal under an original first aid dressing. Fig. 25. Fragment of photograph advertisement of an instructor of physical culture. Observe marked deformity of right great toe. Fig. 26. Hammer-toe caused by short shoes. Fig. 27. Hammer-toe caused by pointed shoes. Fig. 29. Correct outline for inner sole of shoe to fit an undistorted foot. In center is shown an impression of the weight-bearing portion of foot. Solid line shows tracing of outline of foot; dotted line represents correct shape for inner sole. Fig. 30. Feet of high caste Chinese lady, showing typical deformity from bandaging. Fig. 31. Shoes worn on the feet pictured in Fig. 30. The Effect of Foot-Wear Upon the Form and Usefulness of the Foot. BY PHIL HOFFMAN, M.D., ST. LOUIS, MO., CLINICAL LECTURER ON ORTHOPEDIC SURGERY, MEDICAL DEPARTMENT (Concluded from page 409 Last Month). Another product of the tight shoe is the so-called ingrowing toe-nail. The flesh is compressed between the shoe-leather and the nail. Inflammation ensues with the consequent overgrowth of the soft parts. Hammer-toe is a deformity frequently produced by shoes that are either too short or too narrow at the toe. The short shoe over-extends the metatarso-phalangeal joints and flexes the interphalangeal ones; in time the soft structures are shortened, the bone ends accommodate themselves to the forced position, and permanent deformity results (Fig. 26). In this type, as a rule, all the toes are affected. The narrow shoe produces this condition by forcing the great toe into the place normally occupied by the second, which assumes the hammertoe position to make room for its larger neighbor (Fig. 27). This is the reason that when a single toe is affected, the second is most frequently involved. The high heel, especially the one placed well forward, compels the wearer to stand largely on the front of the foot, which must bear more than its proportionate share of the body weight. The habitual wearing of high-heeled shoes leads to shortening of the calf muscles through accommodation to the continually assumed attitude. This is probably the reason that a large percentage of middle-aged women can not dorso-flex the foot to quite a right angle without bending the knee. “Unless dorsal flexion of the foot beyond a right angel is possible, it is impossible for a person to complete the step with the leg straight behind him and the feet pointing forward. Eversion of the foot is necessary, and a completion of the step by roll Read before the Medical Society of City Hospital Alumni, March 6, 1902. |