Wounds in war : the mechanism of their production and their treatment . rus were recorded. None of themrequired operative treatment, but they gave a death-rateof per cent. There were 162 shot contusions of thefemur, 9 of which necessitated secondary amputation, with a mortality of per cent., while the conservative treat- 219 220 WOUNDS IN WAR merit erf the remainder only gave a death-rate of percent. The most common causes of death were pyaemia andosteomyelitis. When the periosteum of the diaphysis of a long bone isseverely contused, but not torn, by a projectile, blood isimmedi
Wounds in war : the mechanism of their production and their treatment . rus were recorded. None of themrequired operative treatment, but they gave a death-rateof per cent. There were 162 shot contusions of thefemur, 9 of which necessitated secondary amputation, with a mortality of per cent., while the conservative treat- 219 220 WOUNDS IN WAR merit erf the remainder only gave a death-rate of percent. The most common causes of death were pyaemia andosteomyelitis. When the periosteum of the diaphysis of a long bone isseverely contused, but not torn, by a projectile, blood isimmediately effused beneath it, and its separation from thebone, over a more or less extended area, occurs. The boneat the point struck is therefore deprived of some of its bloodsupply, and a condition of tension on the bone surface isset up ; besides this, the shock to the bone itself, althoughno fracture be produced, may cause some crushing inwardsof its superficial layers, and therefore some interference withits circulation, a condition eminently suitable for the growth. Fig. bullet flattened against femur.—Netley Museum. of bacteria if they should gain access to the site of the periosteum is torn in these cases, one of thepredisposing causes of suppuration, the tension on the bonesurface, is wanting. As a rule, cases of contusion of the diaphyses shouldrecover in a satisfactory manner, and will invariably do soif infection of the wound be prevented. But with theadvent of micro-organisms at a situation where the tissuesare so ill prepared to oppose their action and combat theirdeleterious effects, complications of the most grave char-acter are certain to supervene. When suppuration occursin these cases, pain, swelling of the limb, and elevation oftemperature will be observed ; these symptoms are evidencesof periostitis and osteitis, inflammatory conditions which, CONTUSIONS OF LONG BONES 221 without active and immediate treatment, will proceed tochronic i
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