Long years of suffering, constant abcesses, exfoliations, atrophy, sensitiveness to the sliirhtt-st atmospheric change, shortening and deformity, the development of phthisis if it be in the constitution these are among the results of a compound fracture bv irun-shot in the middle of the 1 have been able to find the i cages of compound frnciurc of tin- thi-h (parts not specified), in pt at saving the Hint, was made, vry soon; but of tli.ultimate state of the reman: hctlu-r;lir imm.-di,-it(> amputation. in one series of 60, which he m his book, amputato<l l". immrdiat.
t' The remaining l.0 saved, al i miser.i who retained "a deformed member, unfit to fulfil i: V OF THE CULM KAN Finally then, let me repeat the conclusion; that under circumstances of war similar to those which occurred in the East, we ought to try to save compound comminuted fractures of the thigh when situated in the upper third; but that immediate amputation should be had recourse to in the case of a like accident occurring in the middle or lower third. Many of the fractures of the leg were so severe as to call for early amputation. Severe shell or round shot wounds seldom leave much hope of saving the limb, but in a large number, however, of very unpromising cases, the leg was preserved.
A great deal was done in the leg in the way of removing fragments. Guthrie says they can be extracted " to almost any extent and number," and he directs us, if necessary, to saw off irritating parts of the ends of the shafts. If one bone only be broken, and the loss of substance in it is not great, the case will be the more promising, as the unbroken bone keeps the fractured one steady, and the soft parts in place. It is when a scale of the bone, however thin, remains, as we occasionally see it in shell wounds, that functions," and which, he says, they would willingly part with. " Taking a retrospective view," says Bell, " we see in true perspective all the dangers of a nine mouths' cure, which is but a weary travel, step by step, betwixt life and death.
In this view we see the dangers of frequent fevers, wasting diarrhoeas, foul and gleety sores; some dying suddenly of gangrene, some wasted by the profuse discharge and successive suppurations, new incisions and unexpected discharges of spoiled bones; we see those who recover halt ing on limbs so deformed and cumbersome, that they are rather a burden than a help. In the very moment that we hear of such a cure, we know how much the patient must h.-ivc sullcred, and how poorly he has been cured; can, from the long suffering.:! of those who escape, tell but too truly how many must die." tin- best results in the way of cure are obtained. Such was t: in a most successful instance of repair, in a man ui' tin- th regiment, under t; of my friend of that regiment.
I relate it, because it be looked on as an example of a class of cases which not uncommon. A piece of shell struck the edge of the left tibia, and destroyed the greater part of the thickness of its shaft, from below the tubercle downwards three and a half inches. The fragments were at the time of the accident, or afterwards, as tiny became loose; the posterior shell of the bone being, entire, was carefully preserved. Four months afterwards this patient was sent to England with a strong and use till leg, whose only change was a slight bending a condition whieh generally remains in these ease was just such a one as presents th;*. best hope for a good result.