I by no means would; that some most excellent recoveries did not take, j >ns were performed of pieces, inch, whole thickness oftl; wen mii'-li iii"iv rare, and infinitely more tedious, than cases like the foregoing. When the leg is fracture. 1 low d tin- ankle by a ball, the accident is much more grave than when it takes place at the middle, of the limb. have exceed ii in which the tibia was split the joint. The tree anastomosis whieh exists between the, -upply of blood which ready development of a coin; the less drain the: period of i tit.' 1. H call tb retain I WA1I. during cure, render many things practical in compound fractures of the upper extremity, which could ncvi-r IKattempted in like in juries of the lower limb.
The injury indeed would need to be very extensive before we would think of performing amputation at an early period in gunshot wounds of the arm; as,unless the vessels are destroyed, there are many most dreadful and hopeless-looking accidents from which the arm will recover; and besides, secondary amputations are so successful, and resection s so often sufficient to fulfil the necessary indications, that primary amputation is never performed in the upper extremity, except under the most desperate circumstances.* Stromeyer recommends the trunk to be made the splint in treating these cases, so as to do away with all that fear of motion in the fragments which exists, if they untreated, in the usual way. Unfortunately, however, as pus commonly burrows and has to be evacuated on the inner aspect of the arm, it is difficult to carry such an idea into practice.
it appears, was so displeased with the results of his attempts to cure fractures of the upper extremity in the Caucasus, that he was disposed to submit them all to amputation. The world will learn with interest whether his experience in Sebastopol has not been more favourable. The results, with regard to fractures of the fore-arm, The following is a curious instance of recovery from a most hopelesslooking injury. It is related in one of the Indian regimental reports in the War-office. A soldier received, in the Khyber pass, a sword-cut, which divided his arm, bone and all, with the exception of the vessels and nerves, and the muscles on' the inner side. lie also received another wound, whieh laid hare the spine and ribs; yet he recovered, the bone of the arm illegible in the scan of the first
I do not think, lookin as a whole, would lead us to sul.scrilu to s doc'nt alisurpti,.n among those who undergo amputation, than amonthose who lions, and p: li.eir liu, U WAR. Hectic, the renewal of old enteric disease, and cholera, earned off many of our patients under treatment for The results which followed the treatment of gun-shot most instances. Balls perforating either, created a great deal of destruction, but the repair was not slow. " The talent of preserving " was well shown in the Crimean instances, and in general the results rewarded the endeavours made to save the member. It is remarkable how few sequestra separate in gunshot wounds of the hand, even when the shattering of the bones lias been great.
The extrusion of any large piece of bone seldom occurred, so far as I saw. In gunshot wounds perforating the foot, the most marked feature was the great swelling which followed, and the extreme pain which this distention generally caused. How far the rapid cures obtained in the field may remain permanent, I am at at loss to know; but I fear that not a few of the cases "patched up," and sent home, may have to undergo operation at a subsequent date. In dealing with gun-shot injuries, so severe as to demand operation in the field, we can often save more of the part of the hand or foot, than usually after accidents in civil life. The soft parts are seldom so much destroyed, in proportion to the injury inflicted on the hard tissues, by a musket ball as by a wheel of machinery; and thus we are not called upon to remove so much of the member in order to secure a good covering for the hard tissues.