Eh bien! les plus a revenir de mon erreur: les autres ne tarden: nx, de leur bl4inble condesoendanoe, et '. tueuse avec Uquelle j'avais une conduite par unc tongue WAII. inevitable delayed till the patient's constitution had become so depressed as to be beyond reaction. Two circumstances seem to have had chiefly to do with the irreparable character and mortality of compound fractures of the thigh in the Crimea first, the state of health of the men when wounded; and, secondly, the effect on bone of the new kind of ball with which most of these injuries were inflicted. As to the state of health of our patients, it was not merely that they were in so anemic a condition that suppuration and irritation quickly prostrated them; nor was it that their stamina and " pluck " had been destroyed by hardship and suffering; nor that the means of treating them in front, during the early period of the war, were totally wanting; but the chief cause of the reluctance shown by nature to repair the osseous breach was the scurvy-poison which held command in their systems.
This it was which mainly opposed recovery. Callus was not thrown out at all; or if it was, it refused to consolidate. I myself examined the limbs of a large number of men who died at Scutari during the early part of the war, and in not a single instance almost did I observe the slightest attempts at repair; but, on the contrary, invariably found a large sloughexperience, sans avoir reuni tous les elements de la question. J'ai encore jin-rnts a 1'esprit les nombreux blesses de la compagne de 1805, en Italie, chez lesquels je passais des journees entieres a panser des fractures comminutives des os ct succomberent tous, les uns dans les premiers jours, par 1'effet des accidents primitifs, douleurs, convulsions, fievre, rrsorji-tion purulente; les autres apres uu temps quelquefois fort long, lorsque leurs blessures avaient eprouvd un notable amendement, par 1'effet du typhus nosocomial, de la dysenteric epidemique', etc." COMPOUND IKACTURE OF THE EXTREMITIES. tilled with dead and detached fragments of bone, shreds of sloughing muscle and destroyed tissue into which the Mack and lit'dcss bones projected their.niar extremities, and across which, lying in every tion, but seldom in the axis of the limb, were dead and detached sequestra, the fracture-splinters" of ut.
The depressed condition of body to which the hardships of the war reduced the men, made a severe compound fracture of the femur synonymous with death; SO that we mi.Lrht with perfect appropriateness use the words >f Ravanton "I exhausted many times theresources of art without success, incisions, removal of early bleedings of sufficient magnitude, spare dressings, position, infinite care, nothing could against an inevitable death." Most of our nts, as I before remarked, had either suffered from itery or were on the verge of falling into that disease. The vast majority of them had ulcerated intestines, and were thus in a condition of health which did not bear disease. When men in this state received a s> compound fraetuiv. and th.-ir constitutions were taxed 'ijury. there was no reserved fund on which tw.
They had been living up to their income of; i, and so utter failure was the sure result of increased "liture. If when injured they had been taken into the ward of a London hospital. doubt whether they would in most cases have ended more fortunately, either by the limb or by amputation: how much less, then, wh.-u they had to und.Tj-,, tivatment in a i w-dl at first ap1. p-rhap-i, strong enough, and expressed such a WAR. confident hope in the result as almost to deceive their surgeon. The injury might not appear very severe; the bone was undoubtedly broken, but it might not be much comminuted; and thus we flattered ourselves, and began a trial hopefully which always ended in disappointment.
The golden opportunity was allowed to pass, and so we entered on a road which led to death, whether through the portal of amputation or any other. The struggle soon began. Suppuration set in. The disease which lurked in " blood and bone " showed itself. Diarrhea appeared and would not cease. The patient's stomach refused the only food which could be procured. He got emaciated, weak, and irritable. A suspicion was awakened that the bone had been more severely injured than was at first supposed. Things went on from bad to worse. Hectic claimed its share of the waning strength; and whether we operated late or not, the great regret remained that it was not done at first, as the invariable result demonstrated the uselessness of any other proceeding.