X. UK THE EXTREMITIES, OCX-SHOT 1SJUEIES OF TIIK!X>T. In tlie returns of the late war, from April 1st. 1855, 2198 cases of gun-s!mt pear among the men, and 166 deaths therefrom. Of these, 1628 cases and 55 deaths were mere flesh 43 cases and deaths, wounds with contusion and partial fracture of long bones; cases and death, simple fracture of long >hit: 171 cases and 64 deaths from eomi fracture of the femur; cases and i) deaths from the same injury of the tiljhi or fibula alone; cases and deaths from; 88 cases anil 7 deaths from perforating or penetrating wounds of the tarsus, i oases of compound fracture of.Mir, and 91 cases of compound fracture of both bones of the leg wer: to amputation.
There were 1237 cases and 8 deaths from flesh wounds of the upjterex'2 cases an.md partial; of the long bones deaths f fractures; cases, deaths, and ted to from compound fracture of cases, deaths, and II ampntati. mpound fracture of the bones of the forearm. In cases the the carpus were penetrated or perforated, and 48 of these cases were subjected to an the seveninjii in kittle, none arc of more I'lv.ju.-nt ornmvnce or of more serious cons. uliar anx iti surgeon, i manner in whieh their and vails as to many points in; Till-: Ci;LMl-:AN WAI: treatment. This ambiguity as to their manage i -es in a great measure from the many varying causes connected with the state of health of the patient, and the means at hand for his treatment circumstances which fluctuate with every campaign.
In the Crimea, these injuries were peculiarly embarrassing and extraordinarily fatal. In the management of no accidents was so much expected from modern improvements, and by none were we so much disappointed in the results. It was confidently hoped, that in very many of those cases which, in the old wars, would have been condemned to now be preserved, either by the exercise of greater c:m in the treatment, or by having recourse to some of flu modern expedients by which limbs are so often saved at home. But, unfortunately, a sad experience only confirmed the hopeless nature of compound fractures of the thigh by gun-shot, and their very uncertain and dangerous character when the leg or arm were implicated.
In the following remarks on compound fracture, I propose to refer chiefly to those cases in which the femur was broken, and I will notice afterwards similar It can hardly be doubted, that the great striving after conservatism which influenced all the surgeons of our army, was one main cause of that mortality which attended these injuries. We were not prepared to believe, how hopeless they were, till the unwelcome truth was forced upon us by an ever-recurring AYe " When the brigade was lirst landed, an opinion prevailed that ca: thigh -would be met with in which it would be proper to attempt to save the liu.b, and every eate uas carefully examined COMi-urxn FKAuld of accidents, similar at least in name. seen in civil life.
Full uf the promise of the schools, we 'I not admit that any injury apparently so slight I withstand the assiduities of- a wise conservatism. In trying, however, to save limbs we lost many lives, thus ful till ing the prophecy of one of the greatest surgeon sos of promising appeara 1.* reserved for the trial the very cases, in fact, which would have made the best recoveries if operated upon early, and the in tinier to determine the kind of treatment it would require. Two cases were at length brought into the camp, respecting wlii.-h the majority of the.il officers were of opinion that amputation should not In- performed. r.l)>.th young, healthy, and temperate; the injury to the bone and soft parts comparatively slight in both eases.
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