The great success which has attended the excision of joints in civil practice, and a consideration of the fact, that the cases which fall to be operated on in the field are free, not only of local affections in the articulation, but also of any active constitutional disease, made us all naturally sanguine of obtaining the best results from such operations in the field; but unfortunately, the circumstances above referred to interfered so as frequently to leave us no alternative but amputation. So far as my observation went, primary excisions were much more successful than those done at a late date, and this fact is evidenced, both as regards the final results and the length of the period of convalescence, so far as we have returns.
One advantage, with regard to the opportunity of performing resections early, is, that we can in general tell at first sight that such an operation at least is called for. It is not so with regard to a large number of cases for BHOI e although we may not be al.le to determine that subsequent amputation will not l>e required. In the following observations I have not referred to the amount of mobility retained by the joint after our -ions, as the patients went from under my notice too soon for my bein-- able to do so. It is certainly among the disadvantages of military practice during war, that one can seldom trace cases to a conclusion; not only so, but. in such cases as those of resected joints, very much of the after result depends on that careful attention which no one can render so scrupulously as the operator himself; and as it is never in his power to bestow this, we arc not likely to have such favourable results as when in civil practice, the patient remains, till finally cured, under tin- same hand.
The shoulder joint is certainly that to which resection is most peculiarly applicable, from its superficial position, and simple construction. Interference with this articuthercfoiv less disturbing to the constitution of and the re.-ulis of the operation are more ry? than those which tllw a like interference with any of the other joints. The experience of the surgeons in Schleswic-Ilolstcin led them to conclude that secondary operation is less unn-able when the shoulder joint is implicated, than when a late operation is performed on any other joint. the shoulder joint which appear in th' D returns, seem to ha, cessful. cases in which what may be ten: partial resections of the shoulder were performed, i.e., cases in which less or more of the head of the burner us was extracted, without the whole being removed; and I believe the result of such cases to have been, on the whole, satisfactory, so far at least as the healing of the wound was concerned.
It is most curious how much can be done in this way. The after mobility of the articulation will, however, be more restricted in these partial excisions than if the whole joint is resected, and thus an entirely new joint formation permitted. The instances were not, however, very numerous in which the destruction of the bone was so limited as to allow of this partial resection. Very much depends on the careful management of these cases afterwards, especially in guarding against inflammation. In the old war they restricted excision to those cases in which the injury was confined to the head of the bone; holding that, when the shaft was much implicated, exarticulation should be preferred, and this was very much the doctrine acted on during the Crimean war.