It is a remarkable fact, that in these cases the head of the bone so often escaped, when the upper part of the shaft was fractured in pieces, which is probably to be accounted for by its protected position, and perhaps by the same cause as that before mentioned, with reference to the head of the humerus, the non-extension of fracture of the shaft to the epiphyses. Boyer and others have dwelt upon the depth of the parts, the strong ligaments, the difficulty of turning out the head of the bone, as insuperable objections to this operation; but actual experience both in civil WMTXI-S <>r so often perfi >rmed for disease, and especially in our attempts in the Crimea, where were in their natural condition, and the difficulty of turning out the head of the bone increased;i state of the shaft proves that there is no such barri-Ts to its easy execution.
The greatest difficulty lies in tin.after treatment. It is desirable to fix the parts thoroughly, and at the same time to allow of nge of position. Mr. O'Leary managed this, to some y means of a canvas sling for the limb. lixtmv cannot, however, be satisfactorily accomplished in thi< way, whatever power it gives of changing position of the patient. I adopted the inclined in preference to the long splint, because I believe the position to be an easier one for such a case, and also because it permitted the free discharge of the pus, and the easy dressing of the wound without patient. If the idea lately suggested at Kind's College, vhole body, c"itl<l Incarried nut, it tages in the management of "f the hip.
As to keeping the limb in a good position durii; I fear m<>re important ends are lost r it. The uneasiness and ir. and mllcrs ijive, do much to pre-uccess. It matters little what the resulting length roves to be, if the p,ite is saveil; n -miewhat out of the I of amputation an<l km at the hip in cases of compound fractures of the head I. of the i-shot, some, hint i be got from ice in the Crimea. Ou: twenty-three cases of amputation which took place, either in our army or in that of the French, not one recovered; and nearly all died miserably, very shortly after operation. All those, on the other hand, on whom excision was practised, lived in comparative comfort, all without pain, for a considerable time.
Out of six operated on one survived for more than a month, one died from causes unconnected with the operation, and one case recovered entirely. The chance of saving life is thus manifestly on the side of excision, and this is truly the most important aspect of the question. The objection so often advanced to the operation, that the limb resulting from excision is useless, even if true, has nothing to do with the matter. It is a question of deeper and more serious bearing than such an objection would imply. The only point worthy of discussion is, which operation holds out the best chance of preserving life? The little light derived from our Crimean experience is quite conclusive, so far as it goes.
In the one case a life was saved, while, out of four times as many cases of the other operation, not one survived. It is true that many cases submitted to amputation may have undergone more extensive injury than any of those excised, and it is also true that one case of exarticulation did, to all intents and purposes, recover; yet the shock of excision must be much less than that of are not touched, and that those changes in the blood of the limb are not interrupted, which some authorities contend is the cause of death after amputation. In all the cases of excision the loss of blood was trifling a matter of much moment with patients like ours and the WOUNDS OF diate relief fmm pain and irritation was very marked in all the cases. 1 wounds of the hip-joint, are in many iniapted for resection, the injury of the 1 me -n limited, and the soft purls but little destroyed.
There are, \ed in this case. In ( Ippenheim's case, the bone was w down as the little trochanter, and the patient lived eighteen days. Ksmarch relates Schwa: case.