Twelve leeches and hot fomentations were applied, and afforded great relief. The symptoms subsided, and remained in abeyance till about the 29th, when they gradually increased, the joint becoming much swollen and tender, the veins more distinctly visible, and the general health beginning to suffer for the first time, as evinced by slight perspirations, debility, frequent pulse, loss of appetite, thirst, disturbed rest, &c. The swelling of the joint was QUH-SHOT wurxns <>r JOINTS, uniform, and no fluctuation eould he perceived in it, though it w;-.s thought that there was some deep-seated fluctuation about three inches above the joint, on the outer side of tin- thigh. " It was decided in consultation to examine the limb wlii. - under the influence of chloroform, and then to adopt such measure's as the examination might indicate; accordingly, on October 1st, he placed upon the operating table, and ehloroform admind.
With some difficulty, and by using considerable force, tin- tinker could t'eel a part of the head of the tibia, bare and rough, a small piece of bone having been chipped its inner and posterior edge, but the site of not detected, though it was thought to be in the joint, possibly in the spaee between the condyles;iur. It was then decided to make such an incision M would admit of the performance ofeither excision or amputation, whichever proceeding the condition of the indicate. This was accordingly done; and on opriiin-the joint several portions of the cart i lapcovering both bones were found to be partially detac the bone, s: nd their surface eroded. No found, except the small piece chipped off the inner and posterior.-dp- of the head of the tibia." " Bxcinon being QOU decided on, and as the necessary Steps were be; i. pns.-scaped fr,,m a cavity whicli existed in the outer side of the and partiallv >urroundiiii; t!ie t'. innr.
The ball was found to have j.ene. an inch and three the feinn d, as well as a thin thfl In-ad of the tibia. The patella was also < sected out, because port ts cartilage were softened. and partially detached. The slight oozing of blood was soon stopped by cold water." No vessel required a ligature. The edges of the wound were brought together. and retained by sutures and strapping. The extremities of the incision were left open, to allow of the escape of pus, &c. Wet lint was applied, and the limb placed in a straight position on a M'Intyre's splint, with a short whalebone splint on each side of the joint, secured by strap and buckles.
The patient was placed in bed, and a grain of morphia given him. " The portion of femur removed was about one and three-quarter inches long, and presented an ordinary round musket bullet, about half embedded in the inner condyle, the bone not being split, but the joint opened." No symptom arose calling for remark up to the 25th, when Mr. Lakin's report runs thus: " Had continued slowly improving and gaining strength until to-day; the discharge had diminished in quantity. Had not accumulated nor bagged. The limb had acquired slight firmness. The wound looked healthy, and had nearly healed across the front. Some difficulty had been found in keeping it in very accurate position, as he twisted about when using the bed-pan, and he is naturally a reckless, troublesome fellow.
His bowels were occasionally slightly relaxed, but this was soon relieved by a dose of the aromatic mixture. To-day he seems progressing favourably, but has got his limb into a bad position; bent so as to form an angle externally. A slight discoloured patch, as of a commencing slough, on the outer side of the limb, corresponding to the position of the displaced end of the femur, at the upper extremity of the wound. The plane is readjusted, and the limb secured (.i to it ly' bandages. The discharge is airain rather ini quantity. A bad sore had formed upon the.in, but is improving under treatment." Again, on tin- 27th, the report says. Complains rather lilliness this morning, hut has had no rigors. lla> vomited several times, and his bowels have been pur 1 10.