I have conversed with many surgeons of large experience on the subject, but never heard of any case recovering without amputation, in which the diagnosis of fracture of the epiphysis was beyond doubt; yet such cases have Preparation '2604, in the museum at Fort Pitt, was, I believe, obtained from tliis patient, as the. description of it in the catalogue is as folio v, " A record I remember one Case, probably included among the iveoveries, in which a ball passed f tin' joint, causing some eil'u>ioii and swelling in it, with no constitutional disturbance whatever, and resultin the man's return to duty within a hut which t'. r u re put down as a penetrating wound, remarking (as he well might) on the curious immunity from constitutional or sal symptoms which had marked the e; The following is a very interesting ease, and certainly of the most difficult to explain of any with which am acquainted.
I never saw the patient, hut the details Jndly sent me by Deputy-inspector Taylor i Chatham: " Private George Hayes, aged 31, 47th tnentj was wounded at the Alma by a p-apc shot, which entered on the outer side of the ligamenuim.he. and pas.-rd upwards through tiie knee-joint,.:tlie patella in its course, and making its exit at nor Mpect of the thigh abort its middle, partially.>ortion of the patella iii the eoiu>c of treatment, U u rai aents of the femur well as anchylosis of tin- joint, fortunately plaet-. At the time of his discharge he cmild SUSht upon the limb, and could walk aliout without erutehes." I saw another case very similar to In this infltarfCCj the lall had k the man when he was about to kneel, and apparent!; of the tibia.
The ball was from tie 1 of the thigh. Scarcely follow. 'he joint swe!le<l. was painful to ended by Losing part Q -MIGEKY OF TIIK C HIM KAN WAR. motion. If tlu' articulation escaped the passage of the lall, the case was very curious. The round ball sometimes penetrates the lower end of the femur or the head of the tibia without causing splintering, or opening the joint, or at least with an amount of injury to the capsule which is very slight; and such cases may recover, and so shake our conclusions about others of a less anomalous character. Balls, too, may pass very close to the capsule and yet do it no harm, though these cases are put down as penetrating or perforating wounds of the It is undoubtedly often very difficult to know whether the joint has been opened or not, particularly if the ball is a small one, as was the case in one instance afterwards mentioned; and it very often occurs that the missile has run superficially under the integuments, or coursed round the bones, when it appears to have passed through the articulation.
It is to be remembered, also, that the swelling of the joint may be merely the result of a bruise, or of the extension from the neighbourhood of the inflammation which has been caused there by injury, and is thus no sign of direct wound of the joint. Another point which renders these injuries difficult of recognition when the bones are not much implicated, is the length of time which may intervene before the * Alcock thinks that if a ball do not absolutely project within the articulation, or if the foreign body be smooth, and not project much beyond the articulating surface, the limb may be saved. Independently of the f;ict that the cases are infinitely rare in which a ball especially a conical our can thus penetrate, without causing grave and irremediable fracture of the bones entering into the articulation, it is not at all consistent with my observation that such eases can be saved.