That nice adr.pta. however, of i '. vs, tliat accurate fixture of the limb, the careful attention, nourishment, and perfect 96 which such cases obtain in a civil hospital, and which have so much to do with the result, can hardly be!:ied in the field. Mr. Fcr-uson, in the last edition if his admirable manual, thus sums up the advantages which his large experience ascribes to the operation: mid is less than in amputation of the thigh, the ling seldom requires more than one or two ligatures, loss of s is less, and probably on that accoun ifl less shock to the system; the chances of secondary haemorrhage are scarcely worth notice, as the mail. 's left untouched; there is, in short, nothing in t! consequences more likely to endanger tinnt's safety fcl: amputation, whilst the pect of retaining a useful and substantial limb, should i rage both patient and siir-vnn t<> this ii be performed in the field, the so<> he better; for, although iaease, t!i tion soon becomes affected, if it! v to intlammatini, the c- which is to follow may be established before we well danger of debt; ions too, it should always be remembered, do n,t hold out the same prosin military as they do in civil practice.
Thr s;i,d tin- absence of 6 which i pointed or; rirufton, r, fcB ot' much w.-iirht in favour ot are to be dealt with who are so sensitive to any haemorrhages as those wr had to deal with in the Crimea. The resection of parts of the shafts of the long bones was not, to my knowledge, much practised in the Crimea. The lengthened period those cases take to recover, and the trying nature of this ordeal on the vital powers, made such abstinence with us almost a necessity. Several cases resulted very favourably, in which part of the shafts of the humerus, of the bones of the fore-arm and of the leg, were thus dealt with; but in more than one case in which I. knew such steps taken, too much was expected of the reparative powers of our patients, too large an extent of the bone was removed, and thus the operation failed.
It was towards the end of the war that the best results were obtained from these resections. In the case of the tibia especially, the choice between amputation and resection must be guided chiefly by a consideration of the state of health of the patient, whether or not he is in a condition to withstand a long and tedious cure; by the extent of destruction of the bone, and especially of its periosteum, and finally, the means at hand for carrying out the after-treatment. Resections in the continuity of the femur were, so far as I know, invariably fatal. The difficulty of the operation on muscular limbs must of itself predispose to disagreeable False joints are, as is well known, apt to occur after resection in the continuity of bones of the leg and fore-arm, when the operation is practised on only one of their two bones. The success of two cases lately published by Mr.
Jones of Jersey, in which a considerable part of the shaft of the femur was removed., shows thai those operations may be well adopted in civil practice at any rate.