These collections almost always occur in the thigh in preference to the leg. At a late period of the case, the joint puts on all the appearances of white swelling an observation first made by Dr. John Thomson. Military surgeons of all times have recognized the necessity of removing the limb early in these cases when the articulating ends of the bones have been fractured by a ball, and the experience of the late war fully bears out the practice. French and English surgeons were, I OF JOIU think, at one on this in the Crimea. In December, rds of forty 68868 in hospitals, ami all pt those primarily amputated. I have heard incidentally of one case occurring in their army which recovered, but have failed to learn its is certainly very disheartening, as well as humiliating to professional pride, to think that we cannot >uch cases without The very small f visible destruction which is so often present, the slight complaint of pain or appearance of disturb which frequently exists at the period when the limb moved in order to insure success; the very pardonable unwillingness of the patient, especially if he n officer, to submit to so dreadful an alternative, where there is, to him, so little apparent danircr; all ler difficult,the adoption of those n wliich a dire experience has shown to be necessary, for that amputation is our only resource all arlo to find the particulars of I.'MIP cmco in which the knee was penetrated, hut the injury a to lead livery nmdic.L k has tin; of cases in which the aiticul.iti in li an nrticul.iti< rily affected, M recovered, 21 with loss of a lied. is without amput that if the is,.i-i-s.,1 Iealh 14 cases of.siil..
Client aiiipiilation.x t ii Id tin n for result, not a IOM of 25, I rd. li; m primary amptr ds, therefor, have been saved." Of 35 cases in the knee was more lost their lives, ai -t their legs. " After MI> h i the five who recovered preserved good TIIK (MM.MM AN WAR. Outline has seen no case recover in which the was not removed. Larrey reports some, but they were instances of slight injury. Esmarch, from the fields of Schleswic-Holstein, says " All gun-shot the knee-joint, in which the epiphysis of the femur or tibia has been affected, demand immediate amputation of the thigh.
It is a rule of deplorable necessity already given by the best authorities, and which our experience fully confirms." I have often contemplated the laying of the articulation freely open at an early period in these cases, so as to permit of the extraction of all foreign bodies, and the free escape of the pus which must afterwards be formed, the retention of which is undoubtedly one great source of danger. This might be attempted even although it were necessary to lay the whole front of the joint open by an incision similar to that for excision.* The joint has been frequently widely laid open by cutting instruments, both primarily and for disease, and most satisfactory cures have been obtamed.f If, however, the attempt is to be made to save the limb, the most rigid antiphlogistic treatment must bo followed.
Local bleeding by leeches, and the application of cold; the avoidance of all local remedies which are of a relaxing nature; the perfect fixture of the articulation, and the absence of all pressure; as well as the early evacuation, by free incision, of abscesses, and of At the time the above was first written, I had not seen Strombook, and did not know that the same idea had occurred to him, or that, in the only case in which he had practised it, the results had been nu> cooragfog, f Sec especially Paper by Mr. Gay in the Laurel for October 25, 1R,">6., UK jona matter if it within the j"int: l! the leadient indications to lie followed. Hectic, with D ieoompafllinenl diarrlm-a. puruleni M. witli a v implication of internal organs, - which mo; lit Tl.ce of the articular cartilages would he of litth TIP. incut, as they soon disappear; and it' the kept in close contact, firmly fixed, allowed pe, there is no reason why Ic results ini-'ht not be obtained. Such a iin no way so severe as excision of the joint, and yet how successful has this been! The great soure. it ion and danger would be done away with, and if we 'thy patient to deal with, 1 cannot see why -hould fail. 'ii is thought of, the sooner it is undertaken M the operation is performed late, after suppuration have U-en for re very illegible in the scan of the first