The first case was under my immediate notice, and from its presenting what might lia\v been considered the most favourable features for conservatism, it gave me much interest. An officer of the (>>'M regiment, aged 19 years, was accidentally wounded by tion as truly as if amputated, but with the additional circumstances of being converted into a source of misery to the sufferer, an impediment to the tree motion of the rest of the body, and often a cause of irremediable bad health Such cases I hold to be among the worst specimens of bad and injudicious surgery." It is much to be regretted that surgeons cling so much to a few cases of recovery, and shut their eyes to the vast mass of instances in which the attempt to save life and limb has failed, forgetting that " Les miracles ne peuveut servir de base & aucun jugement." John Bell puts this with great force: " Thinking only of this wonderful recovery, the surgeon willingly forsakes an uncomfortable rule to lay hold on this one glimpse of hope, while, indeed, if he reasoned fairly, he would perceive that the exception should be lost in the fullness of the general rule, and not the general rule disturbed by the exception." Alcock, too, says: u In the class of injuries under consideration, this danger is most especially evident.
Many are the extraordinary and most unlooked-for successes attending the treatment of forlorn cases ot injured joints. Were general rules or principles of treatment to be founded on these cases, which are but units among thousands giving contrary results, and were no reference made to these greater numbers which enlarged experience shows must perish in vain attempts to save limbs, an innneiiM sacrifice of life and increase of human suffering would inevitably follow." Guthrie, after emphatically protesting against our being guided by thc.-<exceptional cases, says " If one case of recovery should take place in lil'ty, is it any sort of equivalent for the sacrifice of the other forty-nine? Or is the preserving of a limb of this kind an equivalent for the loss of oin; man?
" w.H-NPS nr JOlfl his own revolver duriivj; the reconnaisance in force at Kinlmrn, on 1st < Vtoher. He was half reclinii'u on the ground at the time of the accident, his h-l't ehed, and his right knee half-bent. His in his riirlit hand, and close to his limit. The mu/./.l lire, ted downwards, and obliquely inwards, towards the middle line of the body. Tin- ball, a small conical. weiirhinic tour drachms, entered at the outer and snrfaee of the lower third of the riirht thigh,;t three inches above the border of the patella, and lodged. The wound appeared to lead into the cavity of rhe joint, and an indistinct grating was said to have been 'omninnieate.l to the hand on moving the patella from to illegible in the scan of the first
The joint was fixed, and as In- was taken on board ship, and put under the immediate el large of my friend Mr. AVhitc of the 3d Drag*.on < iuards, every rare was bestowed on him. On the 24th there was some swelling of the joint, accompanied with pain. The wound of entrance was beginning to suppurate well. Synovia had not been seen to escape, ilis pulse was 78 and soft, and his secretions were natural. The penetration of the joint was believed by all, still an attempt to save the limb was determined on. The usual local and constitutional antiphlogistic remedies, including evaporating lotions, fomentations, leeches and cupping, antimony and calomel, were diligently put into requisition. By the 30th, the joint was much swollen, and painful on pressure.
A spot, about the size of a shilling. over the head of the tibia, was exquisitely tender, lie was feverish at night, when the pain was always much exacerbated. An abscess formed among the muscles of the thigh, and continued to suppurate profusely after being opened. It had no apparent connection with the joinl. Slight hectic set in. The pain in the joint became lancinating and throbbing to a most harassing degree, particularly over the head of the leg bones and over the patella. The articulation assumed all the appearance and feel of a joint affected with white swelling. Tin's was the state of things by November 19th, when amputation was finally decided on, and performed in the middle, of the thigh, the state of the limb not allowing of its performance lower down.