On the 1st December he was transferred to the Castle hospital at Balaclava, at which date the stump was suppurating kindly, but an erythematous blush overspread the integuments of the limb as IHO1 high as the hip. This disappeared in a day or;;'.ii ngth seemed to improve. On the 4th, In- had a slight rigor, which was repeated twice daily. He gradually sank, had cold sweats, dyspnoea, diarrlm-a. and died on tin- Sth. The end of the stump was hollow, and contained much pus, and halt' an inch of the end of tin- femur was dead. The lungs were congested, but beyond this no particular appearance was observed.
The vessels of the stump seemed healthy. In the removed limb, the tissues around the kin-e joint were found much engorged, the articular cartilages and ligaments were In. in the uncertainty which marked the line of procthe outset, tinlong absencserious symptoms thr smallness of the ball, and the fatal result, notwithstanding th<slight injury to the.
It' a tree opening had been made early into ii not have saved lite and limb? Miller, private, 81s1 n-gimmi. wa- admitted into the ral hospital on the!nli.July. his left leg coming forwai was marching down to the tren. he was stru. i.,ell over the lower end of tlif-'liiiir, and tinexternal Miriaee of the knee joint. wound was ai out four inches long, little 1. OF THE CRIMEAN but deep, and opened the joint. The wound was carefully closed by suture, the limb fixed, and cold was applied. Inflammation was violent by the 16th, notwithstanding the employment of every means to moderate it. The wound opened and synovia escaped freely. The constitution did not apparently sympathise much for many days after the local inflammation was considerable.
Pus was poured out freely by the wound, symptoms of pyoemia rapidly set in, and he ultimately died on the 3d of August. The external condyle was splintered into the joint, the cartilages were eroded, but little fluid existed in the articulation. If the joint had been freely laid open after the wound had failed to adhere, might not a better result have been reasonably looked for? Shell wounds of the knee are as a whole not so dangerous as bullet wounds. They frequently merely cut the soft parts open; or if they injure the bone, the larger aperture which they leave acts beneficially in permitting the free discharge of secretions. I have known many shell wounds in the neighbourhood of the joint, and not a few in which the articulation was opened and even the bones injured, ultimately do well, so far as saving the limb goes; more or less anchylosis following.
The followingshort notes of three cases of this description were kindly sent me from Chatham, and are of more use as bearing on this point than other cases, the outlines of which I possess, as they record the state of the patient some time after being injured. Patrick Madden, private', 49th regiment, was struck by a piece of shell on the left knee, when in the trenches, on the 30th of May, 1855. The joint, if not opened, was very gravely injured. He was two months under treatment in the Crimea, with his articulation.,i 3 or JOINTS. much swollen and inflamed, and when he reached 1. land the wound had hcah d. He was invalided on accou:.-lliu.ir, pain, and weakness of left knee," the joint bfinir partially anchylosed. and its tissues thiekene(l.