Private- John iv-inu-nt, a-ed 29, was invalided on the L'.'M April, 1856, for "partial stillness of the left knee," occasioned by a shell wound which partially the patella. Private,1. unes ('allau'han, regiment, aged 21, invalided at the same station, on the 14th April, 1856, for " anchylosis of the left knee." This man had a shell wound of the joint, but no mention is made of any fracture of the hones. The articulation was still painful at the period he was invalided. A paymaster-sergeant, t> the 3Sth regiment. us man. was admitted into the general ital the l>th of.June. While kneeling, he was i ihe knee of the limb not on the ground, by a of shell, which was supposed t<> have
The wound appe.1 into the cavity of the joint, and i injury of the head of the tibia h. udcntly i. The patient would. removal a non-commissioned otlicer, his deijlied with. The limb was sliditly bent. and laidon a while local and constitutional remedies inptly applied. For -i-'ht or ten -titutional, supervened. The /ed and painful. Ota irritabl,'. T!i" p: in was chiefly lide of the joint. tlie joint allaeasedj iill.luly when the limb was removed. For a time he did well, but ultimately sank in the beginning of August. The h iad of the tibia was much injured and split into the joint, while part of its shaft was driven upwards into the cavity, and indented the condyle of the femur.
A piece of the head of the tibia was also driven downwards, and was impacted in its own shaft. The articulation was filled with a dirty pink-coloured matter, but the cartilages were not diseased. The flaps had adhered to a considerable extent, but within them a large cavity was found filled with pus, decomposed tissue, and blood. This cavity extended up along the external surface of the bone to the trochanter major. This case was an example of a large class in which amputation was performed late for gunshot wounds of the knee, and in which this large depdt of pus had formed. These are cases in which adhesion of the flaps by the first intention should never be attempted, but the utmost facility given for the escape of matter.
I have seen only one case in which the patella being fractured by a ball, the joint was not at the same time opened. The bone was in that case " starred," but the ball did not lodge. The subsequent inflammation of the joint was slight, and the recovery good j the motion of the joint being, however, considerably interfered with. Penetrating wounds of the ankle generally did well, although they required long treatment. This is opposed to the usual experience of such injuries, but very much seemed to depend on attention to two things first, that the articulation was rendered perfectly immovable; and, secondly, that one or other of the wounds was so enlarged as to allow of the free escape of all discharges.
If the GUX-SHOT W.rxi>s OF.MINTS. >i-il won generally did best;u i fortunately averse to render th- in free if not so originally.* The truth of this remark I ha-l ample opportunity of verifying. Stmm.pinion, that it' there is much destruction of the exlus we should remove tin- limb, as the foot on the appearance of valgus, and is useless. I have not observed this result. -houlder joint lias recovered well in several cases A I have noticed, where a ball has passed through 1 even in cases in which a good deal of the -f tinlion.- has been destroyed. I suspect, however, that the after-consequences are not always so encouraging as the rapid healing would lead us to expect.
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His joint is quite anchylosed. If excision had been practised early, might not a more useful limb have been retained, and much annoyance avoided? The much greater simplicity and superficial position of the shoulder, than of the other articulations, cause it both to suffer less and to be more manageable \vlien injured. Balls sometimes pass very close to the capsule without opening it, or, at any rate, injure it but slightly. Of this, I believe, I have seen several instances. Larrey has recorded a case in which a round shot passed across the shoulder joint; and although it only abraded the skin, it yet shattered the head of the humerus, the scapular end of the clavicle, as well as the acromion and coracoid processes.