This man was saved by the excision of the destroyed bone. He tells us he saved many cases in which the opening into the joint was not great. If a ball remains impacted in the head of the bone, as it sometimes is known to do, then the sooner it is got rid of the better, as caries of the bone, disease of the joint, and either amputation or death will follow. One case occurred at Scutari, in which the ball was found after death firmly impacted in the round head of the bone. I find the report of a similar case as having occurred in one of the regiments serving in China in 1841-2. In this case also the ball was not removed, necrosis was caused, and the patient died of exhaustion on the fiftieth day.
Malgaigne, however, reports a case in which a ball had been so englobed, and no disease whatever caused in the bone, where a considerable cavity ur JOINTS. lined the ball.. - and iistulous tracks are the things m<>st ti. 1" dreaded in all cases in which the boulder joint is implicated in gun-shot wounds. In the following case of penetration of the elbow, the M a w.tund caused l.y a sword cut from one made ly a ball was well shown. If a ball had passed across the artieulat ion, traetnri 11 bones, excision.1 have been called lor. A dragoon was cut across v of his sword arm by a Russian horseman, at the 1: charge at Balaclava.
The olecranon completely detached, and the joint opened. The wound was immediately closed, the arm placed in an extended position, and cold employed to allay inflammation. Little more was done, and the divided surfaces quickly adhered, and an arm remained which, although not so in its motions at that joint as it was formerly, was yetmostusetul.and w.mld, 1 doubt not, become more so in time. Abscesses around the joint, and <v leniatoiis swellings of the hand and arm are very apt to follow injuries of the elbow. Lanvy thought gun-shot wounds of;!.trly daiiLfr-'iis, from the strong ligaments whi< id it, and the little distensibility of the joint; beneommeodf amputation when it has been lar-vly 11 by a cutting instnim.-nt, and blond has been into tin- cavity.