1 se-n several cases, in which, after - have. made to M ithoul excising it, but; ng. Tin- motion of the joint, and its consequent 086, will be found much, when the arm with'-ut ition. Dupuytren has pointed out important in the OF THE CR1MKAX WAR. position of the aperture is. If at its inner aspect, the secretions get easy exit when the limb is in its natural position, and thus the chance of a favourable result is irreater; if, on the contrary, the orifice be on the outer aspect of the articulation, no position will allow of the free flow of the pus except one, which will prove very fatiguing, and almost impossible to maintain for a long period.
The Returns show the following results as having been obtained from the resection of joints, from the 1st April, 1855, till the end of the war. The imperfect state of the official documents makes accuracy impossible, with regard to the earlier part of the campaign: Cases. Head of femur, 5, primary, of which 1 recovered. ". 1, secondary, fatal. Knee joint, 1, secondary, fatal. Os calcis, and part of astragalus, 1, recovered. Os calcis alone, 1, recovered. Head of humerus, 8, primary cases, 1 " " 5, secondary, no death. and part of scapula, 1, secondary case, followed by death. Elbow joint, 13, primary, with 3 deaths. " " 4, secondary, died from causes not connected! with the operation.
Partial of elbow joint, 3, no death. Larrey performed excision of the shoulder in Egypt 1 times; 4 died 2 of scorbutus, 1 of hospital fever, and 1 of pest, after recovery. In 1795 Percy mentioned 19 cures after excision of the shoulder. Baudens had 13 recoveries from 14 operations (Rev. Med. de Chir., March, 1855). Of 19 operations performed in Schleswic 7 were fatal, most of them from pyoemia. Legouest had cases of primary resection of the shoulder in the hospital at Constantinople, of which 2 recovered. Thus, then, Hennen showed little discrimination in condemning the operation, when he says that it was " more imposing in the closet than applicable to the field." QUN-6HOI WOUNDS OF
Tli above lists by no means represent the whole n. Those who underwent operation Alma aii'l Inkerman, after the battle of Balaclava, aii-l the first winter's work in the trenches, are all excluded, ami thus a vast number of the operations of part of the. war arc omitted. In fact I cannot but think that in this way the majority of the operations do not ap 'he number performed after these early must have exceeded those executed at a subsequent period. ' The articulations injured by balls, although occasionally performed during the Peninsular war, never became a very general practice, nor was it applied t<> some of the joints which later years have shown its advantages in.
The Sehlcswic-Holstein campaign was the peat war in which this conservative proceedingfollowed out on an extensive scale, and the results obt by Langenbeck and Stromeyer attest it- eiiicieucy, although th'-y appear to have had recourse to it in cases ty sliirht injury. These operations certainly mark the surgery of the age, as, in the words of it be said: "C'estunedes plus heureuses tendances dc la chirurgie de ce siecle, (piand la necessity lui met! couteau a la main de ne lui que ce quelle ne 'ni ravii. ritier aussi peu, et de consi-rver alltant <jlie possible.":i'"rdi-d a considerable number of cases adapted to the performance of resection, and I think ur r '1 stand a fair comparison with others, when all the e ire n instances a r< taken into account.
I will not united in as lar-v a pn.por;ises of injury of the joints as we wen hope at the outset of the war it might be; but when a better acquaintance was had with the character of the wounds which this war presented to us, it was easy to understand how such should be the case. The shafts of the bones leading from the joints were often too extensively destroyed to enable the injured parts to be removed by excision; in fact the shafts were so often split, and their periosteal and medullary membranes destroyed, that the resection of the articulation did not suffice to save the limb. Surgeons soon recognized this; but yet it was by no means always easy to determine the true state of things about the joint, till the incisions necessary for resection laid bare the bones, and forced the reluctant operator to convert his operation into one of amputation.