[fragment illegible in the scan of the first edition]
Hy Cases not iuun. BUBO Tin; rm.Mr.AX WAR. structioii may be inflicted on the articulating of the bones without much external appearance of such mischief, we are often deceived in our early examination of these cases, and this is one reason for delaying the adoption of decided measures, though delay so frequent Iv proves fatal. The wound of a ginglymoid articulation is, as a genera! rule, more severe than that of a ball-and-socket joint, chiefly from its more complex structure. Larrey noticed how often tetanus was caused by wounds of these joints. and every surgeon can testify to the extremely severe symptoms which follow their injury. Although it is true in general, that a mere fissure extending into a joint may not be followed by serious results, still it is no less certain that even such apparently trivial accidents are often followed by the most disastrous consequences.
It is a matter of much moment to possess a decided opinion upon the treatment of gun-shot wounds of the joints, as in no class of cases is prompt action so much called for; and none in which, by the parade of a few successful cases, is the mind of the surgeon more apt to be misled. If, on seeing a case, we were able to decide means, or received into a permanent hospital with a lax discipline; and 8. Cases treated under unfavourable circumstances, or those admitted into crowded epidemics prevailing, means either personal or material not fully adequate; with cases of wounds inflicted after a r patient, and the degree of injury...
FOINTS, what ren -iv demanded lor its management, then ibly much si; 'iilt' the neighbourhood of joints pure much attention, not only from the fear of secondary implication ot' the articulation, but on account of the which is apt to ensue in it from long disuse during the period ot' cure. Artificial motion should be i early in these cases. The hip is too deeply placed, and too much protcr crepitation may be perceived.; but the following is one case of description.
It is rel;,t.-d in the n-.-i-t.-r <>f the Dep; Colaba, in the archives of the medical rtment. Al M IMiail. a-'ed 33, wound March, fti/a matchlock which; little above the -Teat troehanter of the WHS lost. His leg became j.oweri coming to Colaba on the 2(5th April, he did note of much pain, except lln- joint lit fullness over the hip was the. I!' injury. Lm-lies and iv employed, and he seemed to get better. On.Mav (>th In- was attacked with trismus, and died on the Jlth. Tin- ball was found embedded in the head of the femur, which, with of the brim of the acetabulum, was shattered, and the capsular ligament formed the sac of an abscess which contained a considerable quantity of pus and spiculro of bone.
The orifice of the wound, it is added, had closed some time previous to death.* Larrey mentions the case of an officer wounded in Egypt, who received a ball in the neck of the femur. The wound closed, and twenty years afterwards, on the death of tinpatient from disease of the chest, the bajl was found impacted in the bone. The knee when penetrated by gun-shot presents an injury of the gravest description. Taking much interest in cases of this description, I visited every one I could hear of in camp, and can aver that I have never met with one instance of recovery in which the joint was distinctly opened, and the bones forming it much injured by a ball, unless the limb was removed; yet the returns show several recoveries after such wounds, some of which, at any rate, I cannot but think are founded on error.