They united readily enough along their edges; but the result of this was, that a large bag of pus was formed within the end of the stump, which continued as a depot for absorption into the system, by steeping the end of the sawn bone and the vessels in its matter, and it burrowed far and wide in the intermuscular spaces and along the bone, and ended not unfrequently in causing considerable necrosis of the end of the divided shaft. Unquestionably it may be said that such collections should have been recognized and prevented; but yet it seems to me, that when ample covering it, and of these the flaps were made. This man lay exposed on the Held for three days; yet he recovered completely.
" His case is peculiar in two respects: 1st, no ligature was needed; and 2nd, at least two-thirds of the face of the stump was the surface left hy the passage of the cannon ball, and yet it healed very kindly." Dr. Taylor informs me that he recently saw this man in good health. He is on the staff in Belfast AM i ffa..it was early in tin- Hast, that primary adhesion was tinran 1 exception, and not the rule; and s were so peculiarly liable to purulent absorption as they were with us; it would liave been ' t have attempted primary union, but to have sucli treatment as best favoured the, frees: ge of the matter so soon as it was formed.!iod of dressing with compresses, recommended Mr.
Luke, was most useful in several cases in which I tried it, in preventing the accumulations referred to. The contrast afforded by the heavy dressings for Miployed by the French and our water dressing marked, and may have contributed something result which obtained in the less prevalence of purulent absorption in our hospitals than with them. as it was with us, it never became the terrible epidemic it was in the French We had no means of trying the method of treating stumps in water, recommended by Langenbeck. The ease with which -ecivtion can be got quit of by position in tin- arm and le-. contributes, I have no 't, not a little to the decreased mortality attending operations, as compared to of the thigh.
surgeons, I am told, when operating ' mefh.nl, which they ircne rally 'lit the posterior ilap, and keep this part open "If the pus. Such a Mep would meet with little favour in this country, but it pmentfl many advantages when purulent absorption is so common, was M. Sedillnt of Strasbur-, I bel proposes a similar modification for gmeral use. IB, of course, most desirable w!un P THE CRIMEAN WAR. hospital jjangrene prevails, but it is just at such a time that this result is most difficult to obtain. Cases of secondary amputation of the thigh for injury of the knee, were always those in which attempts at primary union did worst. The long fusiform collections of matter which are so apt to exist in these cases previous to operation, extended, and did every possible harm.
Careful bandaging from above downwards to the base of the flaps seemed to be highly useful in these cases.* Pus poisoning was unquestionably the chief source of our mortality in the East after amputation, especially after secondary operations. The resemblance between its early features and those of ague was perhaps more marked among our patients than it even usually is. This seemed especially the case among men who had served during the early part of the war, of this, however, I am not certain. We had many most beautiful examples, post mortem, of veins leading from the stump remaining round, patulous, and filled with pus, and sometimes reddened in their interior. It was not uncommon to trace the pus-filled vein from the thigh to the vena cava.
It is a question on which it is difficult to decide * Sir Charles Bell, strongly advocated the bandaging of stumps, "to compress the veins and cellular membrane, so that the adhesive inflammation in the mouths of the veins may prevent the inflammatory action on the face of the stump from being communicated to the great vessels. The great vein," he says, "being properly compressed, adheres, and otherwise it lies loose and open, and the inflammation of the general surface will be communicated to it." It is not for this reason, but'to oppose the burrowing of matter, and to prevent muscular contractions and the protrusion of the bone, that it is now adopted. AMITTA'II' whether or not, when pus absorption is so common as it. it would not be just i Hal ile practice to ligature the chief vein at the time of operation.