head of the humerus was shattered, and partial excision of the tarsus and carpus advised in all cases which gave any hope of saving the hand or foot in a condition of partial integrity and usefulness. The rule was laid down to excise the hip joint when it was severely wounded, without extensive comminution of the shaft of the femur. No case, to my knowledge, favorable for excision of the hip joint occurred in the Army of the Ohio during the campaign. Two cases of amputation at the hip joint have been performed with my sanction and in my presence - one at Knoxville and one on the field near Kenesaw. Both were denier ressorts, and both proved fatal before the patients could be removed from the table.
I may remark, in passing, that I performed the operation of resection of the hip joint, after the first battle of Jackson, Miss., in May, 1863, for comminution of the great trochanter and head of the femur. The patient died in four days, but the progress of the case and the mildness of the symptoms justify, in my mind, the opinion that the operation will frequently save life in a class of injuries, from their nature, almost without exception, fatal. I have removed the large portion of the greater trochanter twice, with good results, as secondary operations. The principle of removing fragments primarily, when detached, is obvious, and has been recommended to the surgeons of the department. Compound comminuted fractures of the thigh were almost invariably amputated primarily when resection took place. The operation was well borne, and the tables will show a larger proportion than usual of recoveries. In hopeless comminution of thigh, ease of position, with reference to drainage and support of the powers of life, were the only points considered in treatment. I have always insisted that this class of cases should be transported by hand whenever it became necessary to move them, and have been usually able to retain them in the field hospitals without removal, excepting for short distances carefully by hand, as long as they lived. When death does not result from primary shock, the average duration of life is from two to three weeks. It is in view of this class of cases and those whose only hope is in absolute immobility, that the question of reciprocity of consideration and courtesy respecting hospitals and all sick and wounded, between belligerents, assumes its immense importance.
There were fifty-nine cases of compound comminuted fractures of the thigh, six of which were immediately fatal. There were forty-eight amputations of the thigh, leaving out those which were not interfered with. The proportion of recovery is 55.5 per cent. One of the cases regarded as hopeless, and treated by resection of the sharp ends of the fragments, is now making a fair recovery, and is mentioned in the list of cases (see James Brewer, private Company K, One hundred and thirtieth Indiana). Resection of femur case Numbers 2. This point will be reverted to again. Resection in cases of comminution of the shaft of either the radius or ulna was encouraged when one bone was entire, but when both bones were comminuted the practice recommended was to remove loose fragments, smooth sharp points, and hope for consolidation, with secondary amputation in reserve. Primary amputation of the upper extremity was discouraged in all but cases which admitted of no possibility of doubt, due reference being had to projects for care and the preservation of immobility. The question of amputation of the arm or resection of the elbow joint is often one of great difficulty.