War of the Rebellion: Serial 073 Page 0528 THE ATLANTA CAMPAIGN. Chapter L.

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Primary complete resection of the joint offers, in my judgment, the greatest prospect of success. Secondary and tertiary amputations, after osteomyelitis is kindled or fully established, are very dangerous to life, and every moment of delay in the amputations necessitates a greater sacrifice of length. With a full and careful examination and estimate of contingencies, every case must be decided upon its merits, and it is impossible as yet to promulgate a general law. It must, however, be said that the chances for life, preservation of constitution, and prevention of suffering, preponderate in favor of primary amputation when the elbow joint is splintered. In this, as in all traumatic amputations, the section should be through periosteum and bone which are free from injury and have not taken on inflammation, and as low as possible. Excisions of the elbow joint require a great degree of attention, local and general, to insure success, which can seldom be furnished in extemporized military hospitals. In a permanent field, well organized, and supplied with pure water and air, I would not hesitate to make complete excision of the elbow in favorable cases. The law of complete excision of the elbow in favorable cases. the law of complete excision for this joint is very generally disregarded in army practice, and the results of the operations are hitherto far from encouraging. I do not think there is any objection to a partial excision when the part injured is small; for instance, the head of the radius, or a small portion of a condyle. I believe the injured portion may be removed with propriety, and the case treated on general principles. I would always recommend partial resection when the case has passed into the pathological condition. Such cases, however, are usually attended by an amount of local and general disturbance which renders amputation the only resource. Complete primary excisions of the head of the humerus is one of the most easily performed and successful operations in army practice.

I deprecate the very long sections of the shaft of the bone, which are sometimes made. I have never seen a useful arm when more than five and a half inches were removed with the head. Partial excision of the head of the humerus is a safe and successful operation. It is especially valuable as a secondary measure, for the removal of caries, or small fragments that have been undiscovered. Scapular motion makes great compensation for anchylosis, and it is frequently better to accept this result rather then incur the risk to life by the more brilliant procedure of complete excision. The utmost conservatism has been recommend and enjoined in regard to the hand and has, as a rule, been practiced with success.

I remark, in passing, that a faulty position is very frequently observed in hospitals, and among discharged and furloughed soldiers, when the fore-arm and hand are in a process of cure from fractures, gunshot injuries, and operations. The hand is almost invariably in a prone position. Asst. Surg. J. D. Johnson, U. S. Volunteers, adapted Smith's anterior splints to meet this difficulty, and introduced [them] into practice at Chattanooga, with my cordial approval, last winter, at the time I was medical director of hospitals at that place. The splint is bent to the proper angle for the elbow, padded and applied to the inside of the arm. It affords easy and efficient support and fully meets the indications, and supports the fore-arm comfortably in the position midway between pronation and supination. I beg leave most respectfully to recommend that wire gauze and perforated sheet zinc, with shears of the requisite size and tem-