There is a second fracture situated about the middle of the bone. From Private James Aitkin, æt. 27, who received a severe shell wound of the left leg in the trenches on August 18th, 1855. He was standing erect at the time. The knee-joint was distinctly opened into, and the head of the tibia severely comminuted. Amputation was immediately performed, and the patient recovered.-Donor, Dr. Cowan, Assistant-Surgeon, 55th Regiment.

The following preparation shows a bayonet wound of the knee-joint, followed by severe inflammation, profuse purulent discharge, and irritative fever, rendering amputation necessary sixty days after the injury. No. 3633.-A portion of quill passed through the original wound shows the direction it took ; it is situated just beneath the level of the patella, and a little to the right side. The synovial membrane is thick and gelatinous. West York Rifle Regiment.-Private John Gannell, of strong, healthy aspect, while drinking in a public-house, on February 5th, 1858, a sergeant of another regiment drew his bayonet and wounded him on the left knee. The wound had every appearance of having penetrated the joint; the pus was excessive; the wound, though small, was deep, and situated just beneath the level of the patella, and a little to the right side of it. Late in the evening of the 5th he was delirious, and in great agony; his sufferings were so great that anodynes had to be largely given before anything like a quiet state could be arrived at; the knee became swollen, and the pain continued, and showed signs of the formation of pus in the joint; abscesses also formed outside the joint, and were opened. A profuse discharge of purulent matter continued from the wound, and the man's appearance, pulse, &c., assumed the hectic character rendering amputation of the limb necessary, which was performed April 6th, and the patient recovered.-Donor, Assistant-Surgeon Taylor, Royal Artillery.

14th Light Dragoons.-Private James Ball, æt. 30, was wounded at Muddenpore Pass on 3rd March, 1858, by a musket ball, which entered the outer side of left knee, and was cut out about two inches posteriorly. Joint primarily injured? The surgeon says, No; but the contrary seems probable. Free incisions around the joint were subsequently required. The limb can now only be flexed to a slight extent, but the joint has

lateral motion in a direction inwards to middle line. Invalided June 29th, 1859.

Sergeant Michael Kearnan, 88th Regiment, was wounded on the 21st of October, 1858, at Burwah, by a musket ball, which entered over the outer hamstring. The wound is now soundly healed. The limb is somewhat atrophied, apparently from disease, but the motions of the joint are perfect. It is just possible that the cavity of the joint was not opened; but from the position of the cicatrices of entrance and of exit, it seems difficult to conceive how this could have been the case; and as usually happens when an instance of wound or injury of more than common interests presents itself, the documents forwarded with it are almost entirely destitute of information. If the joint was opened, the result of the case may be looked upon as most successful, for, as before stated, the motions of the joints are uninjured, and the limb will almost certainly recover its strength under judicious exercise.

ANKLE-JOINT.

The following case was the only admission from India under this head:-37th Regiment.-Private Charles Smith, wounded April 17th, 1858, near Azinghar, by a musket ball, which entered the left instep in front, and about the internal malleolus, and was cut out about two and a half inches lower down, and a little posteriorly. The inner malleolus appears to have been removed subsequently in fragments; anchylosis of the ankle-joint has followed; the foot turns slightly inwards, and the great toe is stiff. Invalided February 9th, 1859.

G. Duddley, æt. 28, 53rd Regiment.-Was wounded in Oude on the 27th April, 1859. The wound was in the right anklejoint; for the most part only a contusion of the skin, but there was a small irregular opening through which apparently a jagged piece of metal had passed, and from which synovial fluid exuded in considerable quantities. Great swelling of the foot set in, but this subsided, and the wound healed. The ankle-joint still remained slightly stiff, but otherwise walked well, and was sent to duty.

CHAPTER XIV.

GUNSHOT INJURY OF THE LARGER ARTERIES, NOT BEING AT THE SAME TIME CASES OF COMPOUND FRACTURE.

UNDER this head one was admitted and invalided from India. It is, however, probable that the case of Private Bulger, which is detailed at page 134, is of this nature.

It is seldom that primary hæmorrhage occurs on the field of battle, even though the ball may have passed directly through the course of a large artery. This is in some measure accounted for, although not entirely, by the round form and the strong elastic coats, but especially by the mobility of the vessel.

Arteries and veins firmly bound to bone are more likely to be injured than those that are lying loose in the fleshy parts of a limb; for instance, the femoral on the brim of the pelvis.

The coats of the veins, being thinner than the artery, are much more readily injured, and primary hæmorrhage proceeds more frequently from them than from the arteries.

Only 14 such are returned amongst the men during the whole period of the Crimean war, and one in an officer.

The following preparation is a beautiful example of the elasticity and toughness of the coats of both artery and vein, and likewise of the mobility of these vessels, allowing of being pushed aside by the ball.

No. 408 (see Plate IX, fig. 3). Portion of the femoral artery and vein, between which a ball has passed, causing mortification of the limb, and death.-Donor, J. Guthrie, Esq., D.I.G. This specimen was taken from Private P. Tumbrill, of the Grenadiers of the 74th Regiment, of good stature, who was wounded on April 10th, 1814, by a musket ball, passing from the inside to the outside of the middle of the thigh; he says it bled considerably at

first, but the bleeding soon ceased; the wound was not painful, and he thinks he observed the leg and foot to be colder than the rest of his body for the first two or three days, but did not much attend to it, further than conceiving the numbness, coldness, and impeded power of motion as natural to the wound.

"On the 18th April the gentleman in charge of this patient pointed him out to me as an extraordinary case of gangrene, coming on without, as he supposed, any sufficient cause. The wound on the outside of the thigh, or the exit of the ball, was nearly healed, and that on the inside was without inflammation or tumefaction, and with merely a little hardness to be felt on pressing. The pulsation of the artery could be distinctly felt to the edge of the wound; the leg was warm; the gangrene confined to the toes; the artery of the other thigh could be distinctly traced down to the tendon of the triceps. As he was at a small hospital about two miles from town, I did not see him again until the 20th, and afterwards on the 23rd, when, although the gangrenous portion included all the toes, it had the appearance of having ceased. Satisfied that it would again extend, I left directions with the assistant-surgeon that the limb should be amputated below the knee.

"The surgeon, whom I had not seen, and who did not understand the subject, disobeyed the order, conceiving there must be some mistake. On visiting the hospital a little after daylight on the 25th, I was greatly annoyed at finding the operation had not been done, and that the mortification had begun to spread the evening before. It was then too late; on the 26th it was above the ankle, with considerable swelling up to the knee; at night the man died, and the next morning, at six o'clock, I removed the femoral artery from Poupart's ligament to its passage through the triceps, which part was affected by the mortification.

"The ball had passed between the artery and vein in the spot where the vein is situated nearly behind, and adherent only by cellular membrane, through which the ball made its passage; the coats of the vein being little injured, and those of the artery not destroyed in substance, although bruised; it was at this spot much contracted in size, and filled above and below by coagula, which prevented the transmission of blood, and the vein above

and below the wound was filled with coagulum, and was also impassable."

This preparation is unique. It is perhaps the only one in existence proving the elasticity which vessels possess, and their capability of avoiding to a certain extent an injury about to be inflicted on them.

LIGATURE OF ARTERIES.

Three cases requiring ligature of arteries occurred: one was deligation of the radial artery, eleven days after a gunshot fracture of the ulna, implicating this artery; another was for secondary hæmorrhage, one month after a gunshot wound of the leg, with partial fracture of the tibia; the ligature was placed upon the lower third of the posterior tibial. third case the femoral artery was tied.

In the

53rd Regiment.-Private Patrick Hanafin, wounded at Lucknow, November 16th, 1857, by a musket ball, which entered on the inner side of the left tibia, about three inches above the ankle-joint, and passed through the fibula, three inches from its lower extremity; about one month after, secondary hæmorrhage took place, following sloughing of the wound, requiring ligature of the posterior tibial at the lower third of the leg. He was also wounded in the right thigh by a musket ball, which entered on the outside near its centre, and passed through in front of the femur, on the inner side, close to the course of the femoral artery. Both wounds are healed.

Private John Skinner, 6th D. G., æt. 24.-Was wounded 24th November, 1858, at Dundekereraih, by a musket ball, which passed through the left popliteal space, apparently injuring the tendons of both hamstring and wounding the artery. The femoral artery was tied at scarpa's triangle on the same day, apparently on account of hæmorrhage. Knee now contracted nearly to a right angle, and any attempt to straighten it gave great pain, extending down the leg to the foot. The foot is cold and numb, and the whole limb is wasted. Invalided on account of impaired use of left leg by result of perforating gunshot wound of ham, with direct injury of the popliteal artery.