MILITARY SURGERY AlfD MEDICINE. 



547 



by the circular or flap operation, is still 

 an unsettled point. The flap operation has the 

 advantage in point of time, and on that account 

 is preferable where time is a consideration of the 

 greatest moment. But the flaps in operations 

 on the thigh are very apt to loosen and become 

 gangrenous or ulcerate, if the patient is to be 

 transported for a long distance immediately or 

 soon after the operation, and in such cases the 

 circular method, as giving a smaller amount of 

 muscular covering, is preferable. In opera- 

 tions on the leg, the circular method is usually 

 best. To avoid sloughing of the end of the 

 bone, the practice is to dissect up the perioste- 

 um from it for an inch or more, and drawing 

 this back, sever the bone at the highest possi- 

 ble point underneath the mass of flesh. 



Exsection and resection of the bones of the 

 tipper extremities have been practised with 

 very gratifying success in many of the general 

 hospitals, the limbs, though shortened, being 

 serviceable and much better than an artificial 

 limb. The operation, though painful and tedi- 

 ous, is justified by the results attained, and is 

 usually performed while the patient is under 

 the influence of antesthetics. Operations of 

 these descriptions on- the bones of the lower 

 extremities have very seldom proved successful. 

 A I'^w c:;?es of successful exsection of the tarsal 

 bones, and four of exsection of the shaft of the 



FIG. 



femur, and one of the head of the femur, are 

 all, or nearly all, that have resulted satisfac- 

 torily, while large numbers have had a fatal 

 termination, a result which perhaps would have 

 followed in any event. 



The instruments used for these purposes are 

 numerous, and most of them are of recent in- 

 vention. Among them are straight and curved 

 bone cutters ; strong forceps for holding the 

 bone, like those recommended by Chapaignac, 

 and improved by Halstead, of Js ew York (fig. 

 26) ; chain saws of various kinds, of which the 

 Symanowsky saw (fig. 27), improved by Tie- 

 mann, is the best, combining, as it does, the 

 advantages of a chain and fixed saw ; it is dis- 

 connected by a spring on the handle, passed 

 under the bone and reattached instantly* and 

 may be made to cut in any direction, even in 

 the segment of a circle ; bone drills of various 

 patterns to make provision for bringing to- 

 gether by wire ununited fractures, among which 

 those of Surgeon Howard, U. S. V., which 

 work with a bow (fig. 28), are best. The 

 interosseous knife of Dr. Sands (fig. 29) is 

 shown. 



The prevalence of hospital gangrene in tha 

 large army hospitals has been a not unfrequent 

 occurrence, though always one greatly dreaded 

 by the surgeon, as seriously aggravating the 

 peril of his patients. It is developed by over- 





FIG. 20. 



f urs-;sou's Lion-jawed, bonc-holdinj 

 Forceps. 



Sjinoaosky's Saw for Boue 

 Reflections. 



Dr. Howard's Bone 

 DrilL 



Dr. Sands' Intes 

 osseous Knils, 



