Wounds in war : the mechanism of their production and their treatment . of which arestated to have suc-cumbed to pyaemia orother infective disease,and it may very wellbe that many of thesewould not have provedfatal had an aseptic con-dition been will be noless effective in savinglife in those cases of pri-mary resection whichdo not die of shockwithin the first twenty-four or forty-eighthours, than it will bein obviating the neces-sity of performing inter-mediate and secondaryresections in casestreated at first conser-vatively. The Cases requiring the Operation of Primary
Wounds in war : the mechanism of their production and their treatment . of which arestated to have suc-cumbed to pyaemia orother infective disease,and it may very wellbe that many of thesewould not have provedfatal had an aseptic con-dition been will be noless effective in savinglife in those cases of pri-mary resection whichdo not die of shockwithin the first twenty-four or forty-eighthours, than it will bein obviating the neces-sity of performing inter-mediate and secondaryresections in casestreated at first conser-vatively. The Cases requiring the Operation of Primary Excisionof the hip joint are those which, on exploration throughthe wound, are found to be complicated with splintering ofthe head or neck, or of both, to such a degree as to rendercure improbable under conservative treatment; cases inwhich not only the continuity of the neck of the femur islost, but also so much bone matter in the form of splintersand small fragments have to be removed as to constitute apractical excision of the joint (fig. 48). In fact, systematic. Fig. of Neck of Femur.—Netley Museum. 192 WOUNDS IN WAR excisions are seldom indicated as primary operations. Theoperative procedure which is substituted for these is onefor the removal of loose splinters, to which is added theremoval of the jagged portions of the neck of the femur bymeans of the saw. Delorme rightly insists that we shouldbe careful not to remove considerable portions of the headwhich are still joined to the neck of the bone, merely forthe satisfaction of doing a systematic operation. If thehead be fractured throughout, and retains no connectionwith the neck, it should be removed, and the neck trimmedwith the saw. Intermediary Excisions may be required in cases whichwere suitable for the primary operation, but in which itwas not performed, either in consequence of want ofaccuracy of diagnosis, or because some insurmountabledifficulty intervened to prevent it. It must be rememberedthat
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