It will certainly be asked, What must be done when the best
applications fail, and must we not amputate when the caries is very
extensive? I answer, that amputation is to no purpose if the caries be
attended with a bad habit of body, and while the morbid cause remains;
when this is removed, we ought not to despair of a cure, although
the greater part of the bone be carious, as the cases I have already
related plainly demonstrate[52]. We ought therefore to try other means,
and trepan the bone in several places, till whatever is rotten be
taken away. There are many bones, whereon amputation, even if it were
of use, is not practicable; if, for instance, the caries has attacked
the upper parts of the humeral, or thigh-bone, the jaw-bone, &c. The
method of treating the diseases of the bones, may be learned from the
cases of so many soldiers wounded at the articulations of the elbow,
knee, &c. and who, by the care bestowed on them in our hospitals, had
their limbs saved, notwithstanding they lost very large pieces of bone;
some of which were separated by nature, and some by the help of the
surgeon: And as no person will deny that the wounds made by a surgeon,
with an exceeding sharp instrument, and with much circumspection, in
order to remove the pieces of corrupted bone, are more easily cured
than wounds that are lacerated and contused, by means of a ball,
grape-shot, or splinters, &c. If the habit of body allows of any hope
of curing the caries, the method I have pointed out § XX. may also be
practiced in this case. It is true, the limb often remains deformed
after it, but this does not always happen; and frequently the callus
fills up the whole vacuity left by the part of the bone which is taken
out, however considerable it may have been. We read of successful
cures, where even the loss of the entire bone has been supplied by
means of a callus[53]; besides, the deformity of the limb does not
take away the total use of it[54].