Without hoping in the first case for a success equal to that of hi. h S. Cooper nu<i and other military surgeons speak, we may reasonably expect that the fatality will be here what it is in the greater part of other that IB to say, that it will not pass the fourth or tin- third of those op. on. In the second case, on the contrary, if w - admit tin- imml.T of guers, who was so decided an opponent to amputation, we mu see the half of the wounded succumh to the primary i-i1,;-. n gangrene, inflammation, abscess, patients in the KID will thuremain, retaining a wound which will call for secondary then the success surpasses all expectation, when we save 9 in 10 operated number of those who survive will be yet less than if we followed the opposite practice; as, accepting the preceding hypothesis as exart we think we have made them more favourable to secondary amputations than facts countenance), there remains 70 to 75 surviving in 100
AX WAR. from it, and not merely those who die after being submitted to the operation then the force of the teaching which inculcates primary amputation in these cases becomes much greater. Besides, as the cases which were retained for trial were always those in which the amount of injury was least severe, and the patients those most adapted for recovery, the presumption in favour of early is the more decided. There can be little doubt that the chance of obtaining consolidation is greater in the lower than in the middle third, as is also the hope of recovery from amputation; so that, taking one thing with another, the experience of this war would lead to the conclusion, that when the thigh is fractured by a ball in the upper third, it should be saved, but that cases of a like injury occurring in the middle or lower thirds.
Those fractures of a simple description, which at times present themselves, are not meant to be included in this remark, nor is it to be understood that, under more auspicious circumstances as to the condition of the patients and the means of treatment, better results than those we meet with may not follow the preserving of the limb. In fact, under ordinary circumstances, recourse should always be had to the steps I before spoke of, with regard to the removal of spiculse in cases of fracture of the lower third, and then try to save the limb; but in a like injury of the middle third, the rule should be to amputate. mediate while there remains 45 or more after consecutive We also hasten to add, that in allowing for the moment tinsuperiority of secondary over primary amputation, we have made an exaggerated concession," &c. It is ci Ttainly very much opposed tn the modern "iidemn limbs without a trial. and I am fully aware how difficult it is to become l>ut tin' unwilling conversion at. though it is generally gained by the loss of several lives.
The French - in the East fully the hopelessness of these cases; hut the fatalitv of amputation was, with them, little behind that of preservation. This expericmv is n< old as the history of war, and comes repeated in renewed accents from tic-field. Military surgeons are almost unanimous upon the necessity of amputating in the cases. and most civilians who have had an opportunity of seeing mueh of these accidents, have come to a like conclusion, as can be seen by the tenor of the communications to the Academy by the first surgeons of France. It would be mere waste ot' time to record the strong and decided verdicts which have been p' on this point, and which find their summing up in the of the greatest surgeons of any a^e or!