However, if the posterior flap is destroyed, we can take a long flap from the front, and vice versa. To 4 of the cases operated on in camp, with the details of which I am acquainted, the operation was not applicable, as the femur was more or less injured, so as to call for the removal of part of it: hence the operation, although termed amputation through the knee, was in reality low amputation of the thigh, such as that now employed in white swelling of the articulation. As to the mode of operation, the French mostly adopted Baudens' method, but in 5 cases operated on in the general hospital that proceeding was departed from, in so far as that the posterior flap was made from within Medicine, January, 1856, gives the results of 18 operations performed since 1850 in America; 5 of these were fatal.
If to these we add 6 cases which have been more recently published with 1 death, we have a total of 61 cases, and 21 deaths, or 34-4 per cent, mortality. A.MITT outwards in place of the reverse, as directed by that wellsurgeon. The anterior Hap. was not made so long. Whatever method of operating be adopted, the great point which demands attention is, to tli - Hap sufficiently broad to cover tin- expanded >t' the femur, which there requires a large and bread. Of the 5 cases operated on in the general ital, <>ne die- 1 of phapvdivnic sloughing on the fortythird day: another, a soldier of the 62nd, died of enteri. ty-seventh day, the stump being healed to a point; a third sank from exhaustion on the ninth day M: a fourth never fairly recovered from while the lifth and last case recovered, under the of Dr.
George Scott, who operated on him. This s- tidier in the i' s.struck on the right t by a ball, on the 8th of September. He himself very slightly injured, as the only tiling he observed wrong with the joint was his inabili it, on account of " something catching in it." A small opening was found in the middle of the popliteal space, slightly external to the middle line, from which a good deal of blood flowed. 'I led into the cavity of the articulation, and spicuhr of bone were A part of the end of the lemur was reitella h-ft. A round ball had pierced 11, d coiidyle, and lodged. T rior flap tually led the end of the lemur; but -utly covered over with illation-, and though the p.-stieiit's very was much ' the format ion of an abscess ai;i.sclcs of the thi-h, which reqv ct health in January.
His stump was strong and firm, and he had nuu'h power over its movements. The patella could be felt on the upper surface, to which position it had been gradually retracted. In several of the cases which I have seen in the French where sloughing of the flaps had taken place, as in this case, and exposed the extremity of the femur, the cartilages were alone thrown off, but not a scale of bone. So far as I can judge, the practical advantages of this operation are equal in value to those theoretical ones which its advocates claim for it, and they would seem to recommend its more general adoption in any future campaign. First of all, the shock to the system is less, and we obtain a larger and firmer stump than when the femur is sawn through; the end of the bone on which the patient has to bear his weight is likewise more expanded, and more rounded, and hence calculated to inspire greater confidence in the patient in the use of it, and less liable to cause ulceration by its pressure on its coverings.* A false leg can be more easily attached to such a stump, and more power is retained in progression from the muscles which remain undivided, than when the limb is amputated in the continuity.