Few now participate in Listen's opinion of a long thigh stump, but, on the contrary, most surgeons try to keep their section as far as possible from The absorption of the condyles of the femur which may go on after this operation, is illustrated by a case mentioned by M. Legouest (Amputation partielles du in which a soldier had undergone amputation at the knee in 1800, in Italy, and " the enormous tuberosities had so diminished in volume that no trace of them could be recognized, but the member presented a cone terminated by a point." So completely had the part changed, that it was only after very careful examination they believed the man's story, that he had been amputated at the joint.
tintrunk. The non-interference with the medullary il ol>viat "t the dangers of amputation, r to Cruveilhier; while the extremity of the femur, which is largely supplied with Mood-vessels, being retained, there is less fear of exfoliation than when the -sue of the bone has been opened by the saw. position of the divided artery in the centre of the S and the few ligatures which are required, are further arguments in favour of this operation. There is little fear but that the flaps will adhere over the cartilaginous extivmity of the bone in fact the cartilages soon ppear during the healing process. There is some appearance of force in the objection which some have advanced to the operation, that from the length of the stump no proper space is left for the play of an artificial joint; but if it be evident, as civil statistics at least, that the fatality attendant on this operation is less than that which follows amputation of the thigh, then any such objection loses all its weight.
1 f thm, cases were selected for the operation in which the femur ivmaininir intact, and the legbones being deed, a sufficiency of flap could be got from the calf, of the leg, and if the amputation was performed. I firmly believe, with Mulicaiirne that it is " Kncmv une de ces operations trop Increment condamnees, ct ijui lorsqu'on a le choix me'rite preference sur ramputati< euisse dans la continuity." < leg was amputated after April 1, 1855, 101 tim with death following in 36 cases, giving a mortality of 35'6 per cent.; 89 cases, and 28 deaths, were prin. MODS, and 12 cases, with 8 deaths, secondary thus ling a ratio of iimrtnl ecnt. of the primary, and for the secondary.
F THE CRIMEAN ^ The rule generally followed in our army, has, I think, been to preserve as much as possible of the limb, but, except in those cases in which the operation was performed just above the ankle-joint, the French appeared usually to amputate at the place of election. I saw no instance in which Larrey's operation through the head of the tibia was had recourse to, but I am informed that it was several times successfully performed in the French ambulances. The greatly improved mechanical contrivances of late years have much changed the bearing of the question with regard to long leg stumps. The facility and moderate cost with which artificial limbs can now be fitted to any part of the limb, from the knee to the foot, has obviated many of the reasons which formerly induced surgeons to prefer the high operation.
Larrey's, through the head of the tibia, is a most valuable one when the destruction has extended high up the leg, as it enables us to retain the use of the knee-joint, as well as diminish the risk to life. That at " the place of election" will, of course, continue to be employed in cases of injury above the middle of the leg; but when the nature of the accident permits of it, the part of the leg which appears to combine most of the advantages sought in leg stumps by both the surgeon and the mechanician, is undoubtedly that in the centre of the middle third. The length of the lever thus obtained, the diminished bulk of the part and consequently of the truncated section, the means of covering the bones, and the room it affords for attaching a limb, are all in favour of this locality.