Many most admirable stumps were made in this part of the limb during the war. In operations for accident, as in gun-shot wounds, we can, of course, operate lower in the leg than we can when the r disease, from the absence of I state of the bone, and the changed and bound! which are so common in cases operated on in civil hospitals. As to tin- operation just above the ankle, which has of so much discussion on the contii we had, so far as I know, no experience in our army; but the French had a good number, which, so far as the conn of the stumps went, were not by any means This operation, although revived by the improved method of procedure introduced into practice by M. r. is yet of sufficiently old date.
It is mentioned by Dionis in his " Cours d' Operations," and by Bromfield in 1740, and afterwards by White, Alanson, and Bell, in England. In France Blandin often performed it in recent times, but was induced to abandon it, like many others, from the bad result lod of operation yielded. P.y M. Lemur's and M. Martin's artificial limb, the operation promises again to come into favour. This oper; appears to me t as to its advantage >ther amput. in the leg. The greatly diminished bulk of the soft and; parts at th- <.f seet'nm, the smaller amoii! k such F will occasion, and the menrapid closing of the are all incontestable.
Its fatalitv in the cases operated on in has been only as 40, and M Arnal tixl WAK. sixth or one-seventh. the mortality of amputation at the place of election is more than one-half (55 in 100 according to Malgaigne). In some hospitals, as in the Beaujon, the mortality has been even less in the susmalleolaire operation than that mentioned above: thus M. Huguier only lost out of 1 4 cases. So then, as far as the mortality goes, there can be no division of opinion, as there is about the second point, the state of the stump afterwards. The difficulty of retaining enough of covering for the bones, the fear of such retraction as will occasion a conicity of the stump, the tenderness of the cicatrix, and its inability to stand pressure, the chance of fusiform collections of pus forming among the tendons, of caries or necrosis of the bones following, all these are among the objections which have been advanced to the operation.
If we, however, carefully examine these by the light of the large number of observations which can now be brought to bear on the subject, we find that the only objections which are of any weight are the scanty covering of soft parts, the tenderness of the cicatrix, and the risk of necrosis. Purulent collections can be easily avoided by careful dressing; and the presence of the other evils, and, in fact, the want of flap also, must be referred to the manner in which the operation has been performed. I have examined a considerable number of those amputated in Paris, and am bound to say that, while in some cases the evils spoken of existed, in the greater number of instances good and firm stumps were formed.
This was especially the case in several which I saw in M. Lenoir's service, in the Neckar. Some of the cases which had been operated on in the Crimea were certainly very bad. At the Society of AM1TTATI" v an Aral), shown by l?arn Larrey, both.hose limbs lr -ihove the inallcoli, in 'ih secondary operations, and seemed to have healed well at lirst; Imt the cicatrix afterwards u'. and at tlie period he was shown t> the S.M ',irly two years after operation), he could not U-- his stumps in any way, from their being in an unhealthy condition. In another case, shown to the on a subsequent occasion, the operation had been performed in 1848, and the man had been an in' of hospitals on several occasions during the interval, mi account of ulceration, abscesses, and necrosis in his stump.
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