I.unvy inform the Sod&4 de Chirurgie that the Russian tlu- same campaign had Informed him that!;rene being very rife in th,-ir army, they adopted the low operation, so as to leave room for a subs. one if the stump went wr-.n: In li.-ivi-allu.li-il to the opernt Me to cases of malignant i its near neighbourhood to the affected part. cumbrous stump. Since 1845 M. Hutin had had 5 cases especially under his notice: one could walk, but with difficulty, and would willingly part with his foot; one had been several times in hospital from the state of his stump, and three had to undergo subsequent amputation. Now all this is sufficiently distressing and discouraging, but in military practice I question whether it is conclusive.
The limited mortality yet presents itself to us as a great fact, which arrests our attention. If when men die so fast after the ordinary amputation of the leg, as they did during the early part of the war in the Crimea, it becomes a grave consideration whether, with all its subsequent drawbacks, we should not adopt this process when practicable. If our choice lay between two operations of equal gravity, then unquestionably we are bound to select that which will provide the most useful stump; but when the chances of death are beyond all comparison greater in the one case than in the other, when, independently of those dangers which attach to the operation itself, the marked presence of an " hospital epidemic '? makes it desirable to expose as small and as rapidlyhealing a surface as possible, then I think it may be conceded that the sus-malttolaire operation has many claims upon us.
Life must be our chief concern; convenience a subordinate consideration. The complaints of patients about the inconvenience of their stumps, must be considered as affording little evidence in the matter, as thefact that they survive to murmur is often due to the very operation against which they complain. If the heel remains, then this operation could not be thought of, but it is in those cases, sufficiently frequent in their occurrence, in which the whole foot has been AMPUTATIO' carried away by r"iinli or higher up, that the la of this method can be weighed. The careful study of those cases in which caries or necrosis has appeared in the bones of the stum]) alter the sus-mallcolaire will be found to have been submitted to operation for disease, and not for injury, and it will rally be found, besides, that a faulty apparatus has been used afterwards.
Everything depends on the careful adaptation of the false foot, and, so far, this is of itself an objection to the operation being performed on the poor; but the view alone I wish to take of it at present, is with reference to military practice, and there it se to promise many advantages at times when there a high mortality alter operations. iputatiou at the ankle-joint was performed 12 t: in the Crimea during the period embraced by the returns, and death followed in 2 cases. Of the total number of cases 3 were secondary operations, and these were all ssful. Syme's operation was as useful and as successful i: nl. modification of Syme's method was, I understand, several times tried at Scutari.
I saw i these cas m ignorant of.nd it (pears to have been recently toll'.rood effectin <> out of 1) which it was is said to approve of its results in a good many cases in wliieh Init; but ' rv of the:>> ruses first reported by M. goff Inn ntly put on record by Hichielis of Mil cons, does not hold out much encouragement to repeat the operation, not only from the long period necessary to a cure, but also from the unsatisfactory nature of the resulting nu-mber. It was reported in the East that this operation had been frequently performed by Pirogoff himself in Sebastopol, but that he had found the calcaneum act as a foreign body in the stump, and was hence disposed t abandon it.
Roux of Toulon's operation was performed once in the general hospital in camp, with most excellent results. The chief objection to this operation arises from the vessels and nerves being drawn under the bone; however, it certainly enables us to form a stump little inferior to Syme's, when the half of the heel has been destroyed. Baudens is said to recommend the flap to be taken from the anterior surface of the joint, or even from its external surface, if it can be got no other where, rather than go above the ankle. Chopart's operation was performed primarily 7 times, one case ending unfavourably, while Lisfranc's was successful in the 4 cases in which it was tried. The step now always followed by Mr.