The most severely injured have their limbs removed early, while the most hopeful are retained for secondary operation, and thus all the advantages of slighter injury less constitutional disturbance, more promising habit of body, and state of general health are denied to the early operations. In truth it may be said, that if, with all the advantages under which secondary amputations are recorded, they appeared as merely equal in success to primary, then the superior claims of AMITTATIONS. the latter to our attention be sufficiently cl how much more marked, then, are the successes of early oper rhen we tind them giving such superior Ato tingeneral;' amputations during the it may In- safely said, that when due weight is i to the many eireumstances which have militated agaii -uccess of all operations, and which have been fully dwelt upm in the course of the preceding pages, those pertbrmed early have afforded a very fair proportion of success; while it cannot be denied but that undertaken late, have l>een followed by most unfortunate results.
A siege presents peculiarly favourable opportunities for testing the value of iputations. Tinmen being close together, and acting within a narrow space, can be seen almost instantly on being injured. be soldier in such circumstances of the sailor on board of his ship; so that the experience of naval surgeons, which is so strongly in i to military siege practice. Unfortunately, the arrange: followed in our army during the siege of Sebastopol, made the elucidation of this point impossible. rgeons were alone sent to the trcnche> luring an assault, when A statl-sur-vnn occupied f the ravines behind each division; but in the hurry D which prevailed at such times, the men he;itcd on wen- lust si'j-ht of: and as by the rules wliich prev ur service, an officer of that rank is not ipulate, except when the surgeon i< not with the ivgi; for the due examin X WAR. of this question.
The French experience, if it were available, would be of much use on this point, as they performed many capital operations in their trench ambulances. Whatever that condition is which is conventionally known as " shock," it seems pretty evident, from t.lu* admission of all, that it is not established for some little time after the receipt of injury an interval which differs in duration, mainly in accordance with the severity of the wound, the agency by which the injury has been caused, and probably the constitution of the sufferer. The evidence of naval surgeons, as summed up by.Mr. Hutcheson, in reference to the absence of shock immediately after the receipt of a wound, must be conclusive to all unprejudiced minds; and instances were not wanting during the late war which appeared to support the same view.
I know of several well-authenticated cases which occurred during the siege, in which the perfect absence of all constitutional prostration after an accident so severe as the carrying off of a limb, and the non-appearance of such shock for some considerable time after, went to prove the same position. If this precious moment could be seized at all times, and that operation performed under chloroform, which assists so much in warding off the " ebranlement " we fear, how much more successful would our results prove, than under any other circumstances they ever can be! It is during this interval, too, that we obtain the full good of the soldier's moral advantages over the civilian. " Cut off the limb quickly," says Wiseman, " while the soldier is heated and in mettle" and the observation is as old as Pard, that while excited by the combat, and AMITTATI.. within sound of tincannon, the soldier or sailor a limb which a few hours of reflect ion him tlie risk of preserving, upon which: tcntion, so as to magnify greatly the dangers of the subsequent operation, over, the removal of the man, before operation, to any distance from the scene of his accident, lessens somewhat his chances of recovery; as, besides the danger that the irritation and pain of such transport, carefully it may be conducted, will occasion, the constitutional depression we dread; the mere loss of 1 which, alth ing on in very small quantities, t flowing in drops, when a drop may extinguish life, 'rious objections to the shortest delay. although that constitutional disturbance h is the result ot' injury is present, is it ssary to wait its subsidence before illegible in the scan of the first