In secondary amputation the excess of skin removes any fear of similar accidents. Chloroform has refuted the argument in favour of the flap operation, founded on the greater speed of its permance than the circular, as such great speed is now a matter of no moment. But however it be with regard to is one fact which any one who hul opportunities of watching matters during tin, part of tinlate war will that the ilar stumps stood tin- transit t<> tin- rear much than those formed l>y the flap method, and thus it would.1 that the former mode of operating is more advan>us in military p ian thr latter. The long s knocked about during the land and sea passage, that they often became loose, got bruised, and ended l.y slouch in.u'; while the iirin, compact stumps le l>y the circular method were little, if at all, injured.
When patients can he treated in to a termination, influence of this circumstance is, of course, null. It may be said that the length of the flaps was a miscommitted in the operation; but, unfortunately, such errors must always be looked for in like circumstances, whe is a lari'e body of operators, most of them witl vious experience in oper, whose r always is to have "too little flap;" for although lick says, that u it ivipr practical experience t<> kimw when to take off a limh how to do it," yet the how must also be studied, like.thing else. In ooi the statistics of amputation perfon: Mg the Crimean war. the li-'i;. the ci between tin1st of April, i 1 the end of -var, and consequently exclude all the unfavmi '.iign, as well as i the
It w; s found impossible to attain to accn; with regard t<> Dtrliei; the field as stated. It i TIIK (KIM KAN WAR. how different must be the lessons derivable from the statistics of this latter period alone, to what they would have been it' the whole period of the war had been During the limited period I have there were 732 amputations in all parts performed, followed by death in 201 instances; of these, 654 operations and deaths were primary, and 78 operations with 3(> deaths, secondary; giving a per-centage of deaths overhead 25'22 for the primary, and for the secondary operations. If we include only the greater operations, amputations of the shoulder, arm and forearm, of the hip, thigh, knee, and leg, then we have a total of 500 cases and 199 deaths, or 39 '8 per cent.; of which total 440 cases and 163 deaths, or 37 per cent, were primary, and 60 cases and 36 deaths, or 60 per cent, were secondary.f The increase of the mortality as we approach the trunk may be shown thus, taking the primary amputations alone as giving the most unbroken series: SUPERIOR EXTREMITY. p.
Ratio mortality per cent. Fingers, 0'5 Forearm and wrist, 1'8 Arm, 22-9 Shoulder joint, 27-2 In my original papers the figures were intended to represent the period of the Avar. I have reason to think, that although, upon a more careful investigation of the returns than could be made in the Crimea, tlu-Mnumbers have since proved not strictly accurate, they yet represent pretty much the results which followed many of the operations as viewed in the more lengthened and less favourable aspect of the war. t See Appendix G. MI TV. Ratio mor: per. Tarsu 1 Ankle joint '21 Leg, 30-3 Knee joint, 50-0 Thigh, lower third 50'0 u middle, 55-3 UJ-IMT 86-8 Hip joint 100-0 The lower extremity was removed at the hip joint seven s during the period included in the returns, and at least three times more previously, giving ten cases, all primary operations, and all ending rapidly in death. >t' these cases was operated on by my lamented friend I >r. i the Alma.
The French thirteen cases, primary and secondary, after the Alma and Inkerman, and all died. One of these, a. was operated on by M. Legouest on the 3rd ot'. 1855, at Constantinople. The upper part ot' femur was completely smashed by a conical ball. Tinflaps had adhered to a point by the middle ot' Dei-ember, at whi.-h date I saw the patient walking about the ward i by all ond danger. Th< Ight On whlcb the order arrived tor sending him to Frane( where he was admitted, l.y into the Yal de Grace he tell when walkinir in the corridor, and hurt his stump so that it bled Inflammation was set up, suppuration. followed, and he months afi.1 the same hospital had three cases, one of which I watched with interest.
Two of these died of haemorrhage, one on the fifteenth, and the other on the twentieth day. The third died of cholera. One of these men was a Russian. The mortality which has thus followed exarticulation at the hip during the Eastern campaign, has been very deplorable; yet, in the cases in which it was performed, no other alternative remained, except to abandon them to inevitable death, which many might be disposed to think the more humane proceeding, as they often linger for a long period before death. M. Legouest's case was unquestionably successful; and, although we can hardly hope with Larrey that this operation will ever be performed as readily as his favourite one at the shoulder joint, still the results of operation at the hip for accident have not been so utterly hopeless as to lead us to abandon it.