M. Legouest has given, in a most interesting paper on the case mentioned above, a table containing most of the recorded cases of amputation at the hip for gun-shot wounds. Of primary operations he has collected 30 cases, all ending fatally; of intermediate or early secondary operations he finds mention of 11 cases, with 3 recoveries; and of operations performed at a period so late as that " the injury had lost all its traumatic character," 3 cases, with one recovery. Thus, if we sum up the whole, we have 4 recoveries in 44 cases, or a mortality of 90*9 per cent. Some of the primary cases died on the table; all of them before ten days except 2, which perished within a month.
The proportion of recoveries among those operated on after the primary period, but before a long elapse of time, i. at some period during the existence of "the traumatic phenomena," was the i hence that would nem the. best tin undertake th '; on. lg tin- Sehleswie-ll'lstein war, amputation at the hip was performed times 5 were operated on l.v ' >eck; only 1 ot' t! a recovered. I find whether were primary or secondary. Jn the Indian campaigns I find mention of only 1 i at tor a gun-shot wound. It w;;.a primary operation, and took plncv in the Punjaul.. Thus, if we reckon the whole number of cases operated r pin-shot wounds, those recorded by Legouest, our own Crimean cases, and the Holstein and Indian ones, we find a total of 62 cases, and 5 recoveries, or a mortality of per e< Mr.
Sands Cox, recording the experience of civil as well as those of military practice, up to 1846, gives in all 84 cases, most of them for injury, with: l of theee moceaefb] caaea ' f ''7:2 and the shock given to the nervous system, as the great sources of danger.
The haemorrhage, at a considerable period after operation, would appear even a more common cause of the fatal event, than the difficulty of commanding it at the time. It will, of course, only be in the event of such destruction to the bone or soft parts, or such other injury to the nutrition of the extremity, as puts resection out of our power, that amputation will be performed. If the fracture of the neck of the bone were slight, as when occasioned by a small ball, or one striking with little propulsive force, such as that projected by the matchlock, then the case, I conceive, must be viewed more as a compound fracture of the upper part of the thigh, and should be treated accordingly.
M. Legouest has recorded 6 cases in which the limb was not removed or resected, and 3 of these recovered. One of these cases of recovery having occurred in 1812, must have been wounded by a round ball; the second was injured in a duel, and hence probably by a small light ball; while the third was observed in Africa, where neither the size nor the form of the balls used by the natives is to be compared to the conical bullet. All three were struck on the trochanter. The fatal cases with us which were not interfered with, took place after the Alma and Inkerman, and hence were probably wounded by conical balls. All are agreed that, when practical, the separation of the limb should be accomplished at or through the trochanter, rather than at the joint, on account of the diminished risk; and this can be more often executed than would at first appear, as it not uncommonly happens that the fracture does not extend to the head of the bone, A.MITT ATI' t seemed at first siirht to do; hence it might be ions, in all doubtful cases, to make the incisions so: amputation at the trochanter.