Taking amputations in all parts of the thigh, then, we find the number of operations after the 1st of April, 1856, was 164, of which number 140 were primary, and 24 secondary operations. The total mortality was 105, or per cent. Of the total deaths, the primary amputations yielded 87, or 62'2 per cent., and the secondary 18, or per cent. It must always be borne in mind, that these results only refer to the period of the war when, as was before stated, secondary operations were becoming very rare, and the state of matters in camp so improved, that the total mortality after amputations was by no means what it had been at an earlier period; so that to say that the average mortality after amputation of the thigh in the Crimea was per cent, does not by any means express the whole truth.
However, if we take the later period only into consideration, then our results may be thus contrasted with those obtained in other fields of observation. TABLE SHOW I NT. Till: <E OF DEATHS AFTER AMPUTATION (PRIMARY AND SECONDARY) OF THE THIGH FOR OUX-SIIOT WOUNDS AND ACCIDENTS. Crimea, British army from April 1st to end of war, 64'0 Constantinople. French Dolma-Batchi hospital. Mntinier,.... 82'6 Brigade, Crimea 65-0 Waterl. Spain, Alcock, fi-'-'i Schleswic-Hi'lstcin, Esmarch, in-lo h army, 1848-50, Djorup, 56-7 Sedillot, " Campagne Constantine," 1837, 87.5 51-4 Polish campaign, Malgaigne, 100-0 m war Hotel Dieu, 1830, 81-8 Cases communicated to the Academy, 1848, 77 J INJURY. Phillip? 71-8 Parisian hospitals, " 73'9 Glasgow, previous to 1848, Law rie 75'0: QUa 72-0 -mas' hospital, South Hnnev 62-5 James, 61-5 University college, Erichsen,...
60-8 Mortality per cent. The usual dism-panry which marks statistical tables is in the almy. Mi<m. That between obtained in mir army, and those quoted fnmi I t!ii" r<, ni tak.-ti u'rajit-1 that one-thinl of the cases "remaining" at the time the return giv n l.y Mr. com; ended unfavourably, which appears a very moderate allowance, when we find such a as 51 out of 94 cases of secondary amputation so entered, and 85 of the primary. f These numbers are derived from a further inv< the Royal try records by Dr. M'Ghic and myself, and include the cases operated A elve years previous to 1853. AVAR. the French, and which were kindly furnished to me by M.
Mourner, is easily understood, when it is stated that of the total number of 46 amputations of the thigh which pivsenti'd themselves in the hospital presided over by that distinguished surgeon, 25 were secondary operations, all of whom perished, while in our returns, and those of the Naval Brigade, there were very few consecutive amputations. Out of 21 primary amputations reported by M. Mounier, recovered. The low mortality among the Indian cases is somewhat -difficult to account for. In calculating them, I did not include any case except those the result of which I could find well authenticated. To distinguish between primary and secondary operations, in many of the cases recorded by the various authors referred to in the above table, was found impossible, but so far as this can be accomplished appears in the following table: TABLE SHOWING THE MORTALITY AFTER PRIMARY AND SECONDARY (DISTINGUISHED) AMPUTATIONS OF THE THIGH FOR GUN-SHOT WOlM>s.
AMPUTA1 TABU ma. old operation has lately been creating some interest in the profession, and was often performed by the French surgeons in the Crimea. The opinion they were led to t'rni of it may be supposed to be expressed by Baudens, when he says (Une Mission Medicate en CrimSe), "It is a truth which the numerous facts observed in the Crimea permit us to affirm, that, whenever it is impossible to amputate the leg, the disarticulation of the knee should be preferred to amputation of the thigh. The former has more often succeeded than the latter." There are not, however, very many cases occurring in the field which are adapted for this operation, as it should be performed only when the injury is limited to the leg-bones, and the femur remains intact; and when this takes place, it often happens that the soft parts are so much implicated as to deprive us of flaps.