. ^3SV íiW/fy Mx^w; ai ■IBWSt ^Si^M' [P^^^gfív.n-'F.^ iVfeiírifc v^api ¿ttilONS AT THE MASSACHL'^-ET™ '■""'"*.! 1JAL, BOSTON, MASS. && i?', *sb 1871 J&$«^ ■fvW Ntó r.HY OF MEr,. :n¡ NLM 001352^ 5 Surgeon Gencral's Office nI' O /I V fif) -i) rf --)V *- / \ s nf^iV "vi 7f\ ' 1 ¡£@Q^é^ NLM001352495 » 4 a C-j-3Zái t /S7/ * i' » V ^ AMPUTATIONS AT THE MASSÁCHUSETTS GENERAL HOSPITAL, BOSTON, MASS. Compiled by JABÍES R. CTLAJ23YICK, M.D, LATE SÜItGICAL HOUSE OFFICER. MAY 1, 1871. ¿yuy-- The following tables comprise the results of 699 major amputations of the Hmbs, The larger part have never before been made public. In 1851, Dr. Hayward pub- lished a list of the amputations performed irj^this Hospital up to that date, but with so few details, that in making up the twésent 3eries it has been found ihiperatively necessary to refer to the original records in order to obtain all the data bearing upon the cases recorded. No pains have been spared to render the abstract correct and complete. The results are compared with those obtained, so far as published, in the New- York City Hospital, the Pennsylvania Hospital and the Boston City Hospital. Of the 699 cases, the result in seven is unknown, either from imperfection in the records, or in consequence of early removal from the Hospital—of course these do not enter into the estímate of mortality. EXPLANATION OP TABLES. " Primary " signifies within 24 hours of the time of the accident. " Secondary " any time after that period. " Pathological " includes all amputations for non-traumatic cases. "Duration" signifies the period from the date of. the accident to the date of the " Length of time " signifies the period from the date of the operation to the date of the discharge. . The fractions ¿, f, f, desígnate, respectively, the upper, middle and lower thirds oí the límb ; and £—§■ desígnate the junctio§ of the upper and middle thirds, &c._ There have been no amputations at the elbow joint, and only two at the wrist joint, which latter have been included in the tables, with the forearm. As my friend Dr. Wood has already tabulated the amputations at the knee joint, they are, with his perrnission, incorporated in this paper, together with his deductions from thThree amputations at the ankle joint—one by each of the three methods of Roux, vSyme and Listou-have been included with those of the leg. In all fatal cases where the cause of death is not especially stated, it may be attnbuted to exhaustion, although in a few of these pyaemia was suspected. 1 AMPUTATIONS AT THE Ph Eh 5z¡ >—i O 1-3 Ph Q P O W ce H ce 525 O •—1 H <1 H P Ph 0.3 3-3 » .» . 'tb • ° I * efe 3. 3 sil 0 3"' hS p-p S K 3 es .•.«•tí* 10 >J ^ ^- ' 3 tf. o c £3= ¿c I -2 •£ PT3 ' 3 cj £ 5cSSc".2'C¿ -o 3 <£; 3 .3 f, o •fí'K -3 ! es„ E| ' <1 ¡25 2* „ Ü3=H C c _C o 3 -»^ cj B >-^> É CJ .3 ^ cj ~J "C 3 "3 O CQ _J 00 ,p. 'p'-"? . 3 ¿CÚ •5 „• = c S< 'te c.'" * *rtffiKCOCOCMCNffiMO>CCS X ^ OeOCMCMCMCMCMCOCOWScOeOCM-^lOeO U tJ s £ s o 2 "ü • Sl|s|2|H >-),*, CC ^ Oi tí t3 Ch HHNHiCiCNOlOO^^lOOH >C»Oi0^ií;iClC'C3>íDCDÍD3l^K 00000000CO00CCCO0000CXJCZ)0000Q0 ccTt— uj'ar'o'o'oo co «3 cm"oí"co" cTcM^tc" ihU)h ' f^r-HCMCM CMCN ¡i 35 b¿ 4"¿ tf> m tu > ¿ ti g &*¿ o ¿ 3 & ^H L. S O 2 fc.T-- 2 O 3 - os &- « * O "c ' hNW*«5©NI»050p-i CN CO ■* irr tíP o c3 ü iJ ^ -»! PS O O ¡z; iJ 0 O 0 te H H ce ¡ Ph ü | H S ^ & HH <í O H w h-1 O p t-3 0 P3 H O H kJ - ^C- ■3 c,8°3 °o o P o Q cj P cj 2¿ Pí tí Ph ¿Ph R« (N •*-*!CM (^ 00 «5 CN r-H CM CN ■-! S-. & 2^3 03 3 _"= S S ^ "m £ •£, O 0_c« O- ^ POCO í P g .-T o ¿3 3 £ 3 - ¿ 3 £ = P O C.x C O o O £ ; 'r^^H (M 73 ¿ 3 fc£ r-N^OOCONMaiNOM •*--i ÍC 1-1 tjh CO •£ o 5 r- O r- 3 - O i 3 P j^ CJ » 32™3.ooP C ^ ° ~ 2 3 5 S O !? Ü CTj CC Ph OOOOCCOOOOOOOOOCC/jCCC/^ be'tiu o 'C to _• o íi 3 HP50O :OB ece £ 1-1 cn co •* »C eo t^OC CJ> o — Table 3. AMPUTATIONS OF ARM.—Traümatic-Primary. No, Operator. Date. Townsend J. M. Warren Clark Townsend Cabot Townsend J. M. W airen Clark Gay J. M. Warren Cabot llodges Clark Gay llodges Cabot Clark Hodgca Cabot líigclow J. M. Warren Gay Cabot llodges Coolidge llodges Bigelow llodges Clark Cabot Clark Julv 24, April 28, April 7, Mar. 29, April 28, Mar. 23, Julv 17, Aug. 18, Aug. 5, May 20, July 13, Sept. 3, April 8, Jan. 2, July 14, Aug. 8, Aug. 15, Sept. 2, Nov. 26, Nov. 28, Dec. 3, Sept. 12, Dec. 10, Dec. 8, Mar. 20, Oet. 29, Jan. Oet. April July Fcb. May May May 31, Dec. 20, April 5, 1847 1848 1819 18-51 18.31 1854 1856 18.56 1857 186U 1861 1861 1862 1863 1863 1863 1863 1863 1863 1863 1863 1864 1864 1864 1867 1867 1868 1868 1869 1869 1870 1870 1870 1870 1870 1871 Occupation. Wcaver Laborer Meclianic Laborer Seainan Mechanic Laborer Housevvife Mechanic Minor Carpcnter Minor Moulder Washerwoman Minor Plumber Minor Servant Minor Baker Farnier Laborer Brakeman Operativo Mechanic Minor Laborer Clerk Carpcnter Fireman Painter Laborer Minor Laborer Scx and Age. Nature of Injury. Comp. com. fract. of arm " " forearm " " arm " " elbow il i. a " " forearm " " elbow « << forearm ii k ii " " elbow " " arm " " forearm " elbow Comp. dislocation at " Comp. com. fract. of arm " " " elbow " " " arm " " " elbow " " " forearm Laccration of arm Comp. eoin. fract. of elbow " " arm " " elbow " " arm t< n ii " " forearm " " arm " " forearm " " arm " " elbow " " arm " " v " " elbow " " arm Laceration of forearm Comp. com. fract. of arm „ Amputation. Dura-____'_____.___ tion. Method Place, 3h. 5 h. 2h. I 2h. 6h. 5h. 2h. 4h. 2h. 3h. 2h. 3h. 5h. 2h. 2h. 3h. 2h. 3h. 2h. 3h. 3h. 8 h. 2h. 3h. 2h. 2h. 2h. 9h. 4h. 4h. 2h. 2h. 2h, 12 h. 4h. 3h. 3 h. ó h. 5h. Circular Flap Circular Flap Circular Flap Circular • i Flap Circular u Flap Circular Flap Circular Flap Circulai Flap i i—; 4-8 Result. Dcath Reeovery Deatli Reeovery Dcath Reeovery Dcath" Reeovery Deatlf Reeovery Death Recoverv Lcngt.h of Time. 4 h. 98 d. 51 d. 46 d. 29 d. 28 d. 54 d. 32 d. 20 d. 41 d. 47 d. 80 d. 19 d. 73 d. 41 d. 18 d. 28 d. 31 d. 22 d. 19 d. 60 d. 23 d. 69 d. 2 d. 69 d. 28 «l. 41 d. 15 d. 91 d. 34 d. 21 d. 28 d. 20 d. 28 d. 43 d. Details. R. R. accident; reduced by discasc & lo«s of blood. Explosión; amputation of othev forearm, R. R. accident} eryc-ipelas. Slougliingof flaps. Cominiíiutcd fracture of otherarm. Intoxication. R. R. accident; scafp wounds. " amp. of fingers; resection of end of bono Slougliingof flaps; death from pya;iuia. Bullct wound. Union by first intention. R. R. accident. Gunshot wound. R. R. accident; acute pericarditis. " " ampu. of leg; d. from collapse. Amp. of other forearm ; death from pyaimia. Resection of end of bone six mos. later. Comp. com. fract. of fíbula; secondary lnemorr. Dclirium tremens, d. from pya-inia. R. R. accident ; disl. hip; hosp.gang; pleuritis. Erysipelas. Erysipelas. K t> w O W a H H Ul Q rA W P> f W o Ul ^3 i—( f> Recovered, 29 üied, 7—Total, 36. Ratio of mortality, 19*44 per cent. Deaths from Exhaustion, 3 " Pviemia, 3 " Collapse, 1 R. R. accidenta 8, of which 5 were fatal, Tahle 4. AMPUTATIONS OF ARM.—Traumatic—Secondary. ^ No ~T 2 4 5 6 7 8 Operator. Bigelow Clark Hodgcs Cabot BiueJow Cabot Coolidge Date. Mav 25, 1847 Jan. 21, 1860 April 24, 1861 Amr. 9, 1864 Oet. 19, 1864 Nov. 15, 1864 Dec. 11, 1865 Sept, 2, 1870 Sex Occupation. and Age. M.22 Laborer Pickle-paeker F. 16 Fisherinan M. 21 Soldier M. 19 Baker M. 26 Brakeman M. 23 Laborer M. 35 M. 52 Nature of Injury. Laceration at elbow Comp. dislocation of elbow " com. fract. of forearm " " " elbow Laceration of arm Comp. com. fract. of forearm Fracture of forearm Comp. fracture of hands Dura- Amputation. Result. Length of tion. 14 d. Method. Place. Time. 86 d. Circular + Reeovery 41 d. u '4 ii 25 d. lid. Flap 3 ii 65 d. 2 mo. Circular f-4 u 14 d. 21 d. " IC 21 d. 2d. ti i—ji Death 23 d. 24 d. II 3 ii 24 d. 30 d. II ih4 ii 30 d. Details. Death from Pyaemia, 2 " Exhaustion, 1 Gangrene up to elbow before operation. Fracture of ihternal condyle, not into joint. " " other forearm; gunpowder explosión. Bullet-wound. R. R. accident; d. from pycemia proved at autop. Erysipelas ; death from pyaiinia. Amputation of fingers. Recovered, 5 Died, 3—Total, 8. Ratio of mortality, 37.50 per cent. R. R. accident 1, which was fatal. Tahlc 5. AMPUTATIONS OF ARM.—Pathological. No. ~T 2 3 4 5 6 7 8 9 10 11 12 1.3 14 15 16 17 18 19 2(1 21 22 23 24 25 26 27 28 29 30 31 32 Operator. J. C. Warren Townsend J. C. Warren Bigelow Townsend Clark J. M. Warren Bigelow Cabot J M. Warren Clark Bigelow J. M. Warren Biuelow Gay Bigelow Gay Bigelow Cabot *< Bigelow llodges Cabot Bigelow Clark Bigelow Cabot Date. Aug. April June Dec. Sept. Sept. Jan. Jan. Fcb. Nov. Nov. July Nov. Jan, Oet. July Mav Feb. Aug. Sept. Mar. Nov. Mav Dec. May Jan. Fel). April Nov. June Jan. Mar. 9, 1825 11, 1827 7, 1839 24, 1840 29, 1847 15, 1847 25, 1851 31, 1851 11, 1853 18, 1853 7, 1857 10, 1858 20, 1858 28, 1859 26, 1859 13, 1860 4, 1861 10, 1862 8, 1862 12, 1862 21, 18ti3 7, 1863 4, 1864 19, 1864 18, 1464 6, 1865 17, 186-5 26, 1865 10, 1867 3, 1870 26, 1871 14, 1871 Occupation. Farmer Spinster Farmer Domestic Shoeinaker Farmer Grocer Domestic Laborer Teamster Spinster Shoemakcr Housewife Minor Farmer Soldier Clcrk Minor Laborer Domestic Minor Spinster Laborer Housewife Lcather-splitter Carpcnter Farmer Domestic Sex and Age. M. 57 M. F. M. M. M. F. M. M. M. F. M. M. F. M. F. F. F. M. M. M, F. M. F. M. F. M. M. M. M. M. F. Disease. Tumor of forearm >" elbow Chronic disease of elbow << «I l< Tumor of elbow Chronic ulcers of elbow " disease" " Necrosis of elbow Tumor of forearm Chronic ulcers of arm " disease of elbow Neuralgia of arm Caries of humerus Tumor of forearm Burns of elbow Tumor of stump Chronic disease of wrist Ulcer of stump Tumor of wrist Neuralgia of stump Neuroma of " Anchylosis of elbow Conical stump Tumor of forearm Anchylosis of elbow Ununited fracture of arm Neuralgia of stump Tumor of elbow , Tumor of forearm Neuralgia of arm Dura- tion. ir y< 7 mo. 3 y. 5 y. 16 y. 2 y. ly. 7 mo. 9 mo. 10 y. 16 y. 4 mo. 7 y. Uy- 15 mo. 18 mo. 5 mo. 6 mo. 3 y. 2% mo. 6 mo. 2 rao. 8 y. 3 v. 9 y. 2 y. 15 mo. 2¿y. 6 mo. 17 mo. 9 rao. 3 y. Amputation. Method. Place Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap M Result. Reeovery Death ti Reeovery Death Reeovery Death Length of Time 191 54 23 13 47 24 100 d. 114 d. 42 d. 37 d. 56 d. 44 d. 53 d. 57 d. 24 d. 18 d. 37 d. 45 d. 19 d. 94 d. 10 d. 21 d. 150 d. 61 d. 25 d. 2 d. Details. Family all phthisical. Encephaloid. Cicatrices of burn. [haemorrhage. Chr. dis. of knee; axillary aneurism; secondary Strumous diathesis; mueh reduced before op. Not fully healed, but doing well. Encephaloid; erysipelas. Cicatrices from erysipelas of 7 yrs. ago. Died 1 year later of phthisis. Needle found in contact with nerve in fore flnger. Sevcral secondary hasmorrhages. Encephaloid; tumor ürst appeared 8 years ago. Amp. of forearm 3 yrs, ago for tumor of hand, Primary amp. for bullet wound. Medullary cáncer. Neuralgia unrelieved 8 yrs. later. Amp. of forearm 8 yrs. ago. Ncarly healed. Erysipelas. Death from pyremia. Medullary sarcoma. Myeloid from radius. a >—i O Ul > W fel Recovered,28 Died, 4—Total, 32. Ratio of roortality, 12'50, Deaths from FLxliaustion, *' Pyonuia, Causes of Araputation were C Tumois in :< Chr. dis. of joi C. Neuralgia 10 cases. Ulcers 3 cases. Caries 1 case. Conical stump 1 7 " Anchylosis 2 " Burn 1 " Neuromata 1 ^ <« Necrosis l '< Unu. fract. I « Tahle- 6. AMPUTATIONS OF FOREARM.—Traumatic—Primary. No. Operator. Date. Occupation. Sex and Nature of Injury. Dura- Amputation. Result Length of Details. Tlavward Age. M. 23 tion. ThT Method. Circular Place. ~3 3 Time. 1 Aprtf 12, 1838 Blacksmith Comp. com fract. of hand Reeovery 49 d. Caught in gcar-whecl of steam engine. >> Townsend Mar. 22, 1839 Joiner M. 17 " u u ii 3h. " " 31 d. Planing machine. 3 .1. C. Warren Mav 12, 1849 Laborer M. 37 ii " both " 7h. Flap a u 71 d. R. R. accident; earpo-mctacarpal amp. of r.hand. 4 Townsend Mav 17, 1850 Minor M. 15 u " of wrist 2 h. Circular u 77 d. Fracture and depression of skull, &c. 5 J. M. Warren Nov. 0, 18.52 Laborer M.24 Laceration of forearm 5h. Flap Death 3¿h. D. from chloroform adm. for ether by mistakc. 6 Clark Mav 5, 18.54 Minor M. 6 Comp. com. fract. of hand 2h. " 5 5 Reeovery 21 d. Hand mangled by circular saw. i " May 9, 1855 Laborer M.26 " u ii 5h. Circular " 43 d. Prematuro explosión while blasting. 13 Townsend July 4, 1857 Laborer M. 23 ii " " forearm 7h. " Death 3d. Expío, of gun; punct. of abd.; d. tr. peritonitis. 14 Gav July 4, 1859 " M. 45 «• " " hand 2A h. a Reeovery 44 d. Gunpowder explosión ; dclirium tremens. 15 Biüelow Nov. 9, 1861 ■i M.36 u " both " 2h. " | Death 6d. R. R. accident; alcoholic habit. 16 Clark July 1, 1863 " M.32 ii u of « 12 h. Flap 3 n 22 d. " " intoxieated on entrance. 17 llodges July 29, 1864 «i M. 50 11 !' IS " Aug. 6, 1864 Machinist M. 27 f W o Ul I—I Recovered, 10; Died, 2—Total, 12, Ratio of mortality, 16-66 per cent. Deaths írom Exhaustion, 1; Pyaemia, 1, Tahle S. AMPUTATIONS OF FOREARM.—Pathological. No.i Operator. Date. s 9 10 11 12 13 14 Si IS 19 20 21 23 24 .). C. Warren Townsend Havward Bigelow Clark Townsend Cabot Clark Bigelow Cabot Bigelow Townsend Cabot Bigelow ,T. M. Warren Bigelow Cabot J. M. Warren Clark Cabot llodges Clark Nov. Aug Mar. May Dec. Jan. April Aug. July Mar. Dec. Jan. Sept. April Aug. Oet. , Dec. Feb. Feb. Feb. Mar. Mav May Dec. Sept. April April 8, 1834 6, 1839 14, 1842 4, 1843 15, 1848 30, 1855 2, 1856 21, 18.58 31, 1858 29, 1859 1, 1S59 19, 1861 24, 1861 11, 1862 8, 1862 3, 1862 20, 1862 11, 1863 12, 1863 28, 1863 23, 1863 2, 1865 13, 1865 18, 1865 21, 1867 12, 1871 15. 1871 Occupation. Minor Ship-joiner Farmer Shoemakcr Housewife Farmer Mechanic ¡ Dress maker Book-agent • Laborer i Minor 1 Laborer Machinist Spinster Shoemaker Laborer Weaver Laborer Carpcnter Fruit-dealer Carpcnter Laborer ii Cook Fisberman Clerk Sempstress Sex and Age. F. 14 M. 72 M. 56 M. 14 F. 26 M. 47 M. 25 F. 31 F. 36 M. 30 M. 5 M. 36 M. 63 F. 24 M. 72 M. 40 M. 50 M.23 M.52 M. 30 M. 62 M. 62 M. J8 M. 53 M. 58 M. 32 F. 47 Disease. Necrosis of carpus Uleer of hand Tumor of hand Necrosis of carpus Tumor of hand Necrosis of carpus u u Tumor of wrist Caries of carpus Necrosis of " Tumor of hand Chronic dis. of wrist-joint Necrosis of carpus Tumor of forearm " " hand Ulcers of forearm Tumor of wrist Abscess of hand Necrosis oS carpus " " metacarpus Abscess of hand ii ii k Tumor of stump Caries of carpus Dura- tion. 18 mo, iy. 30 y. 10 mo. 12 y. 3 y. 2 y. 5 mo, 2 y. 6 mo, 4 y. iy- 3 y. 3 y. 4 mo, 40 y. 2 mo, 9 mo. 0 mo, 4 mo, 2.y. iy- 7 wk, 6 wk, i¿y. 9 mo, Amputation. Method. Circula' Flap u Circular f wr.jt. Flap Circular ii Flap Circular Flap Place m Result. Reeovery Dcath Reeovery Death Reeovery Death Reeovery Length of Time. 18 d 20 d 14 d 25 d 24 d 20 d 25 d 23 d 33 d 52 d 51 d 59 d 13 d 30 d 76 d 58 d 23 d 91 d 8S d 37 d 34 d 21 d 42 d 29 d 34 d Details. Kicked by a cow. After treatment of small tumor by empiric. Osteo-sarcoma; not fully healed. " Malignant" erysipelas. Wrist jammed. " Scroi'ulous." " Cáncer." Window fell upon wrist. After vaccination ; reamp. 2 y. for recurrence. Originating in sprain. Erysipelas. Enchondroma. Epithelial; sloughing of flaps. Following burns; erysipelas. " Cáncer." Extcnsive sloughing of flaps. Albuminuria; secondary husmorrhages ; erysip. Slight sloughing of flaps. Following pcnknife wound of wrist. Pickaxe wound of hand. Death from pyaiinia, as shown at autopsy. Primary amp. of hand for horns of 27 y. duration. Bullet wound of wrist. Recovered, 23 Died, 4—Total, 27 Ratio of mortality, 14-S1 per cent. Tahle f). Deaths from Exhaustion, 3 " Pyaiinia, 1 ' Causes of Amputation were Necrosis in 11 cases. Tumors 8 " Abscesses 3 " Ulcers 2 " Caries 2 " Chr. dis. of joint 1 " AMPUTATIONS AT 1TIP-JOINT.—Traumatic—Primary and Pathological. No. Operator. Date. Occupation. Sex and Age. Injury or Disease. Dura-tion. Amputation. Method. Flap u Result. Dcath Reeovery n Length of Time. Details. 1 2 3 J. M. Warren ii llodges June 19,1858 Mar. 23, 1859 May 29, 1868 Minor Shoemaker Clerk M. ch. M. 17 M.31 Comp. fract. of thigh Tumor of thigh " " stump 1 h. 7 mo. 5 mo. 13 d. 42 d. 60 d. Extensivo laceration of hip; d. from exhaustion. Osteo-sarcoma. " " not fully healed; return of disease in stump and in left breast two yrs. later. >-d O Ul > t-3 O fel 1 Traumatic—Primary amp. with fatal result. 2 Pathological (Tumors) " favorable result. 1 death from Exhaustion. Tahlr 10. No. Operator. Date. Occupatioi __ "cTWaTreñ 1 May 30, 1829 Painter 2 Ilayward June 28, 1831 Minor 3 J. C. Warren June 2, 1836 Laborer 4 Ilayward Sept. 24, 1837 " 5 J. 0. Warren Nov. 5,1838 Painter 6 " Mar. 6, 1845 Laborer 7 J. M. Warren April 6, 1847 " 8 ■i Mar. 31, 1848 Brakeman 9 u April 7, 1848 Artist 10 Parkman Nov. 17, 1848 Tcamstcr 11 J. M. Warren April 2, 1849 Mechanic 12 Parkman June 19, 1849 Engineer 13 Bigelow Dec. 15, 1819 Laborer 14 Townsend Aug. 8, 1851 Mechanic 15 Bigelow Nov. 3, 1851 Seaman 16 J. M. Warren April 10, 1852 Mechanic 17 Parkm ni July 1, 1852 Laborer 18 J. M. Warren Sept. 8, 1852 Seaman 19 " Nov. 27, 1852 Laundress 20 Bigelow Feb. 1, 1C54 Laborer 21 CÍark May 29, 1854 u 22 " June 19, 1854 Minor 23 Townsend Julv 3, 1855 Laborer 24 Gay Sept. 19, 1855 Mechanic 2.5 " Oet. 2, 18.55 " 20 Townsend Oet. 8, 1855 " 27 Clark June 21, 1856 Laborer 28 Gay Aug. 11, 18.56 Minor 29 Townsend Sept. 11, 1856 Brakeman 30 Bigelow Dec. 1, 1856 Widow 31 Gay Mar. 2, 1857 Carpcnter 32 Townsend Aug. 30, 1858 Minor 33 Gay Sept. 9, 1858 Seaman 34 ii Sept. 21, 1858 Minor 35 " Dec. 9, 1858 " 36 Clark May 5, 1859 Riggcr 37 (1 June 21, 1859 Tcamstcr 38 Gav Oet. 10, 1859 Brewcr 39 Bigelow Dec. 8, 18.59 Brakeman 40 Townsend Sept. 5, 1860 Laborer 41 Bigelow Jan. 29, 1861 Inspector 42 Clark April 27, 1861 Minor 43 Gay Oet. 21, 1S(¡1 Laborer 41 J. M. Warren June 6, 1862 " 45 " Julv 9, 1862 Minor 46 " June 20, 1863 Ern.nd-boy 47 Hodgcs Julv 11, 1863 Minor 48 u Sept. 21, 1863 Laborer 49 J. M. Warren April 9, 1864 Dnver AMPUTATIONS OF THIGH.—Traumatic—Primart. Sex Amput ation. Lengtl and Nature of Injury. Dnra-I Result. ot Age. tion. Method. Place. : Time. M723 Comp. com. fract. of leg 20 h. Cireulai 'i Death i 40 d. M. 10 " " thigh 12 h. 1 Flap Rccovcrv 125 d. M.31 " both " 2 h. ;Fl.&Cir. Death' 9 h. M. 39 Comp. fract. of leg 18 h. ¡Cireulai i " 6 h. M.27 Comp. com. fract. of leg 6 h. | " S I Reeovery 135 d. M. 53 u u u n 21 h. 1 Flap " 116 d. M.30 " " " knee 17 h. :Cireular | Death 2 d. M. 20 u u u lcg 8¿ h. 1 Flap 3 i Eeeovery 38 d. M. 33 a u ii u l¿h. | " Death 5 d. M. 36 Laccr. thigh & rup. fem. art. 16 h. Circular i Reeovery 141 d. M.40 Comp. com. fract. of leg 6 h. 1 " 3 Death" 1 h. M.39 ■ i l. n tliigli 4h. í Flap | " 5 h. M. 21 u ii ii i. 2¿ h. Circular | Reeovery 48 d. M.35 « ,i leg 3 h. " | it 77 d. M. 84 n ii a Ui fej Ul O fej fe! > fe" o Ul tíj »—I > Tahle 10 (eoneladed.) AMPUTATIONS OF THIGH.—Traumatic—Primary. No. Operator. J. M. Warren Hodges Cabot Hodges i« Gay Coolidgc Hodges Bigelow Cabot Date. June April July Dec. Oet. Oet, July July Aug. Nov. Jan. 1861 1865 1865 1865 1867 1869 1870 1870 1870 1870 1871 Occupation. Seaman Minor Brakeman Laborer Minor Swiss Tailor Minor Sex and Age. M.24 F. 2 M. 13 M. 21 M.38 M. 50 M. 9 M.40 M. 30 M. 11 M. 13 Nature of Injury. Comp. com. fr- ac, of both legs leg Laceration of thigh Comp. com. fract. of leg Knee joint opened Comp. com. fract. of leg " " bothknees " " thigh _ Amputation. Dura-1____._______ tion. ¡Method. Place 2 h, li h 2 h 20 h 2 h 4 2 1 2 4 3 Circular ii Flap u Cil'cular Flap Circular Flap Result. Length of Time. Death Reeovery Death Reeovery n Death Reeovery Death Reeovery Details. 57 d. Double amputation. R. R. accident. D. from tetanus. R. R. accident. " amp. of other foot. Pulmonary complication ; d. from pysemia. Resection of end of fémur. R. It. accident; exten. lac. of thigh ; d. fr. shock. Fract. of other ankle ; d. from pyannia. R. R.accident; double amp.; d. from shock. Not fully healed; resection of end of fémur. Recovered,34 Died, 25 Relievcd, 1—Total, 60 Ratio of mortality, 42-37 per cent. Tahle 11. Deaths from Collapse, 10 '* Exhaustion, 8 " Shock, 4 " Pyaemia, 2 " Tetanus, 1 R. R. accidents, 27, of which 8 were fatal. AMPUTATIONS OF THIGH.—Traumatic—Secondary. No. Operator. J. C. Warren Townsend J. M. Warren Clark Parkman Gav J. M. Warren Bigelow Hodges J. M. Warren Hodges Date. Nov. Nov. Aug. Jan. Nov. 21 Julv 13 Oet". 15 April 11 Jan. 3 Nov. Julv Oet. Mar. May Sept. 1824 1828 1845 1851 1851 1852 1857 1857 1859 1861 1863 1S64 1865 1865 1866 Occupation. Boatman Laborer Minor Mechanic n Stevedore Laborer Lieutcnant Laborer Tcamstcr Laborer Trader Sex and Age. M.30 M. 17 M. 21 M. 21 M. 12 M. 24 M. 51 M. 51 M. 48 M. 45 M. 28 M. 29 M. 56 M. 57 M. 28 Nature of Injury. Dura- tion. Method. Place. Comp. fract. of leg Lacer. of leg into knee-joint Comp. com. fract. of leg u ti i» Laceration of leg Comí), fract. of lcg Comp. com. fract. of lef "Sí Comp. frac. ank. & lac. thigl Comp. fract. of knee Commin. fract. of leg Fracture of leg Comp. com. fract. of leg Bullet in knee 15 d. 25 h. 3mo, 47 d. 121 d. 42 d. S^h. h2mo 53 d. 24 d. 18 d. Amputation. Flap Circular Result. Length of Time. Death Reeovery n Death Reeovery Dcath Reeovery Death ii Reeovery Death" Flap 12 h. 37 d. 63 d. 23 d. 52 d. 28 d. 23 d. 42 d. 119 d. 6 d. 6 d. 155 d. 3 d. 7 d. 4 d. Details. D. from tetanus, developed before operation. Prematuro explosión while blasting. Dclirium tremens; erysipelas. General anasarca. Bed sores; erysipelas. R. R. accident; thoracic complications. Dclirium tremens. Disloeation of shoulder also. Dclirium tremens; fract. of 4 ribs. Bullet wound ; d. from pyannia. (?) R. R. accident; phlebitis; d:ffuse cellular inflam. Epilepsy ; at aut. enceph. tumors found in brain & R. R. accident ; secondary haemorr. [bothlungs. Bullet wound of buttock; fract. of pelvis. Recovered, 6 Died, 9—Total, 15 Ratio of mortality, 60 per cent. Deaths from Exhaustion, 6 " Tetanus, 1 " Enceph. growth in brain, 1 " Pysemia, 1 R. R. accidents, 3, of which 2 were fatal. ►tí a > t—i O Ul > H /" AMPUTATIONS OF THIGH.—Pathological. Date. Nov. Mar. May Dec. May Dec. May Dec. Dec. Nov. Jan. April Nov. Aug. Sept. Jan. May Dec. Jan. Dec. Dec. June Nov. May Mar. Nov. Oet. Nov. June Aug. Nov. Dec. May May July Aug. Sept. Nov. Feb. June Mar. Mav Sep't. Sept. Oet. ■Oet. Feb. Mar. 13,1823 25, 1824 29, 1824 9, 1826 9, 1827 8, 1827 9, 1828 6, 1828 5, 1829 27, 1830 2, 1832 12, 1832 24, 1832 28, 1832 26, 1832 11, 1833 8, 1833 28, 1833 11, 1834 4, 1835 16, 1836 10, 1837 4, 1837 25, 1839 1839 16, 1842 16, 1842 14, 1843 7, 1814 17, 1815 5, 1845 8, 1845 27, 1845 23, 1846 31, 1847 12, 1847 27, 1847 1, 1847 27, 1847 3, 1348 7, 1848 31, 1849 9, 1849 4, 1849 8, 1849 17, 1849 28, 1849 3, 1850 20, 1850 Sex Occupation. and Age. F. 42 M. 16 M. 18 M. 21 M. 21 M. 21 Shoemaker M. 23 M.24 Servant M. 12 Shoemaker M. 23 M. 13 Cooper M. 26 F. 27 M. 21 Grocer M. 37 Domestic F. 21 Mechanic M. 26 Spinster F. 23 Farmer M. 35 Minor F. 13 Tailoress F. 24 Carpcnter M.27 Med. student M.22 Farmer M. 37 Laborer M. 23 Machinist M. 34 Tailor M. 19 Minor F. 17 Packer M.30 Laborer M.24 Sailor M. 21 Minor M. 19 " M. 12 Domestic F. 21 Physician M. 60 Carver M. 39 Mechanic M.25 Laborer M. 34 Seaman M. 23 Laborer M.22 Shoemaker M. 23 Minor M. 11 Clerk M. 44 Shoemaker M.22 Merchant M. 33 Trader M. 48 Mechanic M.27 Farmer M. 54 Spinster j F. 24 Disease. Chronic disease of knee joint Deformity oí knee Chronic disease of knee-joint n u u n Ulcers on legs Chronic disease of knee-joint Deformity of knee Chronic disease of knee-joint Necrosis of tibia Chronic disease of knee-joint Tumor of leg Chronic disease of knee-joint Necrosis of fémur Chronic disease of knee-joint Ulcer of leg Necrosic of fémur Ulcers of leg Chronic disease of knee-joint Gangrene of leg Deformity and ulcer of leg Chronic disease of knee-joint u u u u Necrosis of leg Deformity from injury Tumor of leg Chronic disease of knee-joint Gangrene of leg Chronic disease of knee-joint Necrosis of fémur Tumor of fíbula Chronic disease of knee-joint Necrosis of fémur Tumor of patella Chronic disease of knee-joint Deformity from cicatrix Dura- tion. 5 mo 7 y. 18 mo 3 y. 4 mo, 3 mo, 10 y. 16 y. 8 mo, 3 y. 7 y. 6 y. 23 y, 3 mo. 20 y. 4 y. 4£y. 2¿y. iy. 13 y. 4 y. 5 y. 24 y. 5v. 4 y. 13 y. 3émo. 5 y. 2 y. 3w. 6 v. 3 y. iéy. 50 y. 9 mo, 2 y. 2 y. 3w. 4 mo. 2 y. lify- 15 y. iy- 3 y. 30 y. 10 mo. 5 y. l¿y. Amputation. Method. Place Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular Flap Flap Circular Flap Circular Flap Circular Flap Result. Length of Time Details. Recoverv 223 35 Death Reeovery Relieved Death R ecovery Death Reeovery Death Reeovery Reeovery Death Reeovery u Dcath Reeovery Death Reeovery Death Removed Reeovery Death Reeovery 208 35 Reeovery 3 6-5 73 5 40 d 39 d 103 d 180 d 49 d 92 d 51 d 65 d 63 d 70 d 56 53 7 162 27 d. d. d. d. d. 39 d. 44 d. 58 d. 2 h. 47 d. 40 d. 27 d. 66 d. 70 d. 48 d. 24 d. 1 d. 46 d. 29 d. 11 d. 51 d. Death Reeovery Death 81 39 87 60 94 281 d. 60 d. 80 d. 11 d. Secondary haemorrhage. Venesectio ad xii. o?. Obstínate vomiting. Secondary haemorrhage. Great liremonhage during op. D. fr. exhaustion. Deformity caused by dislocation of patella. Night sweats. D. fr. exhaustion. Secondary hsemorrhage. Venesectio ad xiv. oz. Secondary haemorrhage. [oped before op. Tumor removed previously. D. fr. pyatemia devel- Resection of end of fémur. Rheumatism. [morrhage, &c. Alcoholic habit. D. fr. exhaustion caused by ha¡- Sccondary haemorrhage. D. fr. exhaustion. [art. Secondary hannorrhages requiring ligation of fem. Thigh caught in coil of rope. Secondary hsemorrhage. [surgicalop. First patient to whom ether toas administered for Phlebitis and embolism shown at autopsy. Mueh redueed before op. by suppuration. [rism. Following liga ture of fem. artery for traum. aneu- Inguinal glands inflamed. Erysipelas. Resection of end of fémur. Nearly whole of fíbula absorbed, encephaloid. Fractured patella. Great suppuration—resection of end of fémur. " Malignant." Great haraiorrhage. D. fr. pysemia. Ulcers on thigh. D. fr. exhaustion. Ul Ul > o W a Ul feí H Ul O fel fe] « o ui ►tí i—< ■-3 l> tr" Tahle 12 (eoathiaed.) AMPUTATIONS OF THIGH.—Pathological. No. ~50" 51 52 53 54 #5 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 Operator. Townsend Ilayward J. M. Warren Bigelow J. M. Wairen Bigelow J. M. Warren Parkman Townsend Parkinan J. M. Warren Clark Bigelow Cabot J. M. Warren Parkman Bigelow Townsend n J M. Warren Bigelow J. M. Warren Townsend n Bigelow Townsend Bigelow Town. end Cabot Bigelow J. M. Warren u Clark J. M. Warren Clark Gay Townsend J. M. Warren Bigelow Cabot J. M. Warren Bigelow J. M. Warren Date. Mar. 22, 1850 Oet. 10, 1860 Dec. 18, 1850 Fcb. 14, 1851 June 10, 1851 Dec. 5, 1851 June 26, 1852 Sept. 8, 1852 Sept. 25, 1852 Oet. 27, 1852 April 19, 1852 Mav 18, 1853 Nov. 28, 1853 Feb. 18, 1854 Mar. 1, 1854 July 29, 1854 Jan. ó, 1856 Aug. 8, 1856 Oet. 22, 1856 Feb. 4, 1857 Feb. 22, 1857 Fel). 25, 1857 Aprii 4, 1857 May y, 1857 Aug. 8, 1857 Sept. 15 1857 Oet. 29, 1857 Aug. 14, 1858 Sept. 25, 1858 Oet. 20, 1858 Nov. 5, 1858 Nov. 20, 1858 Feb. 25, 1859 Mar. 30, 1859 May 11, 1859 May 27, 1859 Julv 21, 1859 Aug. 12, 1859 Aug. 24 1859 Sept. 22, 1859 Oet. 18 1859 Nov. 2, 1859 Nov. 14¡ 1859 Nov. 23 1859 Nov. 30 1859 Jan. 12 1860 Jan. 19 1860 Mar. 3 1860 Mar. 22, 1860 Occupation. Minor Domestic Mechanic Laborer Mechanic Laborer Minor Mechanic Currier Housewife Seaman Sempstress Domestic Minor Clergyman Laborer Farmer Mechanic Laborer Housewife Domestic Laborer Shoemakcr Sempstress Minor n Domestic Minor Stove-dealcr Laborer Minor Currier Paper-carrier Laborer Painter Shoecutter Minor Farmer Laborer Studcnt Marble-poli h'r Cabinet-maker Tanner Housewife Widow L't-house k'per Housewife ftex and Age. Disease. M. 12 F. 26 M. 52 M. 29 M. 43 M. 36 M. 19 M. 22 M. 59 F.41 M. 21 F. 24 F. 40 F. 16 M. 54 M. 17 M. 50 M. 21 M.30 F. 40 F. 22 M. 45 M. 26 F. 27 F. 11 F. 15 F. 30 M. 15 M. 21 M. 25 M. 12 M.30 M.40 M. 23 M. 33 M.30 F. 8 M. 18 M. 21 M. 20 M. 26 M. 21 M. 50 F. 28 F. 45 M. 26 F. 34 F. 23 F.47 Caries of fémur Chronic disease of knee-joint Tumor of leg Ulcers of stump Tumor of knee Chronic disease of knee-joint Ulcers of leg u n n Chronic disease of knee-joint Tumor of knee Chronic disease of knee-joint Necrosis of fémur !! II II Chronic disease of knee-joint Ulcers of leg Chronic disease of knee-joint Tumor of leg Chronic disease of knee-joint ii u u ii Tumor of thigh Chronic disease of knee joint ii ii ii ii Necrosis of tibia Chronic disease of knee-joint II II H I Tumor of thigh " " fíbula Necrosis of tibia ii u u Tumor of fémur Necrosis of tibia Chronic disease of knee-joint Necrosis of tibia Tumor of leg Chronic disease of knee-joint Tumor of leg Chronic disease of knee-joint Tumor of leg Chronic disease of knee-joint Phlcgmasia dolens Necrosis of tibia Dura-tion. Amputation. Result. Length of Method. Place. Time. Circular ~T~ Reeovery 39 d. 18 mo. Flap | ti 99 d. 23 y. Circular | n 45 d. 9 w. u ii 46 d. 2 y. u 3 Dcath 27 d. 25 y. u Reeovery 56 d. 7 y- u s Reeovery 38 d. 16 mo. u 1 Death 7 d. 30 y. ii 3 i 3 Recoveiy 36 d. 5y. k " 38 h. iéy. u ti 43 d. 19 y. Circular u 64 d. 30 y. n I"! «i 51 d. " 3 i 1 3 u 391 d. 8 mo. ii ii 34 d. ly. u u 253 d. 40 y. ii h-í Dcath 66 d, 8 mo. ii 3 Reeovery 81 d. 2 y. ii | !! 84 d. 3 y- ii 3 i e i II 60 d. 8 mo. it II 144 d. 5 mo. u Death 3 d. 23 y. u Reeovery 33 d. 15 y. ii | u 50 d. 7 mo. u 3 1 u 34 d. 2 y. n ii 45 d. 9 y. u u 100 d. 3 mo. ii i ii 39 d. 3 y. n 3 d 45 d. 7 y- n | u 72 d. 2¿y. Flap 3 ii 135 d. iy. Circular 3 u 63 d. 2 y. u l ii 79 d. 5 mo. u | Death 17 d. 18 mo. u 3 Reeovery 60 d. 19 mo. Flap b " 46 d. 2¿ mo. Circular 2 ii 25 d. 9 mo. ii i u 52 d. 3 mo. ii 3 Death 7 d. 15 y. u 3 Reeovery 170 d. 10 nio. u 3 n 71 d. 5 rao. " 3 u 39 d. 15 mo n 3 u 81 d. 18 mo. u 3 Relievcd 45 d. 2 y. " 3 Dcath 27 d. 14 y. ii 3 n 23 d. 14 y. ii 3 Reeovery 55 d. 7 mo. ii g n 21 d. iy- n 3 3 IC 30 d. Details. Encephaloid. Primary amputation forR. R. accident. D. fr. pyasmia, as shown at autopsy. At autopsy rubercles and abscesses found in lungs. Chronic Bright's disease. Great anasarca. Fatty degeneration of muscles. Resection of end of fémur. Fibro-plastic. Singultus. Resection of end of fémur. Obstínate vomiting. Strumous diathesis. Transfusión. Great hasmorrhage. D. fr. collapse. Haemorrhage. Phthisical: Osteo-sarcoma. D. fr. return of dis. 6 mos. later. Sequestrum drawn fr. shaft of fémur. Osteo-sarcoma. Neuromata excised 7 years later. Erysipelas. Bronehitis. Tuberculosis. [haustion. " Cáncer." Secondary haemorrhage. D. fr. ex- Myeloid. Resection of end of fémur 4 mos. later. " Osteoid cáncer." Hasmorrhage. At autopsy tubcrcles found in left lung. Extensive sloughing of flaps. Strumous diathesis. Growth reappearing in stump. Autopsy showed chr. Bright's dis. and pyteinia. Jaundiee. D. before reaching home. Not fully healed. D. fr. phthisis 5 mos. later. Resection of end of fémur 1 mo. later. ►tí É> •—c O tz¡ Ul > H W fej Tahle 12 {continued.) Operator. Date. Occupation. Clark May 2, 1860 Seaman Gay June 5, 1860 Maehiuist " July 9, 1860 Domestic Townsend Oet. 13, 1860 Widow J. M. Warren Mar. 19, 1861 Laborer 11 April 22, 1861 Domestic Bigelow Nov. 7, 1861 " .1. M. Warren Feb. 13, 1862 Cigar-makcr Clark April 16, 1862 Farmer Townsend July 14, 1862 Domestic Cabot Noy. 26, 1862 Painter Gay Oet. 3, 1862 Laborer J.M. Warren April 22, 1863 Operative Clark May 22, 1863 Nail-maker J.M. Warren May 26, 1863 Minor Bigelow July 24, 1863 Farmer " Nov. 2, 1863 Spinster u Nov. 24, 1863 Farmer J.M. Warren Feb. 17, 1864 Trader Bigelow Feb. 26, 1864 Shoemaker Clark April 7, 1864 Cigar-makcr " April 16, 1864 Washerwomar ui ui o W a Ul fe! H H Ul Q fej ¡z: fej w ► f w o ¡XI TJ t—i H f 1 "ahle 12 ( eoneladed.) AMPUTATIONS OF THIGH.- -Pat HOLOGICAL. Sex Amputation. Length No. Operator. Date. Occupation. Housewife and Age. "F.28 ■ Nature of Injury. Chronic disease of knee-joint Dura-tion. 8 y. Result. Reeovery of Time. Details. Method. Flap" Place. 146 Clark Mar. 20, 1867 20 d. 147 llodges June 15, 1867 Soldier M.23 Necrosis of stump iy. u í u 33 d. Pr. amp. for comp. fract. of thigh H moa, ago. 148 Bigelow Oet. 9, 1867 Engraver M.22 Chronic disease of knee-joint 18 y. Circular i i a n 122 d. Extensive sloughing of flaps. 149 " Feb. 17, 1868 Merchant M.38 Tumor of leg 8 y. Flap ii 69 d. Erysipelas. 150 n Feb. 22, 1868 Minor M. 18 ii u ii 6 mo. ii u 39 d. " Cáncer." 151 llodges Mar. 18, 1868 " M. 13 ii u u 7 mo. ti << 33 d. Sarcoma, 152 " May 1, 1868 ii M. 18 " " thigh 2¿ mo. n | u 30 d. 153 Gay July 29, 1868 Mechanic M. 36 Chronic discase of knee-joint 4 mo. n 'i n 47 d. 154 Hodges Sept. 30, 1868 Harnessmaker M. 28 ii ii ii n 3 y. ii 3 n 28 d. 155 Gay Oet. 3, 1868 Bookseller M. 37 u u n n iy. Teale's 4-S y. ii >M 11 27 d. [Jaundice. 163 ii Oet. 29, 1869 Seaman M. 43 Tumor of thigh 3 w. u ♦ (( 88 d. Curvature of spine. Tumor in 1. lumbar región. 164 Bigelow Nov. 6, 1869 Laborer M. 26 Chronic disease of knee-joint 6 y. ii 3 11 156 d. Secondary haBmorrhages. [haem. D. fr. exh. 165 Gay July 14, 1870 Domestio F. 20 1 unior of leg 7 mo. | Death 17 d. Exci. of tumor attemp. 3 wk's before amp. Many 166 Cabot Feb. 21, 1871 Minor M. 15 Chronic disease of knee-joint 2 y. u 3 3 k 18 d. D. from pyaemia. ts Recovered, 128 Died, Relieved, Removed, 34 162 2 2---Total, 166 Deaths from Exhaustion, 21 Pyaemia, Collapse, Ratio of mortality, 20.98. Tahle 13. The causes of amputation were: Chronic disease of knee-joint in 82 cases. Necrosis, 29 " Tumors 29 " Deformitles 6 " Ulcers 6 " Ankyloses 2 " Caries 2 " Gangrene in Excisión of knee-joint Phlegmasia dolens Traum. paralysis Fungus of stump Necrosis of stump Painful stump Ulcer 2 cases. AMPUTATIONS AT KNEE-JOINT.—Pathological. No. Operator. Cabot Bigelow Cabot Bigelow u Hodges Clark Bigelow Cabot Bigelow Catot Date. June 4, 1859 Feb. 8, 1868 Nov. 28, 1868 Jan. 8 1870 Jan. 29, 1870 Mav 23, 1870 June 18, 1870 Nov. 12, 1870 Nov. 19, 1870 Dec. 24, 1870 Jan. 27, 1871 Occupation. Shoecutter Merchant Minor Operative Operativo Minor Wife Farmer Carpcnter Milliner Nurse Disease. Necrosis r. tibia Malignant tumor of leg Chronic disease of knee Pulpydegen. of knee-joint ii ii u u Conical and ulcerated stump Malignant disease of tibia Neeros.tibia& ch. dis.of knee Ankylo. knee & sinuses in leg Caries of kneejoint Abscess of knee-joint Dura- tion. 19 y 8 y 11 mo. 3y- 7 y. 8 y. 14 mo. 13 y, ii y. 25 y iy Method of Amputation. Post. flap u ii Long ant. flap Ant. & post." Long. ant. flap Ant. & post.flap Length Result. of Time. 46 d. Well u 69 d. ii 31 d. n 42 d. Dead 18 d. Well 25 d. Dead 10 d. Well 131 d. Dead 57 d. Well 61 d. Dead 5d. | Details. Recovered, 7; Died, 4—Total 11. Ratio of mortality, 36.36 per cent, Patella and cartil. removed. Reentered for diar- rheea, and died Oet. 2,1859. Patel. & cartil. removed. Sinuses in thigh form'd Short ant. and long post. flaps. Patella removed. Ant. fl. 3 in. below pa.& 1. p. fl. Pyae. gan.& erys. Slight attack of erysipelas. Flaps sloughed. ' [flap sloughed. Long ant.& short p. fl. Dis. cartil. removed. Ant. Pya3mia. Long ant. and long post. flaps. Ant. flap sloughed. ►tí a O Ul W fej Deaths from Exhaustion, 3; from Pyiemia, 2. Tahle 14. AMPUTATIONS AT KNEE-JOINT.—Traumatic—Primary No, Operator. Hodges Clark Hodges Date. Oet. 17, 1867 June 3, 1868 Aug. 6, 1869 June 4, 1870 June 25, 1870 Sex Occupation. and Age. Mechanic M.38 Bookkeeper M. 18 Merchant M. 82 Coachman M. 35 Auditor M. 49 Injury. Comp. com. fract. lef Dura- don. 1 h. 1 h. H h. 2 h. 2 h. Method of Amputation. Ant.&post. flap Length Result. of Time. Well 72 d. ii 81 d. Dead 2 h. " 1 d. " 23 d. Details. Recovered, 2; Died, 3 ;—Total, 5. Ratio of mortality, 60.00 per cent. Deaths from Exhaustion, 3. Amp. of left foot also (procede de M. Roux.) Post. flap sloughed. Had bled excessively. C. com. fract. of pelvis also. Horse R. Road. L. ant.& sh. post. fl.; acute cellulitis; p. fl. slgh'd, R. R. accident, 1, which was fatal. Tahle 7,7. AMPUTATIONS OF LEG.— Traumatic —Primary. No. Operator Date. Occupation. Sex and Nature of Injury. Dura- Amputation. _ Result. Length of Details. __ Age. M.27 tion. f8~hr Method. Place. Time. "82 d! ______________________________________________________________________________.__________.----------------------------------------------------—-----------------------■--------------------------------------------------------——— 1 Havward April 25, 1832 Truckman Laceration of lea Circula. c Reeovery Aleoholic habit. Secondary hsrmorrhages. 2 '»< Mar. 5, 1838 Laborer M.30 Comp. com. fract. of leg 3h. " \ Death" 9 d. Inj. to baek. Jaund. Convul. Cause of d. unkn. 3 ii Jan. 16, 1839 Tcamstcr M. 26 " " u ii t! 22 h. " \ Reeovery 119 d. Delirium tremens. 4 Townsend Aug. 14, 1841 Apple-woman F. 50 h ii u ii II 3h. i n 56 d. Becamc insane and was sent to the asylum. 5 " Nov. 16, 1846 Tanncr M. 35 •« u u ii 11 1¿ h. Flap \ 138 d. R. R. accident. Delirium tremens. 6 n Feb. 20, 1847 Brakeman M.27 ii ii u ii 11 6h. Circular i u 161 d. do. Sceondarv ha-morrhage. Pleuritis. 7 J. M. Warren Mar. 24, 1847 Laborer M. 39 u u u u '• 3h. tí ] f Death 6 d. do. F. of skull. D. fr. comp. as sh. at autopsy. 8 Townsend Sept. 2, 1817 M.40 n u ii ii ankle 4 h. " } u 18 h. do. cont. of abdomen. D. fr. periton. and perf. 9 Sept. 27, 1847 n M. 26 ii ii u n foot 3h. ti j Reeovery 95 d. do. [of sraall intcst. shown at aut. 10 J. M. Warren Mar. 13. 1848 Minor F. 6 ti n ii ii ankle 1 h. tt .i 40 d. do. 11 ii April 27! 1848 Domestic F. 21 «< u ii ii foot 2h. u j ii 115 d. do. Resection of end ofboncs. Erysipelas. 12 n May 8, 1819 Seaman M.27 " u u ii leg 15 h. Flap ] Death 11 d. do. Del. trem. Forearm also injured. 13 i< Oet. 6, 1849 Laborer M.35 ii " u ii leg 5h. " j Reeovery 235 d. do. Erysipelas of scalp and stump. 14 Townsend June 1, 1850 u M.25 n u it n legs 2h. Death 18 d. do. Double amputation. Intoxication. 15 «i Sept. 14, 1850 • < M. 50 u ■i u ii leg 3h. Circular i Reeovery 74 d. do. Sloughing of flaps. 16 J. M. Warren Apri 1, 1851 ii M. 57 u ii n u ankle l£h. Listón' s " 75 d. 17 Townsend Aug. 1, 1851 Domestic F. 18 ii n n n n 17 h. ¿ 109 d. 18 " Aug. 22, 1851 Minor M. 18 n u ii u n Circular ii 91 d. Right thigh also amputated. 10 n Oet. 17, 1851 Teamster M.30 " ■i u ii leg 1 h. " i ii 95 d. Delirium tremens. 20 Parkman Oet. 18, 1852 Laborer M. 33 a n ii n ankle 8h. 11 ; <« 26 d. R. R. accident. [from collapse. " " Fract. of skull and forearm. Died 21 Clark Nov. 17, 1852 Carpcnter M.35 ii n u ii ii 3h. Flap ¡ Death 1 d. 22 Cabot Jan. 21, 1851 Seaman M. 19 ii u u u ii 2h. | Reeovery 42 d. 23 J. M. Warren Mar. 9, 1854 Stonecutter M.32 ii " ti ii n 2h. Flap u 67 d. R. R. accident. Fracture of nose. 21 Clark June 15, 1854 Laborer M. 18 ii u ii n leg 2h. i 58 d. n n 25 June 19, 1854 " M. 24 ii ii ii n 2h. " i Death 3 d. " " Comp. com. fract. of skull. D. fr. comp. 26 n June 21, 1854 n M. 21 n " ii ii ii 3h. !? 7 d. ii n j¡rySipelas. 27 Parkman Aug. 7, 1854 Tradcr M. 57 ii ti u ii foot 1 h. Circular i Reeovery 31 d. it u ü 28 " Sept. 12, 1854 Engineer M.22 " u ■ i u ankle 3h. ll )j ii 42 d. u i< n 29 Bigelow Dec. 5,1854 Laborer M. 28 n ti u ii leg 2h. u | Death 36 d. Comp. fract. of left leg. D. fr. pyajmia. 30 Car>ot Dec. 16, 1854 Seaman M. 33 u u i< ii n Reeovery 125 d. R. R. accident. Secondary hannorrhage. 31 Feb. 14, 1855 Minor M. 16 n u u ti u 2h. n j " 66 d. [thotonos and spasm. 32 Bigelow Fcb. 24, 1855 Book-pcdlar F. 26 u " u ii u 3 h. \ Death 11 d. R. R. accident. Lisfrane's amp. of 1. foot. Opis- 33 Cabot Mav 28, 1855 Laborer M. 19 " u ii u ii 3h. i Reeovery 49 d. Dcliriuní tremens. Not fully eicatrized. 34 " De. 26, 18.55 Domestic F. 20 " ii u ii ankle 2h. " i. 61 d. R. R. accident. Amp. of thumb. Sloughing of fl. 3 5 Clark Mav 18, 1856 Mariner M. 55 " ii u u leg 20 h. " Death 7 d. Obstínate vomiting. 3'¡ Townsend Aug. 12. 1856 Mechanic M 50 - u u u u " Ii 1». " 10 d. Phlcbitis. 37 I J. M. Warren April 18, 1857 .Clerk M. 19 ii u ti ii " 12 h. " n 25 h. Intoxication & great loss of blood. D. fr. collapse. Ul Ul Q W Ul fej Ul fej Í2J fel w í> tr1 W o Ul »—i na Tahle ir> ( continué* ?•) No. Operator. Date. Occupation Tbr Clark Nov. 4, 18-57 Merchant 39 Cabot June 10, 1858 Minor 40 Townsend Julv 5, 18-58 Shoemaker 41 Gay July 12, 18-58 Minor 42 Townsend Oet. 22, 1858 Masón 43 J. M Warren June 17,1859 Washerwoma 44 Cabot June 23, 18-50 Minor 45 Townsend July 4, 1S50 Laborer 46 " July 16, 1S.5!) Seaman 47 Gay July 13, 18: ¡0 Laborer 48 " Aug. 27, 1861 Minor 49 ii Oet. 4, 1861 Laborer 50 Cabot Dec. 25, 1861 Blacksmith 51 G.iy Aug. 28, 1862 Minor 52 Oet. 27, 1862 Ropemakcr 53 .1. M. Warren May 12, 1803 Minor 54 Clark July 13, 1863 Laborer 55 Hodges July 15, 1863 Enginecr 56 >> Julv 18, 18i.3 Laborer 57 n Sept. 12, 1863 Carpcnter 58 " Sept. 15, 1863 Laborer 59 " Sept. 29, 1863 Soldier 60 ii Oet. 29, 1863 Laborer 61 Cabot Feb. 11, 1864 " 62 Bigelow Feb. 20, 1864 " 63 Clark April 2, 1864 Soldier 64 llodges July 18, 1864 Minor 65 Cabot Aug. 14, 1861 Laborer 66 Bigelow Dec. 8, 1864 Brakeman 67 Cllirk April 18, 1865 Laborer 68 " April 20, 1865 u 69 ii June 28, 1865 u 70 Gay Aug. 4, 1865 . Sex and ^ge^ M. 50 F. 7 M. 20 M. 13 M. 32 F. 46 F. 19 M. 35 M.35 M. 68 F. 2 M.30 M. 26 M. 14 M.22 M. 9 M. 55 M.22 M. 26 M. 58 M.32 M. 24 M. 47 M. 35 M. 33 M.30 M. 4 M.22 M. 35 M. 20 M. 31 M. 56 M.35 M.32 M. 19 M.24 M.27 M. 12 M.37 M.38 F. 6 M. 28 M. 60 M. 42 M.43 M. 19 M. 28 M. 9 M. 33 Nature of Injury. Comp. com. fract. of ankle " " foot " " le? " " foot II II II " " ankle " " leg ii a .i " " ankle « i. ieg " " foot " " ankle ■i u n " " leg u ii n u >i u ii ii k u u i< " of both legs n ii ]eg " " ankle " "bothlegs u ii u " " leg " " foot " " ankle n n n " " leg " " foot i. .. ieg u u ti " " foot " " both legs " " ankle " " both legs « " leg u n n ■ i—i O Ul > w fel Tahle IX (eoneladed,) No. Operator. 87 Bigelow 88 Coolidge 89 llodges 90 it 91 Cay 92 Cabot 93 Hodges 94 Gay 9-5 Hodges 96 07 ii Date. Jan. 6, 1869 June 19, 1869 Sept. 14, 1869 Sept. 23, 1869 Oet, 28, 1869 Dec. 14, 1869 Mar. 8, 1870 July 30, 1870 Aug. 29, 1870 Oet. 29, 1870 Nov. 3, 1870 Recovered, 63 Died, 33 96 Removed, 1—Total 97 Ratio of mortality, 34.37 Tahle 16. No. Operator. Date. Occupation. 1 J. C. Warren Feb. 4, 1822 Laborer 2 u Nov. 10, 1827 " 3 G. Otis June 3,1829 Shoemaker 4 J. C. Warren Feb. 26, 1830 Laborer 5 Ilayward June 9, 1831 Carpcnter 6 J. C. Warren Feb. 8, 11131 Laborer 7 Townsend July 17, 1815 Painter 8 n July 25, 1815 ii 9 Bigelow Sent. 21, 1847 Laborer 10 Havward Nov. 8, 1818 Minor 11 Parkman Dec. 7, 1848 Laborer 12 J. M. Warren Feb. 11, 1849 " 13 Parkman Sept. 11, 1849 ii 14 • < June 15, 1850 " 15 ,T. M. Warren April 30, 1851 Seaman 16 Parkman July 28, 1851 Tcamstcr 17 " Sept. 29, 1852 Farmer 18 Bigelow Jan. 7, 18.54 Laborer 10 Townsend July 21, 1854 Masón ?0 •< Sept. 19, 1854 Carpcnter 91 Cabot Jan. 13, 1855 Mechanic 9?, ti Feb. 15, 1855 , Laborer 23 .T. M. Warren Apiil 30, 18,57 ! " V4 Townsend Aug. 18, 18.57 Minor 25 " Aug. 20, 18.>7 Laborer 26 Bigelow iDcc. 22, 1857 , Farmer AMPUTATIONS OF LEG.—Traumatic—Primary. Sex and Age. M.18 F. 2 M* 37 M. 21 M. 18 M. 28 M.31 M. 19 M. 9 M. M. 19 Nature of Injury. Comp. com. fract. of ankle " "of both legs u ,. .< leg i Exhaustion, Collapse, Pya'inia, Shock, Comprcssion, Peritonitis, com. com. foot leg ti foot Dura- tion. 2 h. 2 h. 1 h. 2 h. 2h. 2h. 3 h. 2h. 2h. 3h. Amputation. Method, Circular Flap Circular Flap Circular Flap Place. í i I 3 §4 Length Result. of Time. Reeovery 187 d. Death 4 d. " 6 d. Reeovery 69 d. " 58 d. Dcath 30 h. Reeovery 50 d. " 54 d. n 152 d. h 147 d. n 65 d. Details. Resection of end of bones. Sec. liamiorrhagcs. R. R. accident. Double amputation. Contusión and gangrene of 1. leg. Del. trem. R. R. accident. 4 toes amputated. Erysipelas. " " Extensivo scalp wound. « " Convulsions. Died fr. collapse. Erysipelas. Secondary hajmorrhage. Laceration of other foot. R. R. acc. Hos. gangr. Resec. of end of bones. Erysipelas. 17 4 4 3 2 1 Deaths from Cerebral Arí'ection, 1 " " Unknown Cause, 1 R. R. accidents, 57, of which 18 were fatal. AMPUTATIONS OF LEG.—Traumatic—Secondary. Sex and Age. M. 60 M.30 M. 27 M.49 M. 49 M. 24 M.40 M. 21 M. 25 M. 10 M.24 M. 30 M. 25 M 22 M.31 M.29 M.33 M.40 M. 55 M. 22 M. 23 M. 38 M. 60 M. 14 M. 23 M. G0 Nature of Injury. Comp. fracture of leg Comp. com. fracture of foot Comp. disloeation of ankle " com. fract. of leg it u u u u ■• n ii II f00t " " " " ankle ■i u n n ii u n ii leg disloeation of ankle com. fracture of leg " " " foot u n n leg Dura- tion. ~Í2dT 11 d 19 d. 28 d. 10 d. 2A mo. 15 d. 6d. 3d. 10 d. 34 d. 18 d. 12 d. 28d. 11 d. 20 d. 10 d. 22 d. 40 d. 19 d. 12 d. 2d. 8d. 21 d. 2 mo. Amputation. Method. Placo Circular Flap Circular Flap Circular Flap Circular Flap Circular Result. Death Reeovery Death Reeovery Dcath Reeovery Dcath Reeovery Death Reeovery Death Reeovery .Length of Time. 6 d. 65 d. 10 h. 71 d. 82 d. 33 d. 25 d. 31 d. 119 d. 7d. 83 d. 54 d. 134 d. 140 d. 62 d. 15 d. 7d. 14 d. 18 d. 198 d. 47d. 86 d. 26 d. 93d. 142 d. 32 d. | Details. Delirium tremens. Gangrene. ii ii Aleo, habit. Great loss of blood. D. fr. col. u u ii u •' << Delirium tremens. R. R. accident. Gangrene. Much sloughing before operation. R. R. accident. Resection of end of bones. Very nervous temperament. Tetanus. R. R. accident. Fell upon leg while wrestling. Secondary haemorrhage. Erysipelas before op. Resection of end of bonos. Delirium tremens. Neuralgia. Del. trem. D. fr. pyaemia, as shown at aut. R. R. accident. Sec. hamiors. D. fr. pysemia. Delirium tremens. D. fr. pysemia. " " Erysipelas. Not fully healed. Imbecility. Intoxication. R. R. accident. Refused to submit to prim.'op. Sloughing of flaps. Scalp wounds. Secondary ha?m. Gangrene. u¡ Ul a W a Ul fel i-3 H Ü3 fel ízí fe) W P> f w o ui -o h-t ► Tahle 16 (eoneladed.) AMPUTATIONS OF LEG.—Traumatic—Secondary. No "27" 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Operator. Bigelow Cabot J. M. Warren Townsend Clark Townsend d Cabot « Clark Bigelow Cabot Hodges Bigelow Cabot Cabot Hodges Bigelow Cabot Gav Cabot Date. Jan. Dec. Jan. Feb. June Aug. May Aug. Aug. Nov. Dec. Aug. Nov. Dec. April Dec. Aug. Nov. Dec. Dec. Nov. May Feb. Feb. Aug. Dec. 23, 1858 4, 1858 24, 1860 18, 1860 23, 1860 6, 1860 9, 1861 12, 1861 31, 1861 1, 1861 24, 1862 15, 1863 21, 1863 10, 1863 21, 1864 28, 1864 19, 1865 11, 1865 21,1865 26, 1865 11, 1867 12, 1868 6, 1869 19. 1869 18, 1870 23, 1870 o ex Occupation. and Age. Housewife F. 35 Tailor M. 49 Tearaster M. 65 Charwoman F. 60 Laborer M. 58 Laborer M.22 Minor F.4£ ii M. 11 » M. 4 Seaman M.40 Minor M. 5 Fi reman M. 23 Med. student M.24 Shoemaker M. 44 Laborer M. 55 Cabinetmaker M. 53 Fireman M. 19 Cabinetmaker M.22 Laborer M.35 Tailor M. 21 Seaman M. 18 Teamster M.27 Laborer M. 56 Minor M. 12 Clerk M. 19 Laborer M.27 Nature of Injury. Comp. com. fract. of ankle u u tí u leg u ii «i ii u !< ti tí II II Comp. com. fract. of ankle Comp. com. fract. of lcg Fracture of ankle Comp. com. fract. of leg Laceration of foot Comp. com. fract. of leg Comminuted fract. of ankle Comminuted fract. of foot Comp. disloc. at ankle Comp. com. fracture of leg Comp. disloc. at ankle Comp. fracture of leg Comp. com. fract. of foot Comp. com. fract. of foot Comp. com. fract of ankle Comp. com. fract of foot Comminuted fract. of ankle Comp. com. fract. of leg Comp. fract. of leg Comp. com. fracture of foot Comp. com, fracture of foot Laceration of leg 17 d. 7 w. 18 d. 16 d. 38 d. Dura- tion. Method. Place d. d. d. d. d. d. d. 15 mo. 2 d. 29 d. 17 d. 55 d. 14 d. 21 d. 11 d. 19 mo, 15 d. 21 d. 6 mo 9d. 1 mo Amputation. Circular ii Flap Circular Flap Circular Flap Circular Flap Circular Flap Circular ii Flap Flap Circular Flap n Circular Death Reeovery ii Death Reeovery Death Reeovery Result. Length of Time. os Details. Death Reeovery ■i u Death ii Reeovery u Dcath Reeovery Death Reeovery n Death Reeovery Death 17 d. 59 d. 187 d. 10 235 6 29 50 50 4 26 53 d. 3 d. 8 d. d. d. d. d. d. 60 26 13 64 50 93 d. 45 d. 12 d. 33 d. 67 d. 41 d. Delivered. D. fr. pyaemia as shown at autopsy. Erysipelas. Resection of end of bones. D. from pyaemia. Del. trem. Erysipelas. Resection of end of bones. Mucous and bloody stools. D. fr. pysemia. No lesión found at autopsy. R. R. accident. [1 year later. " " Erysip. Resec. of end of bonea R. R. accident. D. from collapse. D. from pyaemia. Diarrhcea. R. R. ac. Pirigoff 's amp. performed primarily. " " Del. trem. D. fr. pyaem. shown at aut. Phlebitis. R. R. accident. Resection of ends of bones 1 month later. Delirium tremens. R. R. accident. Resection of end of bones. Pyaemia suspected before amp. and found at aut. Recovered, 34 Died, 18- Ratio of mortality, Tahle 17. Total, 52 34.61 per cent. Deaths from Exhaustion, 8 " " Pyarania, 8 " " Collapse, 2 AMPUTATIONS OF LEG.—Pathological. R. R. accidents, 12, of which 6 were fatal. No ~T 2 3 4 5 6 7 8 9 10 11 12 13 14 Operator. J. C. Warren G. Otis J. C. Warren Hayward ii J. C. Warren Hayward Date. Operator. Dec. May Dec. April Mar. Feb. Dec. Jan. Mar. Nov. Feb. Feb. Dec. Jan. 19, 1823 22, 1825 17, 1825 4, 1828 5, 1829 11, 1830 18, 1830 19, 1833 2, 1833 12, 1834 6, 1836 13, 1836 10, 1836 21, 1837 Sailor Merchant Hackman Grocer Housewife Laborer Seaman Baker Silversmith Shoemaker Farmer Chaisemaker Woolspinner Whcelwright Sex and Age. Disease. M. 21 M. 21 M.41 M. 21 F. 50 M. 44 M. 43 M. 5? M. 19 M. 37 M. 43 M.38 M.28 M. 43 Dura- tion. Amputation. Mefhod.jPlace, Frost-bite of feet Chronic dis. of ankle-joint Necrosis of tibia ii ii 'i Tumor of leg Ulcers of leg and foot Deformity of foot Ülcer of stump u n n H u ]eg Caries of tarsus Frost-bite of feet 13 d. Circular 12 y. I Flap 2 y. 15 y. |10 mo.|Circular 20 y. Ut. 20 y. Coñg. 1 3>'- 14 y. 4 y. 1 24 d. Length Result. of Time. Reeovery 61 d. n 71 d. u 30 d. u 65 d. u 47 d. ii 83 d. u 62 d. ii 32 d. ii 33 d. Dcath 20 d. Reeovery 46 d. " 51 d. 1 «« 1 50 d. Details. Double amputation. One flap. Nearly healed. Died one month later. Chills and fever. Growth appearing iu groin. Alcoholic habit. Lisfranc's amp. of foot for frost-bite. D. from pyaemia. Secondary haemorrhage. E rysipclas. Intoxication. a ► h-t O Ul ■•3 w fel Ti %hle 17 ( continued .) AMPUTATIONS OF ] No. Operator. Date. Occupation. Shoebinder Sex and Age. F. 25 Disease. 15 Hayward Nov. 23, 1837 Deformity of ankle 16 it April 17, 1838 Overseer M. 38 Ulcer of leg 17 Townsend Nov. 6,1839 Laborer M. 29 Tumor of leg 18 •i Sept, 28,1840 Mariner M. 18 Ulcer of stump 19 ■i Oet. 18,1842 Farmer M. 73 « n ieg 20 Hayward Nov. 17,1843 Teamster M. 45 " " stump 21 Townsend Mar. 10,1845 Farmer M. 60 Necrosis of tibia 22 ii Dec. 23, 1846 Domestic] f. 42 Chronic dis. of ankle-joint 23 Hayward Jan. 2,1847 u F. 56 Necrosis of tibia 24 J. C. Warren June 14,1847 Mariner M. 19 Tumor of leg 25 Parkman Aug. 23,1848 Mechanie M. 23 Chronic dis. of ankle-joint 26 J.M. Warren April 7, 1849 Minor F. 17 Necrosis of tarsus 27 u May 2, 1849 Domestic F. 28 u ii u 28 Hayward Jan. 13, 1851 Seaman M. 23 Caries of tarsus 29 J. M. Warren April 2, 1851 " M. 22 u ii n 30 Parkman Oet. 10, 1851 Mechanic M. 41 Chronic dis. of ankle-joint 31 Townsend July 3, 1854 " M. 64 Ulcer of leg 32 Bigelow Aug. 29, 1854 Laborer M. 30 " of stump 33 " Dec. 23, 1854 ii M. 22 Chronic dis. of ankle-joint 34 Townsend May 15, 1855 Mechan c M. 56 Ulcer of leg 35 Bigelow Jan. 26, 1856 u M. 25 Gangrene of stump 36 ii May 16,1856 Farmer M. 43 Caries of tarsus 37 J. M. Warren April 23, 1857 u M. 53 Necrosis of tibia 38 ii April 28, 1857 Mechanic M. 25 " " tarsus 39 Townsend June 23, 1857 Laborer M. 63 Ulcers of leg 40 " Aug. 29, 1857 " M. 30 ii ii u 41 Bigelow Oet. 13,1857 Housekeeper F. 56 ii u u 42 " Nov. 28,1857 Mechanic M. 22 Caries of tarsus 43 u Dec. 28, 1857 ii M. 50 Gangrene of foot 44 J. M. Warren May 22, 1858 Laborer. M. 46 Caries of tarsos 45 Townsend July 10, 1858 Lawyer M. 47 ii u u 46 Gay July 16, 1859 Teacher M. 30 Ankylosis at knee 47 Townsend Oet. 15, 1859 Machinist M. 28 Caries of tarsus 48 Cabot Dec. 10, 1859 Blacksmith M. 30 Frost-bite of feet 49 n Jan. 2, 1860 Trader M- 38 Caries of tarsus 50 iy- Flap Reeovery 63 d. 2 y. i ii 60 d. Opiura habit. 28 y. Circular I n 47 d. Erysipelas. 4 mo. ii 1 ii 82 d. 10 d. Flap I n 53 d. Double amputation. 9 mo u I Death 55 d. " " one amo. later than the other. 9d. u i Reeovery 141 d. Amp. of toe of left foot on 97th day. 9mo. Circular 1 Death 28 d. Sloughing of flaps. Obstínate vomiting. 6 y. Svme's 1 Reeovery 35 d. Congenital talipes varus. 6 y. Flap I i< 24 d. 10 mo. Circular I 3 u 50 d. 3 y. u tt 75 d. Hospital gangrene. 12 y. u 3 Death 20 d. Atheroma. Sec'y haemorr. D. fr. pyaemia. Cong u Reeovery 63 d. 19 y. « ? u 137 d. Sciatica, 8 y. Flap | " 34 d. 39 y. !H !< 79 d. Following fracture of fémur. 20 y. u Death 8d. Erysipelas. Profuse secondary haemorrhage. 20 y. ■i | Reeovery 209 d. " 7mo. u I Death 14 d. Profuse sec'y hsemorr. necess. lig. of fem. art. > Ul Ul ¡> Q W d Ul fel Ul

h3 W fej Tahle 17 (eoneladed.) AMPUTATIONS OF LEG.—Pathological. No, ÍÍ3 114 115 116 117 118 ]19 l'-'O Operator. Cabot n Gay Bigelow Hodges Bigelow t! Clark Date. Dec. April Sept. Jan. May June Nov. Mar. 17, 1868 7,1869 14, 1869 7, 1870 6,1870 28, 1870 29, 1870 21, 1871 Occupation. Laborer Seaman Farmer Minor Housewife Clerk Laborer Minor Sex and Age. M. 23 M. 19 M. 69 M. 11 F. 37 M.22 M. 44 M.17 Disease. Conical stump Painful stump Necrosis of tarsus U 11 II Gangrene of leg and foot] Necrosis of tarsus Dura- tion. 4y- 1 v. 15 y. iy. 3 mo. 17 y. 9 mo, 3 mo. Amputation. Method. Flap Circular Flap Circular Flap Circular! Place i-I Result. Reeovery Length of Time. 35 d. 69 d. 52 d. 88 d. 46 d. 47 d. 66 d. Details. Primary amp. for caries of tarsus 4 years ago. " 11 u comp. fract. of ankle 18 m. ago. Alcoholic habit. Erysipelas. Secondary haemorrhage. Erysipelas. Recovered, Died, 104 15 Deaths from Exhaustion, 9 » ii pyaemia» 6 119 Unrecorded, 1- Ratio of mortality -Total, 120 12-60 per cent. The causes of amputation were: Necrosis in 32 cases. Ulcers of stump 20 " Ulcers, 16 " Caries of tarsus, 16 " Gangrene, 7 " Painful stumps, 4 " Ch. dis. ankle-joint 5 " Tumors in Frost-bites Dctbrmities, 3 Conical stumps, 3 Ankvlos. at knee 2 Club-feet, 2 Atrophy, 1 5 cases. 4 The number of deaths from each cause is as follows: Exhaustion, Pyaemia, Collapse, Shock, Cerebral lesión, " compression, Peritonitis, Tetanus, Chloroform, Malignant growth, Unknown, 98=54.44 per cent, of fatal cases 42=23.33 " " " " " 21=11.61 " " " " " 8= 4.44 " " " " " 2 2 2 2 1 1 1 Total, 180 deaths in 692 cases=26.01 per cent, of mortality, exclusive of 7 cases ín which the result is unknown or unrecorded. ► Ul Ul a W a Ul fel Ul Q fel fej W f w o Ul >—i ir1 'f> per ct. (Lancet, Sept. 18, 1869, p. 420). It may also be notcd that the death rate from pyaemia compares very favorably with that reduced by Mr. Bryant from 300 cases of amputation in Guy's Hospital, in which it was 42 per cent, of all fatal cases. Sir J. Y. Simpson in his articles on " Hospitalism" holds that "50 per cent, of the deaths after amputation in our large' hospitals are the result of pyaemia." (Lancet, Oet. 16, 1869, p. 538.) The Massachusetts General Hospital contains 175 beds, including both medical and surgical, arranged in wards varying in capacity from 7 to 21 beds, and an out-building used for a foul-ward. Tabular View of Results at the N. York, Pennsylvania and Boston City, and Massachusetts General Eospitals, andin the British Hospitals as reported by Sir James Y. Simpson. TRAUMATIC PRIMARY. Ne-w York Hosp. Pennbylv. Hosp. Boston City Hosp. Mass. Gek. Hosp. C .ti -o o¿ •o S¿ 05 ■SÉ" O) > ei C £ c > ns H C ~a CJ > •a 63 O 'hs CJ >d C3 o"s o o a> tí R i* H o tí R o H *2 o o n> tí p H ec o o o tí P C "5* « o «a Should. joint 3 4 7 57.L4 » 2 11 18.18 2 6 8 75. 7 8 15 53.33 Arm 14 14 0. 53 5 58 8.62 10 4 14 28.57 29 7 36 19.44 Forearm 8 2 10 20. 78 5 83. 6.2 9 9 0. ??, 7 ?9 24.13 H ip-joint 2 2 100. 2 2 100. 1 1 100. Thigh 4 12 16 75. 14 10 24 41.66 6 15 21 71.42 34 25 59 42.37 Knee-joint ? 3 5 60 Leg 10 7 17 41.17 51 32 83 38.55 1 11 7 18 38.88 63 33 96 34.37 TRAUMATIC SECONDARY (After 24 hours). Ne-w York Hosp. Pennsyly. Hosp. Boston City Hosp. Mass. Gen. Hosp. •o CJ I tí o P H .2 "1 u •d O) >■ o o PS o p o o.tí o 5 « o PSJ3 -d p» o o o tí R o H o¿ rl « o d o 5 o tí d CJ P o H O sj ^ o 5-hould. ji-iut 2 2 4 50. 1 1 2 50. Ai ni 3 1 4 2-\ 6 3 9 33.33 3 5 8 62.50 5 3 8 37 50 1 o1 enrm Ilil -joint 2 1 3 33.33 V 4 11 36.36 2 0 2 0. 10 2 12 16.66 Thigh Kme-joint 8 6 14 42.85 9 6 15 40. 1 3 4 75.00 6 9 15 60.00 Leg 9 2 11 18.18 12 15 27 55.55 . 5 2 7 28.57 34 18 52 34.61 MASSACHüSETTSkGENERAL HOSPITAL. 21 PATHOLOGICAL. New York Hosp. Pbnnsylv. Hosp. Boston Gity Hosp. Mass. Gen. Hosp. Simpson. d CJ Ih <¡> > o u «5 tí d CJ p 3 o H O ct ■|ti Píg d » o > O u V P3 d p 3 O H o¿ .23 ej o d > 8 K d p 3 o o "3 "5 ^ •d u fc. a >■ o o 2 7 28.57 6 6 0. 4 2 6 33.33 23 4 27 14.81 60 15 76 20. Hip-joint 2 0 2 0. Thigh 15 6 21 28.57 28 9 37 24.32 12 4 16 25.00 128 34 162 20.9S 392 239 631 37.87 Knee-joint 7 4 11 36.36 Leg 12 4 16 25. 21 7 28 25. 6 1 7 114.28 104 15 119 12.60 194 89 283 31.45 SUMMARY OF THREE PRECED1NG TABLES. New York Hosp. Pennsylv. Hosp. Boston City Hosp. Mass. Gen. Hosp. Simpson. -d o t. V > o o d 0J p 3 o H o.-.21 * o d V u ¡V > o o d ñ 3 o H O.Ü o"a 1* d O) Ii 0> >■ O o d p 3 o H .23 d o S-i O o d CJ fl 3 O H t4- fc-> OÍS * O d >-o d 0J p 3 O H 0*3 ,3 o tí «S PS *2 OJ PS «g P5 «a P5 4 3 Should. joint 6 7 13 53.84 10 2 12 16.66 4 7 11 63.63 15 11 26 42.30 0 0 0 0 Arm 20 1 21 4.76 62 9 71 12.67 17 10 27 37.03 62 14 76 18.42 187 110 297 37.03 Forearm 15 5 20 25. 91 9 100. 9. 15 2 17 11.76 55 13 68 19.11 204 40 244 16.39 Hip-joint 2 2 100. 2 2 100. 2 1 3 33.33 Thigh 27 24 51 47.05 51 25 76 32.89 19 22 41 53.65 168 68 236 28.81 500 435 935 46.52 Knee-joint 9 7 16 43.75 Leg 31 13 44 29.54 84 54 138. 38.41 22 10 32 3125 201 66 267 24.71 343 270 613 44.04 STATISTICS FOR THE FOUR AMERICAN HOSPITALS. Traitm. Primary. Traum. Secondary. Pathological. -a Ih O.ti £ os d o.-s O) >• d 53 O OS o d f? 25 o «j OJ O 03 8 P O H p o P O 3« O o P O H « O tí Píg- tí «S PÜ 11 4 u tí% Should. joint 21 20 41 48.78 3 3 6 50. 26.66 Arm 106 16 122 13.11 17 12 29 41.37 38 6 44 13.63 Forearm 117 14 131 10.68 21 7 28 25. 38 8 46 17.39 Hip-joint 5 5 100. 2 0 2 00.00 Thigh 58 62 120 51.66 24 24 48 50.00 183 53 236 22.03 Knee-joint 2 3 0 60.00 7 4 11 36.36 Leg 135 79 214 36.91 60 37 97 38.14 143 27 170 15.88 22 MASSACHUSETTS GENERAL HOSPITAL. In view of contradictory opinions which have been held as to the effect of Chloroform upon the final result of surgical operations, it may be interesting to examine the forego- ing tables with a view to deciding it may be in some measure the effect produced by the use of Sulphuric Ether upon the mortality of operations. The dividing line is fixed at January lst, 1847, that being the date from which the use of this ansesthetic became the established habit in the Massachusetts General Hospital. Before Ether. Apter Ether. No. 'Ó OJ O.- d CJ <<- ¿> of Limb. Subdivisión. OJ > OJ O CS OJ OJ O 03 Tahle. O o OJ tí p O CJ OJ tí 24 P 4 03 o 5 Arm Pathological 4 0 0. 14.28 6 Forearm Traumatic Primary 2 0 0. 22 7 24.13 7 "1 • " Secondary 1 1 50. 11 1 8.33 8 tí Pathological 4 0 0. 19 4 17.39 10 Thigh Traumatic Primary 3 3 50. 31 22 41.50 11 " Secondary 2 1 33.33 4 8 66.66 12 tt Pathological 26 7 21.21 102 26 20.31 15 Leg Traumatic Primary 4 1 20.00 59 32 35.16 16 " Secondary 5 3 37.50 29 15 34.09 17 tt Pathological 20 1 5. 84 14 14.28 71 17 19.31 385 133 25.67 At first view this would seem conclusive against the use of angesthetics, but a moment's reflection renders the fallacy sufficiently obvious. A vast number of operations, espe- cially in chronic or long-continued cases, are submitted to by patients and willingly undertaken by surgeons at the present day, owing to the entire immunity from pain and the diminished danger from shock, which previous to the discovery of ansesthesia would not have been tolerated. Among these many, as is well known, termínate in re- eovery which formerly were allowed to die unrelieved, the mortality then not being less, but only attributable to the disease and not to the operation. Furthermore, it must be remembered that improved methods of tr,eatment restrict amputations more and more of late years to cases of the worst character, offering often at the best but a faint chance of preserving life. In 1856 Dr. James Arnott presented statistics to prove that chloroform had increased the danger of operations, but these were contradicted by other observers. So many con- siderations interpose, that a post hoc cannot become a,propter hoc argument in a matter involving so many qualifying circurastances. Finally, in deciding this point, the kind of anaesthetic employed must not be lost sight of. If the paralyzing effect of chloroform upon the heart be as great as is alleged, the use of sulphuric ether is assumed, at least on this side the water, to be comparatively harmless. / \ :£2£fe; T.TJM NÍ'IONAi iIBH NLM DD1352MT 5 >>*v...*»'r5iw ift»^^' iíí-í *\*ft*M* fo/dtft ^W^A'N- Aa'^A'A, -. *->s'A ?W»4 4a: TO' y* iA^n va w M- .¿AaA. :v ^:>M "■■* * J#WP' nir-TT'T-Ti rrr' <- ww Ééá«S!¿ñ- T -, irl^^A^.AA *A A ' <* A, N wa /\ ' ?»•? «Ak«*Ofla*APfiPÍ r'^íJA y T | - 5¥n*W* '** afA^A, a A AaA '/? Or^jBPf *' * A ^ irWr^íKvL Í5¡fttífii/L V/> A -^ 1 w tfW ' A, A a NLM001352495