The proper period for the performance of amputation in cases of traumatic injuries / by B.A. Watson.

  • Watson, B. A. (Beriah André), 1836-1892.
Date:
[1880]
Catalogue details

Licence: Public Domain Mark

Credit: The proper period for the performance of amputation in cases of traumatic injuries / by B.A. Watson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of the leg, 76. Or, for the upper extremity, the whole rate of deaths after primary was 15, against 41 after secondary amputations ; whilst, for the lower extremity, excluding the foot, it was 46 for the primary, against 78 per cent, for the secondary. In the American army during the war of the Rebellion, the mortality after primary amputation of the thigh was 54.13 per cent.; and after secondary amputation, 74.76. In the French army in the Crimea, on the other hand, the mortality after primary amputation of the thigh and arm—amounting in the former limb to above go per cent.—was greater than that after the secondary operation. As has already been ob- served, not only does the rate of mortality differ in primary and secondary amputations, but also the cause of death. Primary amputations are most frequently fatal from shock, haemorrhage, and exhaustion, although death from pyaemia and secondary diseases of a low type is by no means rare in these cases. Secondary amputations for injury most com- monly carry off the patient by the supervention of septic diseases.” Experience, observation and science have finally convinced surgeons, both military and civil, of the ad- vantages of the primary amputation over the secondary ; and the conclusion seems to be fully supported by statistics, but the value of these is greatly impaired by the following : 1. Irregularities in the classification. 2. Insufficient data to enable the compiler to determine the existence or character of complications. 3. Idiosyncrasy of compilers which produces interpretations of figures favorable to their own preconceived theories and opinions. The irregularities in the classification of amputations arising from the fact that one author divides this operation into four classes, which he designates as immediate, primary, intermediate and secondary ; another separates it into three classes which he calls pri- mary, intermediate, mediate or consecutive, and secondary; and the third still farther simplifies it and gives us in his nomenclature only the primary and secondary. The in- tention of all surgical writers on this subject has unquestion- ably been to designate by these terms pathological con- ditions which it was supposed might have important bear-