On the causes of mortality after amputation of the limbs. [Pt. I. Injuries] / by J.H. James.

  • James, J. H. (John Haddy), 1788-1869.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: On the causes of mortality after amputation of the limbs. [Pt. I. Injuries] / by J.H. James. 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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    amputation being performed in the particular region,, but, when there performed, it is because the parts are so extensively injured as to render it impossible to amputate otherwise than high, and even then, it may be supposed, often through unsound parts; one great cause of this fatality in high amputations may admit of an intelligible explanation, and a practical inference might be deduced, i.e., that, disregarding any prepossession as to the fatality of such operation, it would be better to amputate high in the limb, through sound parts, than lower, where they are injured. It may be said, that I have no sufficient grounds for objecting to a received opinion, and explaining the facts, as I have done; but I would submit that the point may be put to the test of experience. It is often requisite in amputations for disease to go high up. Are these cases more fatal than others, and, if so, in what propor- tion ? As far as my own observation goes, they are not so; but this might in no long time be ascertained. It may be said, when we institute a comparison tionsmpUfor between amputations for injury and for disease, disease, un- especially of the thigh, that in the latter case also the often divided, knife often goes through unsound parts; but let us but the con- contrast the different kind of unsoundness. It may dition of . . , . n n , those parts, divide parts, it is true, more or less innamed, in which the ability to —nay, which pus is effused; but if we reflect repair, in- on the nature of these processes, we shall at once see different7 that these are merely natural efforts at restoration, and the parts are both disposed and often able to repair; but in the case of injury, they are torn, mashed, disorganized,—- greatly disqualified for such purposes.* Secondly, the effects of shock are not confined to the imme- diate im- pression,but The immediate effects of the preceding circumstances, i.e., shock, on the one hand, and the consequences arising from amputation through parts whose organi- zation and vital powers are impaired, on the other, in producing a great amount of mortality, will be doubted * Mr. Syme has proposed, as a cause of the remarkable mortality of amputations in the middle of the thigh, the injury inflicted on the medullary membrane; but, independent of other arguments which oppose this opinion, I may mention that the mortality from primary amputations is propertionably great in all the limbs.