Report of the surgical operations performed at the Newcastle-upon-Tyne Infirmary during a period of seventeen years and a half. Pt. 1, On amputations of the limbs / by Samuel Fenwick.

  • Samuel Fenwick
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Report of the surgical operations performed at the Newcastle-upon-Tyne Infirmary during a period of seventeen years and a half. Pt. 1, On amputations of the limbs / by Samuel Fenwick. Source: Wellcome Collection.

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    only one in every 57 cases of the primary amputations, and yet no instance of phlebitis or disease of the viscera was observed in the former; whilst 1 in 9’5 died from phlebitis, and 1 in every 3*56 of dis¬ ease of the viscera in the latter. And again, in Table XXXYI. it will be observed, that, between 10 and 20 years of age, the mortality during the period of shock is 1 in 2, and yet no deaths had taken place out of 4 after the first week; whilst, amongst those between 20 and 30 years of age, although the mortality was only 1 in 12 in the first week, it amounted to 1 in 2*75 after that time. The truth, I imagine, will be found to be, that the exciting causes of these secondary diseases are various; but that a predisposition is given to inflammatory diseases by the removal of any large portion of the body. For, after this operation, the heart and arteries will contain more blood than is required for the body, whilst a less propor¬ tion of venous blood will be formed, on account of its passing through a smaller extent of the capillary system; and, therefore, this fluid will be more highly stimulating than it should be in a state of health, especially when the patient has not been reduced by previous illness. We should also add to this predisposing cause those above men¬ tioned ; viz., that where previous disease has existed, it will be liable to be brought into activity by the state of the patient after the opera¬ tion; and also, that after a certain length of time, if the patient be much weakened, either by fever or by discharge, pneumonia will be as likely to take place as it usually is in other persons in a similar state of health, but in whom it is produced by any other predisposing cause. It is only within the last few years that any satisfactory explana¬ tion has been given of the occurrence of purulent deposits, in different organs of the body, after an accident or operation. The passage of pus into the circulation has, however, been proved to be the general cause of this fatal form of disease; and the further the subject is investigated, the more are we surprised at the frequency with which it takes place after operations. More than one-third of the whole number of deaths after amputation, seem to have arisen from this cause. I have included purulent de¬ posits and phlebitis under one head, as in the majority of cases the former result from the latter; and often, where the more obvious diseases of the viscera have alone attracted the attention of the patho¬ logist, there is every reason to believe the primary cause of death had been overlooked, from want of due care in the examination. When, however, we reflect upon the disposition of veins to inflammatory action, we need not be surprised that it so frequently follows ampu¬ tation. We see phlebitis set up idiopathically, we observe it arising from the passage of a catheter, from small scalp wounds, from an issue near a vein, and from many other equally trivial operations; and how can we expect that these vessels will remain unaffected in the inflammatory attacks of the stump, which are so often observed after the removal of a limb? We should likewise remember, that, in taking up the smaller arteries, the accompanying veins must be
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