850 



SCIENCE 



[N. S. Vol. XLI. No. 1067 



results in the then unsanitary state of all 

 hospitals. 



Mortality After the Four Selected Amputations in 

 Proportion to the Number of Beds in 

 the Sospitals 

 In the large Parisian hospitals ....62 in 100 die 

 In British hospitals with 300 to 600 



beds 41 in 100 die 



In British hospitals with 300 to 201 



beds 30 in 100 die 



In British hospitals with 200 to 101 



beds 23 in 100 die 



In British hospitals with 100 to 26 



beds 18 in 100 die 



In British hospitals with 25 beds or 



less 14 in 100 die 



In isolated rooms in country practise. 11 in 100 die 



In the second he tabulates the mortality ac- 

 cording to the experience of the operator. 



Death Bate After the same Four Amputations in 

 Accordance with the Experience of the 

 374 Operators 

 Those who had done less than 6 ampu- 

 tations lost 1 in 7 



Those who had done from 6 to 12 ampu- 

 tations lost 1 in 9 



Those who had done 12 or more ampu- 

 tations lost 1 in 12 



What an argument for the necessity for 

 a year in a hospital for the recent graduate 

 before allowing him full liberty of action! 

 In France matters were as bad if not even 

 worse. T. Holmes and Bristowe in 1861 

 had found that in Paris, of 102 of the four 

 amputations in question, 67 died, a mortal- 

 ity of 65.7 per cent., or two out of every 

 three. Out of 1,656 amputations in the 

 Paris hospitals collected by Malgaigne and 

 Trelat 803 died, 48.5 per cent., almost one 

 in every two (Simpson, p. 291). 



To-day, how entirely changed is all this. 

 Listerism has transformed what Bell well 

 called "Houses of Death" into "Havens of 

 Safety." No home, however wealthy its 

 inmate, can be as sanitary, as surgically 

 clean or give as good results as a modern 

 hospital. 



The best evidence of the truth of this 

 statement I can give you is the statistics of 

 Dr. W. L. Estes," of South Bethlehem, 

 Pennsylvania. They are of especial value 

 in that they are the statistics of the same 

 surgeon in the same hospital and on the 

 same class of patients. He reports the re- 

 sult in 724 major amputations. In 616 

 single amputations there were 28 deaths, a 

 mortality rate of 4.54 per cent. Of 469 of 

 the four selected amputations, 25 died, a 

 mortality of 5.3 per cent. Of synchronous 

 double, triple and one quadruple amputa- 

 tion, many of them complicated with other 

 wounds and operations, there were 108, with 

 19 deaths, a mortality of only 18 per cent. 

 It is very noticeable that in an earlier paper 

 in 1894 in which he had reported the first 

 46 cases of synchronous double, triple and 

 quadruple and complicated amputations, 

 there were 13 deaths, 28.3 per cent., whereas 

 from 1894 to 1913 in the last 62 such cases 

 there were only six deaths, a mortality of 

 9.6 per cent., showing again the value of 

 still larger experience even to an already 

 experienced surgeon. In the second series 

 there was no quadruple amputation. 



But as officers of the Medical Corps of 

 the Army you will be especially interested 

 in the facts as to military surgery before 

 and after Lister. Capt. Louis C. Duncan 

 of our corps published a very interesting 

 and comprehensive article^" just before the 

 present European war broke out. 



He states that in Motley's "Rise of the 

 Dutch Republic" in three volumes cover- 

 ing "30 years of almost constant sangui- 

 nary warfare" in the sixteenth century he 

 "never once alludes to an army surgeon or 

 an army hospital" ! The surgeons were un- 

 doubtedly not officially attached to the 

 army, but were in the suites of kings, 



15 Annals of Surgery, July, 1913. 



16 Journal of the Military Service Institutions of 

 the United States, March-April, 1914. 



