WOUNDS. 



to the advantages and rieceflity of immediate amputation, 

 •wrhenever the injury is fuch as to remove all reafonable hope 

 of ultimately faving the limb. See Ranby's Method of 

 treating Gun-lhot Wounds, edit. 3. p. 29. London, 

 '1781. 



The following account of this interefting fubjeft is prin- 

 cipally abftradted from the third edition of Cooper's Dic- 

 tionary of Praftical Surgery, publifhed in the year 18 18 : — 

 After the battle of Fontenoy, in the year 1756, the Royal 

 Academy of Surgery in France offered a prize for the bed 

 diflertation on the gun-fhot injuries requiring immediate am- 

 putation, and on other cafes of the fame nature, where the 

 operation, thougli deemed inevitable, might be delayed. The 

 prize was adjudged to the differtation of M. Faure, the main 

 Dbjeft of vvhofe paper was to recommend delaying the oper- 

 ition. The fide of the queilion efpoufed by M. Faure has 

 'found fome modern advocates of dillinguiihed talents and 

 celebrity. Suffice it to mention the names of Hunter, 

 baron Percy, and Lombard. It is, however, only juftice 

 to M. Faure to Itate in this place, that though he re- 

 a;arded immediate amputation as full of danger, he admitted 

 that there were feveral kinds of injuries of the extremities 

 :in which it was indifpenfably and immediately required. 

 " The enumeration," fays Dr. Thomfon, "which this author 

 lias given of thefe injuries is more full and dillintt than any 

 which had been publiflied before his time ; and, what may 

 ippear fingular, it does not differ in any effential refpeB from 

 the enumerations given by later writers, who in combating his 

 lopinions have reprefented him as an enemy to amputation 

 ;in almoll all injuries of the extremities." See Report of 

 jObfervations made in the Military Hofpitals in Belgium, 

 p. 169. 



Although in France the academy of furgery thought 

 proper to decree the prize to M. Faure, whofe doftrine 

 thus received the higheft approbation, yet in that country 

 very oppofite tenets were fet up by fome men of diftin- 

 iguifhed talents and extenfive military praftice. Thus Le 

 Dran, confulting furgeon to the French army, in his work 

 on gun-fhot wounds, publifhed in 1737, exprelsly ftates, 

 ;" that when the amputation of a limb is indifpenfably ne- 

 cefFary in the cafe of a gun-lhot wound, it ought to be done 

 without delay." {Aphorifm9.) M. La Martini^re, in 

 iparticnlar, wrote fome excellent arguments in reply to M. 

 jBilguer ; arguments which would do honour to the moll 

 laccompliflied furgeon of the age in which we live. (See 

 ;Memoire fur le traitement des plaies d'armes a feu, in Mem. 

 de I'Acad. de Chirurgie, torn. xi. p. i. edit, in i2mo.) 

 M. Boucher, of Lille, was an advocate for the fame fide of 

 the queilion. ( See Obf. fur des plaies d'armes a feu, &c. 

 a Mem. de I'Acadr de Chirurgie, torn. v. p. 279, &c. edit. 

 ;n i2mo. ) Sciimncker, who was many years furgeon- 

 general to the Prufiian armies, publiflied in 1776 an elfay 

 on amputation, in which he particularly mentions, that 

 during his ftay at Paris in 1738, the furgeons of the Hotel- 

 Dieu had been in the habit of performing immediate ampu- 

 tation in fevere injuries of the extremities. He alfo declares 

 him/elf an advocate for operating immediately, in all cafes in 

 •which amputation from the frjl appears to be neceffary, and 

 inlitts, in a particular manner, on the increafed danger which 

 he had feen arife from the operation during the fecond 

 period. He gives, as Dr. J. Tliomfon has obferved, a 

 minute and circumilantial enumeration of thofe injuries, 

 both of the upper and lower extremities, in which he con- 

 ceived amputation to be neceffary, and in many of which he 

 had aftually performed it with great fuccefs. Schmucker 

 appears to Dr. Thomfon to have given a better account 

 than any preceding military furgeon 0/ the injuries of the 



thigh ; and from the rcfults of his experience, he was led 

 to beheve, ih^it though compound fraflures of the lower part of 

 the thigh-bone might, in favourable circumjlances, be cured with- 

 out amputation, yet that this operation is peculiarly neceffary in all 

 cafes in which the fradure isfitualed in or above the middle of 

 that bone. ( See Unterfuchung fiber die Abnehmung der 

 Glieder von J. L. Schmucker. Vermifchte Chirurgifche 

 Schriften, band i. Berlin, 1785. ) With the foregoing high 

 authority we have to join one of not lefs celebrity, namely, 

 that of M. Larrey, who has proved moll convincingly, that 

 when amputation is to be done in cafes of gun-fhot wounds, 

 nothing is fo pernicious as delay. See Memoires de Chi- 

 rurgie Militaire, tom. ii. p. 451, &c. 



The principles inculcated by M. Larrey are, in point of 

 faft, the fame as thofe which were fo ftrenuoufly infilled 

 upon by Mr. Pott, in his remarks on amputation. Mr. Pott, 

 indeed, was not an army furgeon, and what he fays was not 

 particularly deligned to apply to military praftice, but he 

 has reprefented, as well as any body can do, the propriety 

 of immediate amputation for injuries, which leave no doubt 

 that fuch operation cannot be difpenfed with. 



Mr. John Bell, amongll the moderns, alfo defended the 

 propriety of early amputation, long before the fentiments 

 of later writers were ever heard of; He dillindlly ftates, 

 that " amputation Ihould, in thofe cafes where the limb is 

 plainly and irrecoverably difordered, be performed upon the 

 fpot." (See Difcourfes on the Nature, &c. of Wounds, 

 p. 488. edit. 3.) Indeed, notwithftanding all the modern 

 pretenlions to novelty upon this interefting topic, we mull 

 acknowledge, with Dr. Thomfon, that the evidence in 

 favour of the advantages of immediate amputation has 

 always preponderated over that for delay. See Report of 

 Obf. made in the Military Hofpitals in Belgium, p. 225. 



The Itrongell body of evidence upon this matter, how- 

 ever, is .adduced by M. Larrey, whofe fituation at the head 

 of the medical department of the French armies has 

 afforded him moft numerous opportunities of judging from 

 aflual experience. 



" If we are to be told," fays he, " that the amputation 

 of a limb is a cruel operation, dangerous in its confequences, 

 and always grievous for the patient, who is thereby muti- 

 lated ; that, confequently, there is more honour in faving a 

 limb, than in cutting it off with dexterity and fuccefs ; 

 thefe arguments may be refuted by anfwering, that ampu- 

 tation is an operation of neceflity, which offers a chance of 

 prefervation to the unfortunate, whofe death appears certain 

 under any other treatment ; and that if any doubt fhould 

 exifl of amputation being abfolutely indifpenfable to the 

 patient's fafety, the operation is to be deferred, till nature 

 has declared herfelf and given a pofitive indication for it. 

 We are alfo juftified in adding, that this chance of pre- 

 fervation is at the prefcnt day much greater than at the 

 epoch of the academy of furgery. We learn from M. Faure, 

 that of about tliree hundred amputations performed after 

 the battle of Fontenoy, only thirty were followed by fuc- 

 cefs, whilft, on the contrary, fays M. Larrey, we have 

 faved more than three-fourths of the patients on whom 

 amputation has been done, and fome of whom alfo had two 

 limbs removed. This improvement is afcribed by M. Larrey, 

 ift, to our now knowing better how to take advantage of 

 the indication and favourable time for amputating ; 2dly, to 

 the dreffings being more methodical ; 3dly, to the mode 

 of operating being more fimple, lefs painful, and more 

 expeditious, than that formerly in vogue." 



To the preceding authorities againfl delaying amputation, 

 in cafes of gun-fhot wounds requiring fuch operation, we 

 have to add that of Mr. Guthrie, deputy infpeftor of mili- 

 tary 



