WOUNDS. 



tary liofpitals, whofe opportunities of obfervation, during 

 the late war in Spain, were particularly extenfive. Mr. 

 Guthrie, however, does not recommend amputation to be 

 done immediately, if the patient be particularly depreffed by 

 the fhock of the injury direftly after its receipt. " If a 

 foldier, at the end of two, four, or fiK hours after the injury, 

 has recovered from the general conftitutional alarm occa- 

 fioned by the blow, his pulfe becomes regular and good, his 

 ftomach eafy, he is Icfs agitated, his countenance revives, 

 and he begins to feel pam, ftiffnefs, and uneafmefs in the 

 part : he will now undergo the operation with the greateft. 

 advantage, and if he bears it well, of which there will be 

 little doubt, he will recover in the proportion of nine cafes 

 out of ten, in any operation on the upper extremity, or 

 below the middle of the thigh, &c. If, on the contrary, 

 the operation be performed Ijefore the confticution has re- 

 covered itfelf, to a certain degree, from the alarm it has fuf- 

 tained, the additional injury will moll probably be more 

 than he can bear, and he will gradually fink under it and die." 

 (On Gun-fhot Wounds, p. 24. London, 1815.) As far 

 as our experience goes, however, all delay is improper when 

 the neceffity of amputation is undoubted, at leaft all delay 

 beyond the fhort period, during which the faintnefs imme- 

 diately arifing from the injury ufaally lafts. In the cam- 

 paign in Holland, in 18 14, the moll fuccefsful amputations 

 were thofe done in the field hofpitals direftly after the 

 arrival of the patients. On this point, however, hardly any 

 difference of fentiment prevails, becaufe all naval and mih- 

 tary furgeons agree, and mean, that amputation is not to be 

 performed till the faintnefs and deprefiion of the powers of 

 life, direftly following the v/ound, have been fufficiently 

 obviated for the patient to bear the operation well. The 

 feeming difference, therefore, on this matter, between 

 Mr. Guthrie and Mr. Hutchifon, is not very material. 

 (See Hutchifon's Praftical Obf. on Surgery, 1817.) It 

 appears from fome returns, collefted by Mr. Guthrie, that 

 in the peninfula, the comparative lofs, in fecondary or de- 

 layed operations, and in primary or immediate amputations, 

 was as follow : 



Upper extremities 

 Lower extremities 



Secondary. Primary. 



- 12 to I 



? to J 



The great fuccefs attending amputation on the field of 

 battle was alfo convincingly proved after the battle of 

 Touloufe. Here of 47 immediate amputations, 38 were 

 cured, while of the 5 1 delayed operations, on that occafion, 

 21 had fatal terminations. P. 42 — 44. 



Laflly, we have to notice, amongll the advocates for im- 

 mediate amputation, Mr. Hennen, a furgeon employed with 

 our army in Spain and the Netherlands. " The queftion," 

 fays he, " of immediate amputation has of late attracted an 

 attention, which its great importance naturally calls forth ; 

 but it appears to nie, that an idea has been impreffed upon 

 the minds of praftitioners in civil life, that doubts as to the 

 propriety of the praftice had exifted among the Britifh 

 army furgeons. For niy own part, I have never known 

 any differences of opinion on the point. In books, it is 

 true, it has been moft amply difcuiled before the prefent 

 generation were in exillence ; but in Britifh praftice all 

 doubts have long been at an end. It is but jullice to 

 Britifli furgeons, both naval and military, to declare, that 

 immediate amputation is neither a new doftrine nor a recent 

 praaice among them. Sec." See Hennen's Obf. on iome 

 important Points in the Pratlice of Military Surgery, 

 p. 45. Edinb. 1818. 



If, however, militaiy furgeons have definitively fettled 



the great queftion, that in all cafes in wliich a limb cannot 

 be faved, the fooner amputation is- done the better, the\ 

 neither have, nor probably will ever be able pofitively t 

 fettle and define the exatt degrees of injury which, in everv 

 inllance, ought to be followed by putting the former rule 

 in praftice. In fad, no part of furgery is more difficult, than 

 that in which the queftion of the poftibility or impoffibility I 

 of faving wounded limbs is iubmitted to the judgment and i 

 determination of the praftitioner. Some injuries, indeed, 1 

 are fo bad, that no difficulty in making a decifion is ex- | 

 perienced ; but there are other cafes, in which the damage ' 

 done to the parts is lefs violent and extenfive, and in which ■ 

 the exaft degree of mifchief is not at firft apparent. There '. 

 are, in fhort, numerous doubtful examples, in which the 1 

 formation of a right judgment is equally difficult and 1 

 important. ]• 



The annexed remarks will convey the fentiments of fome ji 

 of the lateft writers on the fecond great queftion in military i 

 furgery. What are the exaft cafes in which amputation \ 

 fhould be done immediately, and what are thofe in which '. 

 the operation may be deferred ? 



Of Cafes in ivhich Amputationjljould be done immediately. — . j 

 Firft cafe. A limb carried away by a cannon-ball, or the ' 

 explofion of a howitzer, or bomb, requires amputation ■ 

 without any lofs of time: the leaft; delay puts the patient's ■ 

 life in danger. 



In this cafe, the neceffity of the praftice is inculcated by 

 M. Faure himfelf, as well as by Schmucker, Richter, 

 Larrey, Dr. Thomfon, and every modern writer upon gun- 

 fnot wounds. 



If the operation be not fpeedily done, pain commences, 

 fever occurs, and the funclions become difordered ; the 

 irritation then increafes, and convulfive motions take place. 

 If the patient ftiould not be a viftim to thefe firft fymptoms 

 (continues Larrey), gangrene of the ftump is occafioned, 

 the fatal confequences of which it is extremely difficult to 

 prevent. 



Second cafe. When a body propelled by gunpowder 

 ftrikes a limb, in fuch a manner as to fmafh the bones, 

 violently contufe, lacerate, and deeply tear away the foft 

 parts, amputation ought to be immediately performed. If 

 this meafure be neglefted, all the injured parts will foon be 

 feized with gangrene : and befides, as M. Larrey has ex- 

 plained, the accidents which the gravity of the firft cafe 

 produces will alfo here be excited. It is only doing juftice 

 to the memory of M. Faure to ftate, that this fecond cafe' 

 was one which he alio particularly inftanced as demanding 

 the immediate prrformance of amputation. See Prix de 

 I'Acad. Royale de Chirurgie, torn. viii. p. 23. edit. l2mo. 



Third cafe. If a fimilar body were to carry away a great 

 mafs of the foft parts, and the principal vefTels of a limb 

 (of the thigh for inftance), without frafturing the bone, 

 the patient would be in a ilate demanding immediate am- 

 putation ; for, independently of the accidents which would 

 originate from a confiderable lofs of fubftance, the limb 

 muft inevitably mortify. Mr. Guthrie alfo fays, " a cannon- 

 (hot deftroying the artery and vein on the infide (of the 

 thigh), without injuring the bone, requires amputation." 

 (P. 185.) When, however, the femoral artery or vein is 

 injured by a mu(l<et-ball, or fmall cannifter-ftiot, this gentle- 

 man recommends tying the veflel above and below the 

 wound in it, if the nature of the cafe be evinced by hemor- 

 rhage. But lie believes, that when both vein and artery are 

 injured, amputation is neceflary. (P. 186.) An injury of 

 the femoral artery, obferves Mr. Guthrie, requiring an 

 operation, and accompanied with fracture of the bone of the 

 raoll fimple kind, is a proper cafe for immediate amputa- 

 8 tion I 



