A report on amputations at the hip-joint in military surgery / by George A. Otis.
- George Alexander Otis
- Date:
- 1867
Licence: Public Domain Mark
Credit: A report on amputations at the hip-joint in military surgery / by George A. Otis. Source: Wellcome Collection.
24/110 page 22
![■1-1 Professor J. J. Ohisolm, of the Medical College of South Carolina, has communicated a report that Surgeon Myddleton Michel had amputated at the hip-joint several times, and that Professor P. F. Eve had performed the operation once at least. Dr. Eve has contradicted this report, so far as it relates to himself. It is unnecessary to recapitulate more of these indefinite statements. The fifty-three authenticated operations now to be described are divided into four categories: primary, intermediate, and secondary amputations, and reamputations. Practical surgeons are very generally agreed at the present day that amputations for injury should be classified in at least three categories, according to the period at which they are performed, and that the old division into primary and secondary operations is insufficient.1 Beyond question there are three distinct, successive, and easily appreciated periods in which amputations are performed: the period between the reception of the injury and the appearance of the inflammatory symptoms; when inflammatory action has commenced and is more or less capable of disturbing the animal economy; and when the violence of the inflammatory symptoms and symptomatic fever have abated and the suppurative stage is fully established. Operations done in either of these periods differ widely in their attendant circumstances and in their results. It is important therefore that they should be grouped in separate classes. Some authors subdivide still further, and separate the first class into immediate amputations, or amputations sur le champ, performed, without awaiting reaction, at the earliest possible moment after the reception of the injury, so that the shock to the system from the operation may be confounded, so to speak, with that from the injury, and primary operations performed after reaction and previous to the accession of the inflammatory stage.2 M. Legouest would separate the third class into consecutive amputations, done during the suppurative period after the acute inflammatory symptoms have subsided, and ulterior amputations, performed when the traumatic phenomena have entirely disappeared and the case has become assimilated to a case of chronic disease.3 These refinements could hardly be adopted in dealing with extended statistics. It is greatly to be desired that a uniform system of classification of amputations and of their nomenclature should be adopted by surgeons, in order that the results of operations performed at different periods should be compared with precision. At present, authors refer to the first class as immediate or primary; to the operations done in the middle period as delayed, tardy, mediate, intermediate, intermediary; to those of the third period as consecutive, ulterior or secondary amputations. And there is great confusion in the definition of these epithets.4 Some surgeons mean by primary amputations those done 1 Beraud, Denonvilliers, and Gosselin, in Compendium de CMrurgie Pratique, T. II, p. 504. Baron Hippolyte L/AKREY, Bulletin de V Academic Imperiale de Medecine, Tome XXV, p. 647. Dr. Hamilton, A Treatise on Military Surgery, ]i. 428. Mr. Fek<;i>shn, .( System of Practical Surgery, 4th London ed., p. 197. Alcock, Notes on the Medical History and Statistics of the British Legion in Spain, p. 67. M. J. Eoux, Be V Osteomy elite, etc., p. 109. BALLINGALL, Outlines of Military Surgery, 5th ed., p. 424. Mr. Erichsen, however, (Science and Art of Surgery, 2d Lond. ed. p. 22,) declares that this distinction is a somewhat trivial one. M. Legouest (Diet. Encycloped. des Sciences Med., 1865, T. Ill, Art., Amputation) advises five divisions. BOYER, Traiii des Maladies Chirurgicales et des Operations qui leur conviennent, 5th ed., Tome IV. Hutchison, •s' I'rartinrf Oh.i<nations in Surgery. |>. (i. Dr. Hamilton, Loco citato. Guthrie, Commentaries, Ac. 3 M. Legouest. Diet. Encycloped. des Sciences Med. Paris, 1865. Tome III. Art., Amputations. L exactitude dans la denomination des amputations suivant le moment oil elles sont pratiquees est un des desiderata importants de la science; e'est un element capita] a la determination de l'epoque ou il convient d'operer dans le cas de lesions trauniatiques. M. Legouest. Loco citato.](https://iiif.wellcomecollection.org/image/b20422155_0024.jp2/full/800%2C/0/default.jpg)
