A summary of the results recorded in a series of lectures ... on the nature, progress, and treatment of complicated injuries of the extremities, and on amputation and its effects in civil and military practice / [Sir Rutherford Alcock].

Rutherford Alcock

Date:: 1841

Credit: A summary of the results recorded in a series of lectures ... on the nature, progress, and treatment of complicated injuries of the extremities, and on amputation and its effects in civil and military practice / [Sir Rutherford Alcock]. Source: Wellcome Collection.

6/24 page 6

$irritation kept up, exhausting all the powers of life. As the cases for which amputation is re¬ commended are always deemed incurable, we may consider that all, sooner or later, lead to death by these diseased actions, if life be not cut short by the more sudden appearance of some fatal and irregular action. Thus much for the effects on the system of the local diseases for which amputation is usually performed. We may safely conclude that the diseased actions do not kill rapidly ; patients linger for years, living for half a life¬ time with ulcers, tumours, and even diseased joints and caries; yet all that are incurable ultimately hasten, and not only indirectly, but often in a direct manner, the death of the patient. Effects upon the System of Complicated Inju¬ ries of the Extremities occurring in Civil and Military Life. Leaving the class of chronic diseases of the extremities, and their effects upon the system where any actions set up are in the majority of cases characterised by little in¬ tensity, and kill rather by the gradual ex¬ haustion of the system from long-continued waste and irritation, than by the development of sudden and fatal supervening diseases during treatment. What did we find the effects of severe injuries of the extremities fracturing the bones, crushing and lacerating the soft parts, to be, when they are treated without the intervention of amputation ? What is the proportionate mortality, and what the causes of death ? Cases of injury in their progress present a vivid contrast to the cases of chronic disease. As the morbid state in injuries is sudden in its supervention and violent in its characters, so are the diseased effects resulting neither mitigated in form nor slow to destroy : that an injury to the extremities is more danger¬ ous than a chronic disease, becomes the first and inevitable inference. Whatever dangers amputation may bring, we are thus informed, therefore, that they are superadded to a class of cases often rapidly fatal without its aid or intervention. In diseases requiring amputa¬ tion, the site or nature of those actions is of comparatively little importance—not so in injuries. Many circumstances and conditions require consideration in determining the ef¬ fects upon the system of injuries, which exer¬ cise but an obscure or trifling influence on the progress and results of cases of disease. Different classes of injuries give different results. There is a difference to be observed even between the injuries of civil and of mili¬ tary life, where fracture ofbone and laceration of soft parts may alike be the chief features of the case. Ourstatistics on theresultof injuries in civil hospitals are very imperfect; the two American hospitals to which I have alluded, are far from being as complete as could be desired. In reference to the results of treatment without amputation adopted for injuries of civil life, I am only able to refer you to Dr. Lawrie's paper singly among the records of surgery, for a few data in a collected form. In 40 compound fractures and dislocations treated and not amputated, 17died; giving a mortality of 1 in 2.3 in the lower extremity, and of 1 in 2.2 in the upper. The diseased actions supervening and causing death is not stated. It is remarkable that in this series the upper extremity gives a mortality even greater than the lower. In reference to the injuries of military life, chiefly gunshot, the largest number recorded showing the mortality of injuries of military life (where one or more bones of the extremi¬ ties are broken with laceration of soft parts), we owe to the conviction of the fatal results of amputation entertained by the surgeon- general of the Prussian army in 1762, M. Bilguer. In 816 gunshot fractures of the extremities received into the hospital under his direction at one time, in no single instance was amputation permitted. Of this series (in round numbers) one-half died ; one fourth lived, retaining crippled and useless limbs: one fourth alone were re¬ turned cured, able to do duty in person, or to work at any trade. Of the diseased actions causing death, no¬ thing is said. This deficiency, however, in the preceding lectures, I have supplied by the results of another series of cases treated in hospitals under my own direction. In reference to the mortality and disability resulting in this series consisting of 235 cases, including 55 partial fractures of the bones of the extremities, you have seen that 82 were amputated. 38 of which were followed by death. 38 of the remainder died under treatment. 76 The mortality was 1 in 3—one-third. And more than half of these cases of death without amputation were induced by vital ac¬ tions, disturbed, impaired, and finally arrested without organic disease or lesion of structure ; the remainder with affections of viscera, often purulent depots, and various accidental or irregular actions, such as secondary haemor¬ rhage, gangrene of limb, &c. 115 recovered with useful limbs—say one- half. 44, or somewhat more than one-fifth, re¬ covered, but crippled by the removal of a limb. 159 Thus the united favourable result, as regards$