Report of the surgical operations performed at the Newcastle-upon-Tyne Infirmary during a period of seventeen years and a half. Pt. 1, On amputations of the limbs / by Samuel Fenwick.

  • Samuel Fenwick
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Report of the surgical operations performed at the Newcastle-upon-Tyne Infirmary during a period of seventeen years and a half. Pt. 1, On amputations of the limbs / by Samuel Fenwick. Source: Wellcome Collection.

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    between 30 and 50 years of age, the amputations for diseased joints in the lower extremity have been least successful. How carefully, then, should we in these operations consider the time of life at which our patient has arrived before pronouncing a favourable prognosis! The mortality in the second week after the operation shows us, that it is in the occurrence of a less amount of secondary inflammations that the superior success of early and extreme age consists. If we compare the average mortality during the second week after amputations for diseased joints, in persons between 30 and 50 years of age, with that occurring in the same period of life in traumatic amputations, we shall discover but little advantage to arise from the circumstance of the disease having previously existed; the mortality after the first week being, in the former class of amputations, 1 in 3*55, whilst in the latter it is 1 in 2*83. That the time required for cure also increases with the age is worthy of remark; each period between 10 and 50 years of age being marked by a very gradual increase, whilst below and above these periods the difference is very considerable. Amongst amputations of the lower extremity performed for other diseases, a different law of mortality may be observed; and this we might be led to expect, on account of the subjects of the operations of which it is composed, not having been so much reduced by disease as those cases from which the other side of the Table has been formed. Amongst the other pathological amputations, the usual comparatively small amount of death from secondary disease in persons below 20 years of age is observable; but in the succeeding period, in which, amongst amputations of diseased joints, we re¬ marked the mortality to be still comparatively small, we here find it to have risen to an equality with that of the most fatal age. It is curious that, amongst these amputations, the time of cure is as great below 20 years of age as at any future time, therein differing from the results obtained by the analysis of cases of amputation per¬ formed for diseased joints. In Table XXXV. I have classed together all the pathological amputations of the upper extremity, the numbers of the operations performed for each disease being too small to admit of their separa¬ tion. No regular increase in mortality corresponding with the age can be remarked. The fact, that only 1 out of 8 of these cases of amputation who were above 50 years of age died, whilst 1 out of 4*5 perished who were between 20 and 50, is valuable with reference to the operation of resection of the elbow joint. It teaches us to perform the latter operation during the earlier periods of existence, as there is both a greater chance of its being successful, and a less probability of recovery if amputation be resorted to; on the other hand, after 50 years of age, the hazard from the amputation de¬ creases, whilst the danger from the removal of the joint becomes greater. It is worthy of observation, how slow the wound is in healing, below 20 years of age, amongst pathological amputations of