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

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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$20 and 40 years of age, 4 died, or 1 in 5*5; whilst of 20 cases who were between 40 and 60 years of age, 2 perished, or 1 in 10; and of 4 persons above that time of life, none died. It should be, there¬ fore, borne in mind, in attempting to save a dangerous case of com¬ pound fracture of the leg without amputation, when the person is between 20 and 30 years of age, that there is less chance of a patient reaching the period of suppuration, when secondary amputa¬ tion, if required, is most successful; although, if that operation can be performed, there is greater probability of recovery than if it were performed upon a person below 20 years of age. In persons between 30 and 40 years of age, I should imagine the attempt to save a compound fracture of the lower extremity was exceedingly hazardous, both on account of their liability to the secondary inflammations which are apt to follow the accident, and also because, if the secondary operation be permitted, the chance of recovery after the amputation is so small. As the amount of fatal disease between the fourth and twenty-first days after compound fractures has been so much smaller in persons between 40 and 60 years of age than in those of the period immediately preceding that time of life, we must either suppose that the surgeons of the New¬ castle Infirmary had amputated a large number of the worst cases who were at this time of life, which they would have attempted to have saved if their ages had been less; or, otherwise, that persons of that age suffering severe accidents, are really less liable to fatal diseases between the fourth and twenty-first day after a compound fracture, than those between 20 and 40 years of age. But, from whichever of these causes this small amount of mortality has arisen, it is evident that accidents of greater severity, occurring in persons between 40 and 60 years of age, may be more safely deferred to the suppurative stage than is usually imagined. And, although the mortality in the case of secondary amputations above 50 years of age, is 1 in 1*33, yet we have found, by Tables XXXVI. and XXXVIL, that an equally excessive amount of death takes place amongst those at that time of life who undergo the primary operation, when performed on the lower extremity; whilst in the class of diseased joints, to which secondary amputations are most similar, the number of deaths is remarkably small at that age. In order, however, to settle points of this importance, we should have large numbers of carefully ob¬ served and minutely classified cases, both of amputations and of compound fractures ; for, I believe, there are few investigations more likely to prove useful than those which can be made regarding the age at which we may most safely treat a compound fracture without amputation. I I before stated my belief, that the discrepancies between the results of the practice of different hospitals respecting the mortality of the sexes, must be explained by the varying habits and occupations of the males and females in the districts to which the reports relate. The next Tables, however, show that, when analysed according to-$