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Show auromriox. ‘20-'11 ral the effect 01' the great exhaustion and debility in a consti. tution already so much reduced, that there were not powers to produce adhesion, or to enable the patient to go through the stages of healthy suppuration. When the leg' is amputated in this situation, it is like the operations we perform in the dissecting room. The muscles and skin are soft and loose, and do not take upon them a due degree of action ; or they separate from the bone, and leave it dead, with the parts in the state which I have described. I must present another picture to my reader, that of a man dying from amputation in the heyday of health and full action. There follows not high inflammation, nor the flushed face and delirium of fever; but the shock given to the system, through the nerves, and particularly all'ecting the stomach and the brain, carries the patient on? before the third day. He sinks i" l: V' 'wvv‘mu H i a $3. _, .. "a" he V Mtwn‘m W .. ‘.-.\.~«:-- she. ...~. ‘, "L i 7‘ 265 surnames. the soft parts, either from the blow or from the ends of the bone piercing the integuments. It is only when the parts are irrecoverably bruised, that you amputate immediately ; where the bones and flesh are crushed flat. But evon here it is not the fracture ; it is the bruise, and the general injury which decides. The reason of amputating in these cases is this, the parts cannot recover, and presently the whole system begins to sympathise with the debility of the part injured; so that not only that part falls into gangrene, but such a simi- larity of action pervades the whole body, that you cannot af- terwards cut off the limb. If you do attempt to cut it oil‘, the stump will exhibit the same alarming symptoms of gangrene with the original wound. It is therefore upon the general injury, compared with the powers of the constitution, and particularly on the bruising and laceration of the parts, that we have to fix our attention, not on the mere fracture of from tue tune 0f the operation ; .hne "" are accustomed to find a wretch who seems exhausted by long disease, 5100? the bone. We should have two objects in view; to save the limb altogether, or at least to preserve it so long that suppu- Isloundly 0'" the night 0f the operation, {01? "1911.1" time, Pel‘ ration may be established, and the system accustomed to diseased action, and so reduced as to acquiesce in a moderate and safe degree of inflammation, when amputation is performed. When we are apprized how soon the general state of the aps, during many months, and gradually rev1ve and gain strength from the time of the operation. I must say, however, that 1 have not seen this fatal etfect of amputation; and of the friends whom I have consulted, all have the conviction of the danger, but none have given me instances in their own practice. ._ In common practice, amputation is performed ninety times in a lnn‘idred, for ulcer with carious bones, and for Willie swelling of the joints. The evidence of this necessity is the sinking of the strength under the irritation of the disease, when all our resources have been tried in vain. But there are cases in which the most experiCHCed sur~ goon will have diiliculty to determine whether amputation v, ill save the patient or accelerate his doom. <3 of fractures, ancurisms, and gangrene. These are cas- Our surgeons in the best practice have, I believe, laid aside the idea of am; putating in cases of compound fracture. Fracture of the bone has never in itself been properly the occasion of this open ration, nor even when complicated with a simple wound 0:" system influences the state of a sore or a wound, and that the converse of this in many instances holds true, viz. that an active local disease induces a prevailing similarity of action in the system at large, we learn to be cautious of amputating in the active state of the disease. Violent inflammation we must restrain and subdue, before we amputate ; and even gangrene must have stopped before we can promise success to the operation. For if this gangrene be spreading from the place originally affected, the general system is already influenced, and the new injury you are about to inflict in the rcgu~ lar form of an operation, is not the less on that account an inVOL. I. r. 53 ' , " "7- i ; .VlllNl M09917! ‘2 '' j |
