โ Scribed by George W. Crile
No coin nor oath required. For personal study only.
EST& gives a study of 724 major amputations. The mortality for single major amputations is a little better than before the present series-4.30 per cent (former 4-76). This is but small improvement. We have to consider continually saving of blood, asepsis and antisepsis, and carefully discriminate when to operate.
Systolic pressure below 80, contraindicates. The author's material is of a somewhat special character, owing to the proximity of great steel mills, mines, etc. There are not a few cases of double major synchronous amputations (mortality 23.68). The author adheres t o the old classical amputations, mahng little attempt to devise new ones.
He gives figures from the Mayo clinic-5835 indoor patients. These are summed up under infections, pulmonary complications, thrombophlebitis, rashes, epididymoorchitis, acute dilatation of the stomach. There were 111 cases of infection, the rationale of which was for the most part unknown. Certain factors were, introduction of the hand through a too small opening, and escape of secretions into the peritoneal cavity. The great majority of these infections were peritoneal. There were 80 cases of pulmonary complications, not counting embolism, of which there were 3. The 80 cases were divided among pleurisies, broachitides, bronchopneumonias, and lobar pneumonias, bronchitis being the most frequent. There was no palpable connection between the operation and the pulmonary complication. The greatest number of bronchitis cases followed posterior gastroenterostomy, and next in frequency appendicectomy and inguinal hernia ; the greatest number of pleurisies followed appendicectomy, etc. There were 16 cases of thrombophlebitis, chiefly on the left side. In a larger series of operations--8,703--there were 119 deathsbetween I and 2 per cent. Ashhurst and John3 attempt to bring together the various methods in the rational treatment of tetanus. The authors believe that an intensive and synergistic treatment begun very early in the case would reduce the mortality to 20 per cent. Antitoxin should be injected by all the routes-intraspinal, intracerebral, intraneural, intramuscular, intravenous, and subcutaneous, and the doses should be comparatively frequent and large. Phenol injections may be superadded, and perhaps cholesterin and magnesium sulphate, as well as the usual depressants. The author's mortality of 56.5 per cent up to 1912 is about the average of recent reports. Since that period, and under the above management, seven out of eleven cases have been saved (36.36 per cent mortality).
Three other authors quoted have saved two cases out of three. In many series of cases, the mortality is from 65 to 85 per cent.
The blood-pressure is a valuable guide.
Beckman2 writes about the complications following operations.
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