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the profession. Hoping and believing that I have secured a report of all favorable results, and almost if not all unfavorable ones, in this State, with the exceptions mentioned, I offer them to the profession as the first reliable gleaning, if not the first attempt to glean the results of the most important operations made in accidental surgery in time of peace in this country. Of the amputations made during the last ten years in Buffalo, now containing nearly two hundred and fifty thousand inhabitants, perhaps ninety-nine hundreths of them were caused by railway injuries. Of those made in the State in the same length of time, it is safe to estimate nineteen twentieths as having had a like cause; and this estimate would probably hold good for most of the Northern States. After railroads, comes modern machinery as a cause for amputations; and after this cause, comes "frost-bite," leaving, as will be seen, the smallest fraction of all the amputations that are now rendered necessary as having been caused by a civilization of fifty years ago. From the diary of one of the most experienced surgeons in former days in western New York, before the time of railways and modern machinery, and published in "The History of the Town of Concord," we find this old hero, as he certainly was, taking a retrospective view of his professional life. The following is his language: "I think I must have treated, during the almost fifty years that I have practiced, some twenty-five or thirty cases of fractured skull; and I must have amputated as many arms and legs." This statement appears in the diary of Bela H. Colegrove, a surgeon who began his practice in 1820 in western New York. From my intimate personal knowledge of the man and of the territory over which he practiced, and from my knowledge of many of his operations, I feel like vouching for the authenticity of his statement; but my object in making this quotation, with my comments, is to show the radical changes that modern inventions have made in the practice of the surgical branch of our profession.
Our manufactories, modes of travel, and internal commerce, have wrought such a change in this branch of our practice, that to-day, instead of making as many amputations as we do
operations on the skull for fracture, we probably, especially in the older States, make fifty times as many. And as we look into the future, we can see little hope of lessening the accidents which require major amputations. Those that require but the amputation of fingers, a hand, or at most an arm, we can reasonably hope will be greatly lessened by some safer method of coupling cars than by hand. This branch of surgery has increased out of all proportion to our increase in population; and it will continue to increase with the increase of manufactures, travel, and internal commerce. But while these are the sources from which spring so many cripples, they, too, are the sources to which cripples can almost always look for employment that will afford them a good support, however much they be maimed.
It can not be said now, because a man has lost an arm or a leg, or even both arms or both legs, that he might better be dead. In former times, when the peg-leg and the empty sleeve were the only alternatives for a man who had lost a limb, and heavy manual labor the only means of support, the loss of a member often consigned him to penury and want; and especially would the loss of both arms or of both legs deprive him, not only of all means of obtaining a livelihood, but of the ability to walk or to wait on himself. Not so at the present day. Men who have lost both arms drive spirited horses, operate the telegraph or the telephone, act as flagmen, &c., while those who have lost both legs walk our streets without exciting suspicion that they have artificial limbs. They act as engineers, telegraphoperators, book-keepers, and in many other capacities, for which services they obtain not only a support, but accumulate a competency for old age. In our modern civilization, there is something for every man to do, if he will, whether he have limbs or not. While comparatively few of those who graduate at our medical colleges will make operative surgery any considerable part of their practice, the day has gone by when the educated physician can hope, through a lifetime, to steer clear of all connection, direct or indirect, with the question of amputation. Some will aim in the beginning of their professional life to
secure a surgical practice, especially in amputations. Others will be drawn into it by the people and by their older professional brethren. Others, living on the line of some railway, will of necessity be called to attend those injured at their very doors; and, when not expected to operate, many will be called upon by friends to examine and pass judgment on the propriety of operation. Any man who has ever had the name of doctor will be liable to be consulted upon the question of amputation. So, do what we will, live where we may, the doctor of medicine must know something more about the results, at least, of operations of this character, than the people at large.