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establishing precedence, which has in some quarters been denied me. What I claim, as original, is the healing of the stump as an open wound, and, as the result of my means for attaining this object, comparative freedom from suppuration and rapidity of the healing process.

On motion the Section adjourned.



By E. ANDREWS, A.M., M.D.,


The results of surgical operations are not alike in all places. Climate, and the habits of the population, as well as other local influences, powerfully affect the mortality of operations, and to a corresponding degree modify the rules by wlrich their safety is determined.

This important truth has received very little attention hitherto, and it is with the hope of placing it in a clearer light that the accompanying facts are presented.

The following statistics of the surgery of the Lake States are not copious, but they have been collected with great care, and with special attention to the securing of honest and impartial reports. They are derived

1st. From the records of Mercy Hospital in Chicago.

2d. From such imperfect records of other hospitals as were obtainable after the great fire.

3d. From private practice of various surgeons scattered through the Lake States, known to me personally as men of truth and honor.

4th. From records of my private practice.

5th. The statements respecting other regions are taken from the various hospital records already before the profession.

6th. I have rejected entirely all that class of scattered cases to be found by looking over the medical journals, because such records always contain too great a predominance of successful instances, and too few of the fatal ones, to give anything but a flattering and delusive sum total.

The numbers presented therefore are moderate, but they represent practice as it actually occurs.


There is no reason to suppose that this operation is performed with any more mechanical skill in the Lake States than elsewhere, yet it is subjected to influences, presently to be discussed, in consequence of which, it is more successful than in most of the localities whence our published statistics are derived.

TABLE I.-Showing the Mortality of Herniotomy in the Lake States

compared with the same operation elsewhere.

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From this table it appears that while surgeons in other parts of the world report after this operation a mortality of from 41 to 79 per cent., it is only 26 per cent. in the Lake States.

This curious difference is partly due to the fact that nearly all the cases are from private practice, because from the habits of our people, these patients are almost all promptly operated on at their houses, and rarely make their appearance in hospital at all; yet this cannot be the whole explanation, for by Dr. Cheever's figures, private practice in Boston gives for the same operation a mortality of 41 per cent. The other influences are probably as follows:

1st. The population of the Lake States contains a large per. centage of emigrants, who are not only in the prime of their age, but, like emigrants everywhere, consist of the more vigorous individuals of the population from which they came, and are therefore better able to bear the operation successfully.

2d. A still more important fact is that emigrants everywhere are intellectually the more alert and quick-witted part of the people. In cases of strangulated hernia, among us they rarely neglect themselves, but send at once for surgical help, so that probably they come into the hands of the operator earlier than in European countries, and consequently at a more favorable period for success.

Ibid. I See Report of Boston City Hospital.

* Ibid.

6 Ibid. 8 Archiv Klip. Chirurg., III. Band, 30 Seite. 6 Bericht k. k. allgemeinen krankenhauses. Wien, 1861 to 1871. 7 Statist. des Hôpitaux de Paris, 1861 to 1863.

3d. Owing to the dryness of the western climate, and the habits generated by frontier life, the people of the Lake States live more in the open air, and in houses less close than at the east, so that septic complications occur much less frequently than in regions where different habits prevail.

Similar results are obtained by studying the record of major amputations presented in the following table.

TABLE II. -Showing the Mortality of the four Major Amputations in

the Lake States compared with the same operations elsewhere (operations through the joints excluded).

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In this table a result is reached similar to that in Table I., viz., that the mortality in the Lake States is much less than that given in statistics gathered elsewhere, with the exception of Sir J. Y. Simpson's astonishing statistics of British private practice, which latter figures we will presently examine. Laying them aside for the present, we find that the Pennsylvania Hospital reports the mortality of the four major amputations as 25 per cent., the New York Hospital as 32 per cent., Boston City Hospital 38 per cent.,

| Report of Boston City Hospital.
2 Boston Med. and Surgical Journal, May 1, 1872.
3 Works of Sir J. Y. Simpson, p. 338.

4 Ibid., p. 304. 5 Statist. des Hôpitaux de Paris, 1861 to 1863. 6 Aertlichen Bericht k. k. allgemeinen Krankenhauses. Wein, 1861 to 1871.


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