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1 Montgomery... Rochester.. 1848 M. 3d M. 3d Perkins..... Adult Recovery. 2 New York Hos
6 Reported by Dr.
7 Van Pelt.
8 Muller, U. S. Army..
Cause of operation.
L. 3d L. 3d McGath..... 50 Recovery. 30 Recovery. Recovery.
1857 L. 3d L. 3d
Frost-bite..... Both hands
Recovery. Recovery. Adult Recovery. 30 Recovery. Recovery.
Powers 22 Recovery.
These tables are founded on written reports now in my possession; and the accuracy of the reports, I do not question. The tables show, in brief, only the name of the operator, the place where the operation was made, the year, the site of the operation, the name of the patient, the age, and the result. Unless the patient was a child or an old person, I have made no effort to ascertain the exact age; and the tables often omit the age, when the patient was an adult. The name of the patient is not always given; in fact, it is frequently omitted, especially when the patient died.
In looking over these tables, which contain reports of ninety
1 1 Bryant, "Practice of Surgery," Philadelphia, 1885, p. 1001.
two cases, we observe that nineteen twentieths of the amputations were in consequence of railway injuries. A few of the amputations of the upper extremities were for injuries caused by the premature discharge of cannon; while ten cases are recorded of amputation of the legs rendered necessary by frost-bite. The railway injuries were the most serious. Nearly all the cases of amputation of upper extremities, for whatever cause, were successful, the patients recovering.
The cases of amputation for frost-bite were confined to the feet and legs and were successful. Of the thirty-four cases of amputation of the feet and legs for railway injuries, nearly twothirds recovered. Of the amputations through one thigh and the opposite leg, numbering seventeen, eight recovered. Of the six cases of amputation through both thighs, half recovered; two of the recoveries being boys of eight years of age, and the amputations being through the lower third. The case reported by Dr. Burr was the only one of recovery in an adult. This man was twenty-four years old, and the amputation was through the middle third of both thighs. Of the amputations through the thigh and upper extremity, six in number, one half recovered. Of the amputations of the leg and upper extremity, five in number, three recovered. The only case of amputation of three limbs for railway injuries, both forearms and one leg, recovered. I have placed in these tables two remarkable cases which were operated on outside of this State, both of frost-bite. In each case, both hands and both feet were amputated, and both patients recovered. One operation was performed by Dr. Tremaine, U. S. Army, now of Buffalo, and Professor of Surgery in the Niagara University; and the other was done by Dr. Muller, U. S. Army.
There is no mention in the tables of the methods pursued by the different surgeons in making the amputations; but, by the reports that I have in my possession, it appears that those who have operated the most frequently practiced different methods, according to the characters of the cases. Dr. Leroy McLean, who has made more such amputations than any surgeon in the State, and with the best success, generally practiced the circular operation, but he did not confine himself to this method.
Dr. Burr, in his remarkable case, practiced the circular method. In four cases of double amputation and the one of triple, I practiced the flap method, four out of the five cases recovering. In the last case, the thigh amputation was made as high as the middle of the upper third, while the amputation through the leg was just below the knee. It is probable that the method of making the covering for the stump has very little to do with the result. The surgeon who adopts the best means for preventing hæmorrhage before, during, and after the operation, who removes every part that might slough, who operates the most rapidly, and, after the operation, makes his patient the most comfortable, while he keeps the stump the cleanest, will have the best results in any considerable number of cases.
No surgeon would think of administering an anæsthetic, with a view of amputating two or more limbs, to a patient whose pulse, voice, and countenance showed him to be already suffering from great shock, whatever the circumstances might be. The anesthetic and the amputation would be, almost certainly, fatal; for, however skillfully and rapidly performed, these operations produce of themselves a considerable shock to the system. Many of the cases that might justify an amputation, were only the limbs injured, are accompanied by internal injuries which render hopeless the life of the patient; but in those cases in which the limbs are the only parts injured, if the patient be not in a condition that justifies an amputation immediately after the injury, he probably never will be. If the surgeon hope for reaction in these cases, he will generally be disappointed. There are some cases in which parts in addition to the limbs receive injury the effects of which are transient, such as blows upon the head, over the stomach, etc. In these cases, the patients may improve so as to warrant an operation that was not justifiable immediately after of the injury. When a patient's injuries are confined to his limbs, and he is in a condition that will justify their amputation, the sooner the surgeon operates the better. Delay and transportation jeopardize the prospects of recovery.
THE FUNCTION OF THE AURICLES.
By U. C. LYNDE, M. D., of Erie County.
THE heart is double, consisting of a right ventricle, or right heart, and a left ventricle, or left heart. The two hearts, called respectively the right and left ventricles, though very similar, are unlike in the thickness of their walls; those of the left being more than twice as thick as those of the right. The capacity of the two are the same; each being capable of containing about six fluid ounces. The valves of the two, which serve to prevent the return of the blood after its expulsion from their cavities, are called semi-lunar and are alike; while the respective valves, that admit the blood into their cavities but prevent its escape, are slightly different, that of the right heart being called the tricuspid, and that of the left, the mitral. Each heart has two apertures, making four in all. These apertures are unlike in size. They range as follows, beginning with the smallest: 1, the aortic; 2, the pulmonary; 3, the mitral; 4, the tricuspid. The same quantity of blood passes through all four of these apertures and in nearly the same time, the same time being occupied in its admission into the hearts, and the same time being occupied in its expulsion. A little more time is occupied in its admission than in its expulsion. The forces employed, at the respective apertures, are in inverse proportion to their respective sizes. The left ventricle contracting with more force than the right and expelling during the same time the same quantity of blood, its outlet is, consequently, smaller than the outlet of the right; and as this ventricle will, on account of the greater thickness of its walls,
return to its normal state, that of dilation, with more force, as a consequence, its suction-power will be greater than the suctionpower of the right; and we accordingly find that its aperture, which admits the same quantity of blood in the same time, is smaller than the aperture of the right. The two functions, the production of the systemic and pulmonary circulations, are so important that on their performance depends the life of the organism. That nature has chosen the simplest and the best means will not be questioned. The means chosen consist of two parts, the right and the left ventricles; and all appurtenances to these parts are but means for the carrying out of the two objects stated above. These means are, like the central organs, of the best and simplest kind, consisting of vessels to carry the blood from the heart and of vessels to bring it back again, the cardiac extremities of the latter vessels being called auricles. These auricles are entirely passive, being but the expanded terminations of the veins, and serving, first, as the confluence of the great veins, second, as diverticula to the blood from these veins during the contraction of the ventricles, and third, as reservoirs for the ready supply of blood to the ventricles.
Among the reasons that may be given why the auricles do not contract, are the following: While the veins of the extremities are provided with valves simply to counteract the force of gravity and the tendency that the muscles might have to retard the returning circulation, the great veins emptying into the auricles have none. The terminations of the veins at several sites would hamper the auricle in the act of contracting. The ventricles are surrounded by the pericardial fluid, while the auricles are attached to the pericardium. Polypi can have their growth in an auricle and affect the auricle only by distending its walls, not materially influencing its function. Nearly the whole surface of the auricle in some animals is frequently covered with several times its thickness of fat. Its basilar attachment is nearly as broad as the base of the ventricle. As the auricles have no valves to protect the venous circulation, if they should contract while the heart is sound, their contraction would