LIST OF MAJOR AMPUTATIONS PERFORMED AT THE MASSACHUSETTS GENERAL HOSPITAL FROM 1822 TO 1850.

First.-Cases from 1822 to 1850 (reported by Prof. GEO. HAYWARD).

Total from 1822 to 1850, 173; recovered, 141; died, 32: per cent of deaths, 18.5.

Second.-Cases from 1850 to 1860 (collected by Dr. BENJ. S. SHAW).

Total from 1850 to 1860, 207; recovered, 160; died, 47: per cent of deaths, 22.7.

Total of amputations (except of hip and shoulder), 380; recovered, 301; died, 79: per cent of deaths, 20.8.

Amputations at Hip and Shoulder Joints from 1850 to 1860.

In a paper published by Mr. Callender, the mortality, after all amputations, at

St. Bartholomew's Hospital, London, is given as follows:

Total, 358; recovered, 284; died, 74

Per cent of deaths, 20.7

Dr. Norris, in the "American Journal of Medical Sciences," July, 1854, gives the following statistics of amputation at the Pennsylvania Hospital, before 1850: Total, 196; recovered, 148; died, 48 Per cent of deaths, 24.5.

Dr. Simpson, in his lecture published in the "Medical Times and Gazette," Feb. 6, 1864, quotes the following:

Out of five hundred and twelve amputations of the thigh, leg, arm, and forearm, performed in the Parisian hospitals from 1836 to 1841, and collected by M. Malgaigne, two hundred and eighty-one proved fatal. In other words, fiftyfive out of every hundred thus operated upon died.-Archives Generales de Médecine, tome 58, p. 389.

Out of two thousand and forty-six similar amputations occurring in British hospitals and in private practice, collected by Dr. Fenwick, five hundred and twenty-four proved fatal. In other words, nearly twenty-six in every hundred thus operated upon died.-Monthly Journal of Medical Science for October, 1847, p. 238.

Dr. Fenwick has collected together, from civil and military practice in Great Britain, America, and France, a list of four thousand nine hundred and thirtyseven amputations of large limbs. Of these patients, a thousand five hundred and sixty-five died, or nearly thirty-two in a hundred.

EXCISION OF JOINTS.

The excision of diseased joints, as a substitute for amputation, which was revived a few years ago by Mr. Syme, more particularly for the elbow and shoulder, has lately been practised on most of the larger joints of the body, and has passed into surgery as one of the established operations. The excision of the knee, in particular, has been much more frequently performed than that of any other large joint; the diseases which, in civil practice, require surgical interference, being much more frequent in the case of the knee than of the elbow. By this operation, many limbs, which would otherwise be condemned to amputation, are saved, and made useful to the patient. Excision is, of course, applicable only to cases in which the limb is otherwise sound, and the movements of the hip and an

kle unimpaired. Performed upon adults, it already counts a great number of most admirable results: but, in the case of young children, a very grave objection has arisen from the fact that in several instances, at first reported as successful, the growth of the limb has been arrested; leaving it, at last, many inches shorter than its fellow. There is no doubt, that, if the epiphyses of the bones are wholly removed, the subsequent growth is more impaired than when they are preserved. It is therefore proper, in children, to pare off from the articular surfaces as thin a slice as is consistent with the removal of the diseased bone and the whole articular cartilage. In one case in my own practice, in a little girl of about eight years of age, an entirely useless and bent-up limb, the result of scrofulous white swelling, was made serviceable by removing the ends of the bones, and straightening the joint. I saw this patient, at the end of three years, perfectly well, and walking with a slight limp. The limb was shorter than the other; but the pelvis had so adapted itself as to make the loss of length less evident than might have been expected.

I have performed excision of the knee-joint three times with most gratifying success. In a fourth case, that of an adult female,-which, from the first, seemed a less promising one for the operation than the others, amputation was afterwards necessary.

In two or three excisions of the shoulder-joint for caries, the results have all been successful.

The advantages of excising the head of the humerus and the articular surfaces entering the elbow

joint are undoubted. The decision in the case of the knee-joint can be hardly yet considered as finally made.

CANCER.

The question of the removal of malignant tumors by surgical operation has been a subject of discussion from the time of the father of medicine. It was the opinion of Hippocrates, that the disease had much better be left to itself; and that the patients died sooner when the attempt was made to remove it, than when it was allowed to pursue its natural course. The same views, substantially, have been held, until within a few years, in England and the United States.

In a report made to the American Medical Association in 1852, supported by cases which had occurred in my own practice, I felt justified in drawing the following conclusions: first, that, in a certain number of cases, cancerous tumors, once removed, do not return; secondly, that, in certain other cases, the patient, after an immunity for a longer or shorter period, has a return of the disease, requiring a second operation, which sometimes proves successful; thirdly, that although, in a great proportion of cases of extirpation, the disease returns, either in the neighborhood of the wound or in some internal organ, yet, even under these circumstances, it generally re-appears in a less loathsome form, and is attended with much less suffering, than if the original local disease had been allowed to proceed to a fatal termination; fourthly, in consequence of the immu

nity from pain afforded by the use of anæsthetic agents, one of the most serious of the old objections to extirpation no longer exists.

After an experience of ten years since this report was made, I feel even more fully convinced of the propriety of removing cancer,-particularly of the breast, except in cases of marked impairment of the health from the disease, or when there is evidence of decided constitutional infection; and this opinion would be justified, even if we admit that the disease is never really destroyed by surgical removal. I am fully confident, however, that, in a certain number of instances, the disease is radically extirpated by the operation. There are still living, and in good health, several patients upon whom I operated for undoubted malignant disease ten or fifteen years since. I have also a patient, now in a state of perfect health, in whom the disease occurred five separate times within two years, and was as often removed; the last time, more than two years ago. In another case, operated on in 1859, in which a large scirrhous tumor of the breast was rapidly approaching the surface, the whole disease was removed, and the patient recovered her health. At the end of eighteen months, a tumor appeared in the axilla; which, after attaining the size of an apple, was enucleated from among the great vessels and nerves. At the end of a year, a hard tumor, imparting almost a bony sensation, appeared near the spinous process of one of the dorsal vertebræ this was also removed; and the patient finally died, with cerebral symptoms, four years after the first operation. During