Of 310 amputations 25 died, 172 recovered in the field, and 113 were sent to the rear, of whom one-sixth may be considered to have died, making a total of 45 deaths in 310 cases—the proportion of upper extremities to lower in the 310 being as 182 to 128, thus greatly influencing the result, which is consequently much more favorable than if the numbers had been reversed. The proportion of upper to lower extremities in the secondary amputations, as by return No. 3, is equally in favor of the upper, and can only be accounted for, when compared with Return No. 4, by the army being constantly in motion and the hospitals at a distance. The difference of results at the several stations is also remarkable; it is so with the divisions in the field. The 3d and 4th divisions, under Staff-Surgeons Lindsey and Boutflower, kept their amputations with them in bivouac, and their success is remarkable; that of the 4th division has no parallel. The light division, on outpost duty, could not keep their amputations. These two returns include 886 amputations.

The labors of the surgeons of the army may be judged of by the fact that, during the last three months of the year to which these returns refer—viz., from September 25th to December 24th, 1813—the number of sick and wounded amounted to 37,144, a number nearly equal to that of the whole army.

No. 5.—Return of Capital Operations, Primary and Secondary, performed in the British General Hospitals, Brussels, or brought in from the Field between 16th June and 31st July, 1815.

OPERATIONS.
General total.
Primary operations.
Died.
Remaining.
Proportion of deaths
to operations.
Secondary operations.
Died.
Remaining.
Proportion of deaths
to operations.
Total remaining.
Of these
doubtful.
Transferred to
Antwerp.
REMARKS.
Shoulder-
joint		 8 6 1 5 1 to 6 12 6 6 1 to 2 11
Hip-joint 1............ ... 1... 1... ... 1......A French
soldier,
who
recovered.
Thigh 148 54 19 35 1 to 3 94 43 51 1 to 2 86 9 4
Leg 93 43 7 26 1 to 6 50 16 34 1 to 3 60... 4
Arm 72 21 4 17 1 to 5 51 13 38 1 to 4 55... 6
Forearm 39 22 1 21 1 to 22 17 5 12 1 to 3 33... 3
Carotid
artery
tied		 1............ ... 1... 1... ... 1......
Trephine 2............ ... 2 1 1 1 to 2 1... 1
Total 374 146 32 104... ... 228 84 144... ... 248 9 18

LECTURE VIII.

CHARACTERS OF HOSPITAL GANGRENE.

164. This most destructive disease owes its names of hospital gangrene, phagedena, gangrenosa, pourriture d’hôpital, sloughing ulcer, etc. etc. to the different appearances the affected parts assume on different occasions, according to the intensity of the morbid poison applied, and possibly also to the state of constitution of the individual attacked. The peculiar nature of this poison has not yet been ascertained. Professor Brugmans says that in 1797, in Holland, charpie composed of linen threads cut of different lengths, which, on inquiry, it was found had been already used in the great hospitals in France, and had been subsequently washed and bleached, caused every ulcer to which it was applied to be affected by hospital gangrene; and the fact that this disease was readily communicated by the application of instruments, lint, or bandages which had been in contact with infected parts, was too firmly established by the experience of every one in Portugal and Spain to be a matter of doubt. Its character as a thoroughly contagious disease is indisputable. Its capability of being conveyed through the medium of the atmosphere to an ulcerated surface is also admitted, although some have thought that the infection was not always applied to the sore, but affected it secondarily, through the medium of the constitution. Brugmans says that hospital gangrene prevailed in one of the low wards at Leyden in 1798, while the ward or garret above it was free. The surgeon made an opening in the ceiling between the two, in order to ventilate the lower or affected ward, and in thirty hours three patients who lay next the opening were attacked by the disease, which soon spread through the whole ward. Our experience in Portugal and Spain confirmed this fact, and left no doubt on the mind of any one who had frequent opportunities of seeing the disease, that one case of hospital gangrene was capable of infecting not only every ulcer in the ward, but in every ward near it, and ultimately throughout the hospital, however large. The disease, as long as it remains unaltered by destructive applications, may be considered to be infectious as well as contagious.

This infection can penetrate the dressings so as to affect the ulcer through them, although requiring a difference of time in different parts of the body. Ulcers on the lower extremity experienced the influence of the morbid poison in general at an earlier period than those on the upper extremity; and a wound might be seen in a healthy state on the arm, while one on the leg had been evidently suffering from this disease for some days, if the complaint had become mild, or somewhat chronic. If the morbid poison were in its active state, then the deterioration of the ulcers on the arm was almost if not quite contemporaneous with that on the leg.

165. Mr. Blackadder has given the following account of the disease from inoculation in his own person, which is, therefore, more to be relied upon than any other:—