Dr. J. Arnott stated that the pyæmia, of which many of the patients died after amputation, had probably been rendered more prevalent and fatal by the use of chloroform; but Mr. Thomas Holmes, in one of his able replies to the remarks of Dr. Arnott, points out that pyæmia had been prevalent also in cases of compound fracture, and others in which the patients had no chloroform. He stated that this complaint had been more prevalent in St. George’s Hospital during the three years in which Dr. J. Arnott’s statistics of amputations had been collected, than in the previous five years, in which chloroform had been used.[[143]]
A very valuable paper on the result of operations performed in the Newcastle Infirmary, before and since the use of ether and chloroform, was published last year by Dr. Fenwick.[[144]] He says, respecting his tables, “in the first series are included the operations registered in the operation books of the Newcastle Infirmary from 1823 to 1843; but, as the record is imperfect, the actual period embraced is seventeen and a half years. In the second, are the operations registered since the first employment of ether; and as the use of anæsthetic agents has been general in all the more important operations since that time, these figures may be used to show any disadvantages likely to arise from the employment of chloroform.” Dr. Fenwick continues:—“Before the use of chloroform, there were registered 225 amputations of the thigh, leg, and arm, of which 54, or 24 per cent., died. Since the use of anæsthetic agents, 149 cases of similar operations have been recorded, of which 36 died, showing also a mortality of 24 per cent.
“Before, however, we can draw any conclusion from such facts, we must carefully exclude all those circumstances which are already known to produce an effect upon the mortality of amputations. It is, for instance, well known that amputations performed on account of accidents are, on the whole, nearly twice as fatal as those required for long standing disease. Now, if we divide the foregoing numbers into these two classes, we shall find that before the introduction of chloroform there were 144 pathological amputations, with a mortality of 19 per cent.; while since its employment there have been only 61, of which 13 per cent. have died; and while of 81 traumatic amputations which took place in the former period 32 per cent. died, only 31 per cent. perished in the latter period. The equal mortality obtained from a general average of all amputations is thus seen to have arisen from the smaller comparative number of operations performed for diseases.”
After giving a table which shows the result of each kind of amputation in the two periods, he adds, “It is plain from the above table that since the employment of chloroform there has been a diminution of mortality; thus in amputations of the thigh for disease there has been 5 per cent. less death, while after accidents 17 per cent. have been restored to health, who formerly would have perished. In the pathological amputations of the leg there is a difference of 8 per cent. in favour of chloroform; and while one out of three died after the removal of the forearm for accidents in the former series of cases, no death had occurred out of eight in the latter. The only exceptions are to be found in the traumatic amputations of the leg, and in the pathological amputations of the arm. In the former there is an excess of deaths since the introduction of chloroform amounting to 5 per cent.; and in the latter, the cases, being only two in number, do not warrant us in drawing any deduction from them.”
Dr. Fenwick found that the mortality from lithotomy had been greater since the introduction of chloroform than before, but that the increase was confined to the cases occurring in adults; and he justly attributes this to the fact of the more favourable cases having been operated on by lithotrity. He says, “However paradoxical it may appear, I believe that as surgery improves the general average of mortality, both after amputations and lithotomy, will increase; in the former, from the operation being confined more and more to those suffering from accidents, and in the latter, from those with a healthy condition of the kidneys and bladder being selected for the action of the lithotrite, and the worst cases only submitting to the knife.”
Dr. Fenwick gives a table showing the causes of death in the fatal cases of lithotomy before the use of chloroform and afterwards, by which it is seen that, in the latter set of cases, a larger proportion of the patients had been afflicted with organic disease, in addition to the stone. He says:—“This table shows that the relative proportion of deaths arising from the operation in healthy persons has diminished since the use of chloroform, 58 per cent. having died in the former, and only 47 per cent. in the latter.”
Dr. Fenwick inquires into the result of a considerable number of operations in the Newcastle Infirmary, before and after the use of chloroform, in addition to those mentioned above; and gives the following summary towards the end of his paper.[[145]] “We find that there has been a decrease in mortality since the introduction of chloroform in the following operations:—
| Per cent. | |
|---|---|
| Pathological amputations of the thigh | 5 |
| Traumatic amputations of the thigh | 17 |
| Pathological amputations of the leg | 8 |
| Amputation at the shoulder joint | 7 |
| Traumatic amputation of the arm | 5 |
| Pathological amputation of the forearm | 33 |
| Traumatic amputation of the forearm | 16 |
| Ligature of the brachial artery | 20 |
| Ligature of the arteries of the forearm | 25 |
| Amputation of the penis | 11 |
| Amputation of the testis | 14 |
| Excision of the elbow | 30 |
| Tumours of the axilla, etc. | 8 |
| Tumours of the bones, etc. | 4 |
“There has been an increase of mortality in:—
| Per cent. | |
|---|---|
| Traumatic amputation of the leg | 5 |
| Pathological amputation of the arm | 41 |
| Lithotomy | 10 |
| Herniotomy | 12 |
| Amputation of the breast | 1 |
| Tumours of the head, etc. | 5.” |