limited experience in military surgery. At the beginning of the wars which have for some time past desolated the fairest parts of Europe, both the Continental and the British surgeons rather inclined to the side of delay; but experience has now taught both the French and the British surgeons the advantages of operating on the field of battle.

The objections made to this appear to have been founded chiefly on theoretical grounds;-these are examined and refuted in a very luminous and satisfactory manner by Mr. Guthrie; but the argument drawn from actual, extensive, and general experience, is so paramount, as to render all other exposition of the merits of the question most unnecessary in this place.

At first sight, indeed, it is obvious that, if a man must lose a limb, he had better lose it immediately, than after three or four weeks of pain, and suffering, and fever, and inflammation, suppuration, gangrene, and danger. It is certain also, that, in this struggle, many would die before the period of his last chance for recovery by amputation could arrive; but even this period, when the patient has survived and attained it, is less favourable for the operation than the moment when the accident was received; and, of any equal numbers of operations performed, the one number on the field of battle, and the other at the secondary period, it appears in evidence, that a far greater proportion of the former recover than of the latter. As the most satisfying proof of this leading fact, we shall content ourselves with exhibiting the following tables from the book now before us:

"Return of the capital operations performed at the hospital stations, between the 21st of June and the 24th December, 1813, of the army under the command of his Excellency Field-Marshal the Duke of Wellington; being a period of six months, from the advance of the British army from Portugal, until its establishment in winter quarters in front of Bayonne.

Amputation of the upper extremities, 296 116 105 75

The operations at the shoulder-joint not included.

"Return of the capital operations performed in the same period on the field of battle, and for the most part kept in regimental and divisional hospitals.

Lower extremities,

Total number of operations,

Amputation of the upper extremities, 163

Number operated

upon.

"The cases marked "under cure," in both statements, having passed the period of danger, are considered as recovered; and from this it will appear that the comparative loss, in the secondary or delayed operations, and primary or immediate operations, is as follows:

Under cure.

"This difference is certainly very remarkable, and it is so well known to all the surgeons of the British army, as a constant occurrence, that there is no longer among them any doubt on the subject; and the following statement of operations performed on officers and soldiers, in consequence of the battle of Toulouse, will probably be even more satisfactory; as the medical duties both in the field on the day of action, and in the hospitals afterwards, until the final evacuation of Toulouse, were more immediately under my observation and control.

"Of the eight that died of amputation of the lower extremity, three were shortly after the operation; which was performed as high as possible in the thigh by the circular incision, and one officer.

The reasons of this difference of success are, that, in the primary operations, the amputations have been performed on a healthy subject, and on sound soft parts; and hence the VOL. VI. зт No. 24.

Number operated

upon.

Of which died.

Discharged cured,
or considered out

of danger when
transferred from
Toulouse.

Of which died.

Cured.

stump generally heals by the first intention, and without accidents. In the secondary amputations, on the contrary, the health has been broken by much suffering for three weeks, or more; and the soft parts which are cut by the surgeon have been altered by inflammation; hence the stumps seldom heal without suppuration; often they ulcerate; and sometimes the limb becomes gangrenous, or the patient is attacked with fever, and dies from internal suppurations.

On the subject of gangrene we have also some excellent and judicious observations from Mr. Guthrie; and especially from one kind of gangrene peculiar to gun-shot wounds of the extremities,—that which is the consequence of the wound of the principal arteries of a limb. The gangrene in this case commonly begins in the lower part of the limb, below the wound, perhaps in the toes and fingers, and spreads upwards; and the experience of Mr. Guthrie leads him to conclude, that this case forms an exception to the general rule of waiting in gangrene for the line of separation, before proceeding to amputate.

"Having lost all the cases of gangrene succeeding to wounds of arteries, and other cases of greater injury, in which it supervened on the third or fourth day without much previous inflammation, I began to think it an error to wait for the line of separation, when there appeared but little prospect of its formation. In two cases after the battle of Salamanca, in which I had reason to think the gangrene was of this kind, ̧ I amputated with success; a third died after amputation, but not of gangrene affecting the stump; and a fourth and fifth, which I left for the appearance of the line of separation, or the cessation of the gangrene, very soon died. This practice, in cases of severe injury, after gun-shot wounds, has succeeded in the hands of others, even in England."

After discussing all the questions and points of practice connected with amputations, generally as connected with gunshot wounds, Mr. Guthrie proceeds, in distinct sections, to the consideration of the particular operations.

Under each head he not only describes the modes of operating, but, with a freedom and ability which experience alone

can give, he points out the nature, variety, and extent of those wounds and accidents which require the operations in question. These observations are most valuable and instructive, but scarcely admit of abridgment or analysis; and this is a book which we are most unwilling to save any one the trouble, we ought rather to say, the pleasure and profit of perusing. The account of the operations performed at the hip and shoulder-joint, are especially interesting. The former operation has been more than once performed by Mr. Guthrie, and other British surgeons; we regret to add, that in one case only has it been completely successful. But this one is sufficient to justify an operation from which surgeons in general have shrunk. The operation of the shoulder-joint has become as perfect and as successful as any other operation.

A surgeon in private practice, who performs a few annual and great operations, is still timid and apprehensive, compared to the military surgeon; and there is nothing more worthy of a passing remark, than that confidence and intrepidity which the military surgeon acquires, and which is in truth so necessary for him to have in the discharge of his important and arduous duties. Mr. Guthrie has no silly fears of hæmorrhagy and uncompressed arteries, in cases where experience has taught him confidence. He cares not, indeed, in most cases, whether he has a tourniquet or not; an instrument which in some cases is, indeed, useless, as in operations at the. great joints. In these he trusts with the most perfect confidence to the manual compression of the artery above the clavicle, and on the brim of the pelvis.

"The fear usually entertained by surgeons, is that of incontrollable hæmorrhage; and Mr. John Bell (whose works have done so much good in the surgery of arteries), has here done much mischief, in persuading many young men that hæmorrhage from large arteries is not to be restrained by any pressure; which is, in my opinion, one of the principal errors of his work, in relation to military surgery, and is indeed almost as great an error as any he has laboured so effectually to

overturn.

"He says, p. 415 of his Principles of Surgery, 'I will re