REPORT OF AMPUTATIONS 
PERFORMED AT 
THE HOSPITAL 
OF THE 
UNIVERSITY OF PENNSYLVANIA 
FROM 
SEPTEMBER 30, 1874, 
to DECEMBER 31, 1888. 
BY 
LEWIS H. ADLER, Jr., M.D., 
LATE RESIDENT PHYSICIAN, UNIVERSITY HOSPITAI 
FROM THE 
Medical and Surgical Reporter, 
May ii, 1889. From the Medical and Surgical Reporter, 
May 11, 1889. 
REPORT OF AMPUTATIONS PER- 
FORMED AT THE HOSPITAL OF 
THE UNIVERSITY OF PENNSYL- 
VANIA'FROM SEPTEMBER 30, 1874, 
TO DECEMBER 31, 1888. 
BY LEWIS H. ADLER, Jr., M.D., 
LATE RESIDENT PHYSICIAN, UNIVERSITY HOSPITAL. 
The cases tabulated in the following paper 
comprise largely amputations done on 
account of railway accidents; which are 
always extremely dangerous, and are liable to 
be followed by bad results, even in subjects 
enjoying perfect health at the time of the 
accident, owing to the tendency to the 
development of mortification and pyemia. 
Again, the results of the work of such men 
as Dr. D. Hayes Agnew, Dr. John Neill, and 
Dr. John Ashhurst, Jr., in a large institu- 
tion such as the Hospital of the University 
of Pennsylvania, cannot but add somewhat 
to our knowledge of the mortality resulting 
from amputations. 
The majority of these operations were 
done before the present strict antiseptic 
treatment came into vogue, and it is certain 
that the statistics of the future will make a 
better showing. But still, the care and 
personal attention of the Surgeon-in-chief, 
which have always characterized the treat- 2 
ment of such cases in this Hospital, both 
during the operation itself and during the 
period following it, are important factors in 
the reduction of the mortality from this 
operation. 
I have followed in the arrangement of the 
statistics in this paper the plan adopted in 
similar papers, by both Dr. George W. 
Norris,1 and Dr. Thomas G. Morton,2 sur- 
geons to the Pennsylvania Hospital, in their 
published reports of the statistics of ampu- 
tation. 
In the tables sub-joined, all amputations 
in which the operation was performed within 
twenty-four hours subsequent to the accident 
are included under the head of Primary. 
The other divisions—Secondary and 
Chronic—explain themselves. 
Of 290 patients upon whom 320 amputa- 
tions were performed during a period of a 
little over fourteen years—(extending from 
the opening of the hospital, in 1874, to 1889 
inclusive) 73 died, or 25.1 per cent. 
Of this number 21 were primary double 
amputations; 3 primary triple amputations ; 
1 secondary double amputation, and 2 were 
double amputations for chronic trouble. 
1 American Journal of the Medical Sciences, vols. 
xxii, xxvi and xxviii. See also a similar account, 
dating from January I, 1850, to January I, i860, with 
a general summary of the mortality following the 
operation in the Pennsylvania Hospital for 30 years. 
Contributions to Practical Surgery—Norris. Lind- 
say & Blakiston, 1873. 
2 American Journal of the Medical Sciences, 1870 
and 1875. 3 
Of the 21 primary double amputations n 
patients recovered; io died, or 47.6 per 
cent. 
Of the three primary triple amputations 
2 patients died, or 662/3 per cent. 
The case of secondary double amputation 
recovered. 
Of the cases of secondary amputations for 
chronic trouble, all the patients recovered. 
Tables of Double and Triple Amputa- 
tions. 
Double amputations : 
Result. 
Age 
Shoulder-joint and arm 
Primary 
Died 
21 
Arm and thigh .... 
66 
Rec. 
28 
“ leg 
“ 
D 
21 
“ “ . . 
66 
“ 
35 
Forearm and leg . . . 
66 
R 
48 
« « 
66 
66 
45 
Hip-joint and leg . . . 
66 
66 
i5 
Thigh and foot . . . 
“ 
D 
25 
Knee-joints (both) . . 
66 
R 
28 
66 66 
66 
D 
32 
Knee-joint and leg . . 
66 
66 
41 
66 66 
66 
66 
5° 
66 66 
66 
R 
25 
Legs (both) 
66 
“ 
22 
66 
66 
D 
21 
“ 
Chronic 
R 
23 
66 
Primary 
D 
6.3 
“ 
“ 
R 
18 
Leg and foot . . 
“ 
66 
25 
“ 
66 
66 
19 
66 
66 
D 
34 
66 
66 
R 
21 
Feet (both) 
Secondary 
66 
29 
66 
Chronic 
66 
61 4 
These cases number 24; 14 patients 
recovered ; 1 o died, or a percentage of 41.7. 
Triple amputations: 
Result. 
Age. 
Arms (both) and thigh . 
Primary D 
*5 
Forearm, thigh and leg 
“ R 
26 
Forearm and legs (both) 
“ D 
45 
Of the 263 patients who had but one limb 
amputated, 201 recovered; 62 died, or 
24.4 per cent. 
180 cases were primary single amputations; 
of this number, 140 patients recovered; 40 
died, or 22.2 per cent. 
3 were cases of secondary single amputa- 
tions ; of this number all the patients died, 
or 100 per cent. 
80 were cases of single amputation for 
diseases of a chronic nature ; of this number 
61 patients recovered; 19 died, or 23.75 per 
cent. 
Table showing the various Single Ampu- 
tations, with the Results. 
8 Shoulder-joint amputations . 
. Primary 
Result. 
R 
3 « “ “ 
<< 
D 
2 “ “ “ 
. Chronic 
R 
30 Arm amputations 
R 
5 “ “ 
D 
4 “ “ 
. Chronic 
R 
20 Forearm “ . . . 
Primary 
R 
2 “ “ 
U 
D 
5 “ ... 
. Chronic 
R 
3 Wrist-joint amputations . . 
. Primary 
U 
15 Hand amputations . . . . 
Ci 
“ 
3 “ “ • • • 
. Chronic 
u 5 
Result. 
I 
Hip-joint amputation .... 
Chronic 
D 
12 
Thigh “ .... 
Primary 
R 
14 
a tt 
ii 
D 
II 
U it 
Chronic 
R 
7 
a tt 
“ 
D 
1 
a tt 
Secondary 
it 
11 
Knee-joint “ .... 
Primary 
R 
3 
4t tt 
41 
D 
3 
tt a 
Chronic 
R 
5 
“ “ 
U 
D 
34 Leg amputations 
Primary 
R 
12 
u u .... 
“ 
D 
26 
<< a 
Chronic 
R 
6 
a a 
« 
D 
2 
a a 
Secondary 
it 
1 
Ankle-joint amputation . . . 
Primary 
it 
7 
Foot amputations 
“ 
R 
7 
tt it 
Chronic 
tt 
Table Showing the Percentage of Mor- 
tality of Single Amputations upon 
the Different Parts of the Body : 
13 shoulder-joint amputations, 
39 arm “ 
mortality 3 
Per cent, 
or 23 
“ 5 
“ 13 
27 forearm “ 
“ 2 
“ 7-4 
2i wrist-joint & hand “ 
“ 0 
c< 
I hip-joint “ 
“ 1 
“ IOO 
45 thigh 
“ 22 
“ 48.8 
22 knee-joint “ 
“ 8 
“ 36-4 
80 leg “ 
“ 20 
“ 25 
15 ankle-joint & foot “ 
“ 1 
“ 6% 
ioo of the above amputations were of the 
upper extremity ; of this number io patients 
died, or io per cent. 
163 of the amputations were of the lower 
extremity; of this number 52 patients died, 
or 31.9'per cent. 6 
1 
AGE. 
Single 
Amputations. 
Synchronous 
Double Amputations. 
Synchronous 
Triple Ampu- 
tations. 
Primary. 
S’c’nd- 
ary. 
Chronic. 
Primary. 
S’c’nd- 
ary* 
Chron- 
ic.* 
Primary. 
R 
D 
D 
R 
D 
R 
D 
R 
R 
R 
D 
19 and under 
39 
5 
1 
9 
0 
3 
1 
Between 20 and 30 ... . 
55 
9 
12 
5 
6 
4 
1 
1 
1 
“ 30 and 40 . . 
25 
12 
2 
18 
4 
° 
3 
40 and over 
21 
14 
22 
10 
2 
3 
1 
1 
Table Showing the Influence of Age upon the Mortality 
after Amputations. 
* None died. 7 
In one of Dr. Geo. W. Norris’s papers 
upon amputations,1 previously referred to, 
mention is made of the mortality of such 
operations in the following terms:—“In a 
large hospital no operation is more fre- 
quently called for than that of amputation, 
and even where the time for doing it is 
judiciously determined, and the operation 
itself dexterously and well performed, the 
dangers to which the patient is afterward 
exposed, are so great as to render the sub- 
ject worthy of all attention from the practi- 
cal surgeon. Contrary to the opinion gen- 
erally prevalent in this country, amputation, 
even under favorable circumstances, is very 
frequently followed by fatal results in civil 
hospitals. In the practice of the Hotel 
Dieu, of Paris, it is said that not more than 
half of the cases prove successful,2 and I 
have the authority of M. Hache, a former 
interne of the hospital of St. Louis, of the 
same city, for stating, that out of twenty 
successive amputations made in the year 
1833, in that institution, twelve died, or 60 
per cent. With one exception (that of a 
toe) all these were capital amputations, and 
at the time the statement was made some of 
the patients were remaining still uncured.” 
When we recall the fact, which is often 
overlooked in the comparisons of older sta- 
tistics with those of the present day, that 
1 American Journal of Aledical Sciences, August, 
1838. 
2 Gazette des Hopitaux, 1834. 8 
anaesthetics have only been used to relieve 
suffering in these capital operations for a 
little over 40 years, and that the additional 
suffering inflicted before their use added 
largely to the shock and consequent mortal- 
ity of this operation—we must, in summing 
up our conclusions as to the more favorable 
results obtained now, give credit to anaes- 
thetics as important factors. 
Again, the facilities for handling cases 
requiring amputation are greater now; the 
perfection of the railway system permits of 
the early inspection of the patients by the 
surgeon; and the accommodations offered 
to patients recently injured in the numerous 
hospitals scattered over the land, where with 
careful nursing and the constant presence of 
the house-surgeon, dangers can be met and 
guarded against—all tend to lessen the mor- 
tality of amputations. 
From this resume of amputations per- 
formed in a little over 14 years at the Uni- 
versity Hospital, it appears— 
1. That amputations of the lower extrem- 
ity are more liable to prove fatal than those 
of the upper extremity. (Norris.) 
2. That the rate of mortality is greater in 
proportion to the proximity to the trunk of 
the part amputated.1 
3. That, contrary te the statements 
usually made in other published statistics, 
the mortality of amputations for chronic 
1 Ashhurst, Principles and Practice of Surgery, 
4th Ed. page 112. 9 
disease is about the same as for recent 
injury—the former being 23.75 per cent., 
the latter 24.4 per cent. The explanation 
of this may be found in the fact that many 
of the cases were operated upon for chronic 
disease of a malignant character—sar- 
coma ; etc. 
4. That the danger increases with the age 
of the individual operated upon—a point 
previously brought forth in the investiga- 
tions of Dr. Norris.1 
5. That in double synchronous amputa- 
tions the prognosis is very favorable when 
the patient is under 30. Above that age 
the mortality is at least 75 per cent.—one 
chance in four in favor of recovery. 
41 North Twelfth Street. 
1 American Journal of the Medical Sciences, August, 
1838.