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J R Soc Med. 2001 December; 94(12): 657.
PMCID: PMC1282319

Amputations at the London Hospital, 1852-1857

Mr Chaloner (August 2001 JRSM, pp. 409-412), commenting on the use of chloroform in the Crimean War, suggests that the wounded who were transported to Scutari to have operations performed there would have been less likely to die as a result of anaesthesia than those who were operated upon in the field soon after their injuries, because they would be less likely to be hypovolaemic (if they survived the journey) and better able to withstand the depressive effects of chloroform.

In the official report the figures for the administration of chloroform are poor and only a few deaths are recorded1. One young soldier having a minor operation became violent and almost certainly died of cardiac arrest due to ventricular fibrillation.

In the French Army—more than ten times the size of the British Army—no deaths due to anaesthesia were reported in 25 000 cases; careful instructions about its administration were issued2. Since the time of Larrey, it was the custom to perform amputations as soon after injury as possible, because a recently wounded soldier fared better. The ambulances volantes allowed operations to be performed at or near to the front line. In the British Army, just over 1500 received chloroform3. At the beginning of the war there were no ambulances. For this and other reasons, amputations were not always performed as quickly and there is no evidence that the army surgeons received specific instructions in the use of chloroform.

The transport to Scutari, which took several days, could well have increased the chances of hypovolaemic shock and infection, and therefore of death, before or soon after arrival, as Mr Chaloner suggests.

References

1. The Medical and Surgical History of the British Army during the War against Russia in the years 1854-1856, Vol 2. London: Harrison, 1858
2. Scrive G. Relation Médicale de la Campagne d'Orient. Paris: Libraire Victor Masson, 81 1854: 81
3. Howat DDC. French and British anaesthesia in the Crimea—a comparison. Proc Hist Anaesth Soc, 1998;24: 29

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press