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.”