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appearance and fairly circumscribed swelling. No evacuation of the bowels had taken place for over two weeks, and as the patient suffered from singultus and constant pain over the epigastric region, a light cathartic was given, which, in twenty-four hours, gave relief. The four frozen limbs were enveloped in a solution of zinc chlorid. The frozen ears and cheeks healed in due time, and the gangrenous parts of the nose separated and soon healed, with the loss of the tip and parts of the alae, leaving the septum somewhat exposed. On January 10th the lines of demarcation were distinct and deep on all four limbs, though the patient, seconded by his wife, at first obstinately opposed operative interference; on January 13th, after a little hesitancy, the man consented to an amputation of the arms. This was successfully carried out on both forearms, at the middle third, the patient losing hardly any blood and complaining of little pain. The great relief afforded by this operation so changed his aversion to being operated upon that on the next day he begged to have both legs amputated in the same manner, which was done, three days afterward, with the same favorable result. After some minor complications the patient left for his home, perfectly recovered, June 9, 1866. Begg of Dundee successfully performed quadruple amputation on a woman, the victim of idiopathic gangrene. With artificial limbs she was able to earn a livelihood by selling fancy articles which she made herself. This woman died in 1885, and the four limbs, mounted on a lay figure, were placed in the Royal College of Surgeons, in London. Wallace, of Rock Rapids, Iowa, has successfully removed both forearms, one leg, and half of the remaining foot, for frost-bite. Allen describes the case of a boy of eight who was run over by a locomotive, crushing his right leg, left foot, and left forearm to such an extent as to necessitate primary triple amputation at the left elbow, left foot, and right leg, the boy recovering. Ashhurst remarks that Luckie, Alexander, Koehler, Lowman, and Armstrong have successfully removed both legs and one arm simultaneously for frost-bite, all the patients making excellent recoveries in spite of their mutilations; he adds that he himself has successfully resorted to synchronous amputation of the right hip-joint and left leg for a railroad injury occurring in a lad of fifteen, and has twice synchronously amputated three limbs from the same p
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