The Dickinson press., 1888-07-07
CUTTING OFF A LEG.
AMPUTATIoN REALLY AN EASY AND
eLooDLEss OPERATION.
Practical Surgery in a Hospital-A Pa
tient on the Surgeons Table-How
Hemorrhage Is Prcvented-The knife
at Work-The Forceps,

tient the Surgeons Table-Hov
Hemorrhage Is Prcvented-The knife
at work-The Forceps.
An amputation, while serious is really
very simple operation A layman who sees
an amputation of leg for the first time is
surprised that there is about it so little that
is startling or shocking to his nerves. He
naturally expects to see serious hemorrhage
and rapid work to prevent the patients
bleeding to death. He is surprised to find
that, on the contrary, it is one of the most
bloodless operations performed on the sur
Geon's table. The first leg amputation seen
by the writer was performed upon a man Of
middle age, who was suffering from advanced
necrosis, or death of the bone of the right leg,
just below the knee The patient had been
brought into the umphitheatre of the city
hospital for treatment two weeks before the
time of aEputation On tho first occasion
lie was not ready to submit to amputation,
although the doctor advised it, and the sur
gcon then operated upon the bare chance Of
saving the limb. He found OH examination,
however. that great cavity had formed in
the bone, the first cause having been an in
jury, and there was hardly chance of saving
the smb. The patient not having consented,
however, to lose the leg, the treatment at
that tilue was limited to merely cleansing the
wound and closing it up. The doctor stated
then that even if the disease was checked and
cure was begun, it would require at least two
years for enough fresh bone to form to make
a whole limb.
Mechanical appliances in the way of art-
fetal limbs are now so skillfully made that
wooden leg. as it is ordinarily called, is al
most as good as one Of flesh and bone. 1t
certainly is not worth two years time to n
man in active life to spend in trying to save
BADLY damaged leg. AT all events, this pa
tient seems to have come to that conclusion
and two weeks after his first appearance he
was again upon the surgeons table, and the
necessary instruments for amputation were
by the side of the operator 1t was doomed
necessary to take Off the leg just above the
knee joint. The appliance which does away
with all hemorrhage in amputation is called
the Esmarch bandage. This is simply a long
belt of India rubber about two and n half
inches wide, which Is wound tightly about
limb, beginning at point below where the
ahmuputation Is to be made, and extending
spirally, like the stripes of a barber's pole
but overlapping toward the body for
point Of the bandage nearest the body stout
rubber cord is tied very tightly The rubber
band is then unwound and the limb is left
altogether bloodless, and with the blood YES
sells tightly compressed at the point whore
the rubber cord remains. The effectof wind.
ing the rubber about the limb in this way is
to drive the blood from all the veins and ar.
teries back into the body, and to leave be-
ind h,,ft 10,
Then the surgeon begins his work. He
need not hurry-he has plenty of time to do
his work carefully and thoroughly. In the
case in point he proposes to cut the bono
about three inches above the knee Joint. The
desh was sound and healthy from the knee
joint Upward. and it was necessary in this.
as in all cases Of anputation, to so cut the
tissues that there would remain flap. as it
ordinarily called. ot flesh which should com.
pletely cover the end Of the bono where it
was taken off. Taking n rather narrow
bladed scalpel Or surgeons knife, sharp
pointed and with blade about l2 inches
long, he 'apidly cut the flesh from the knee
pan iiagonally upward to the point where lie
proposed 20 sever he bono and likewise u,
the opposite side of .he limb making i
shaped incision On each side If she log
throusb a.l 'he lssues TO ,he bone Not
lrop ,f blood follosel ,he course If tbs
knife IN l.! is Vork. rhe ,utting If .he
tissues &cuois't 'carce!y ,hree minutes and
then ;hs 'ur5eon Vas raM7 70 lse .hs sa .
THIS instrument. ,lth oush. If course, II liner
naS, vas practically 3he 'ame as shat lsetl
in III ordinary 5u5ch.rs shou and ,be
sursa'n Used : about ,hs sam, xay md
aeou. IS raoiu uy ,s 1u.char you'll ,ut
!hraush leg of 'eef. This finished the *
sruH7' oart 'f iho operation, and 1t had
occupi I'd scarcely i've min1.os
The more dslicate AMI mora ;eIious ,art
of the operation followed Tbs COMPRISES
the taking up of the large and small blood
vessels and lying up 'r isaSing hem Tho
important arteries and larger ,eins wero
easily discovered and tho ends of hem ;e;zoG
with artery fogcci,s These 'orccps were M
piled and ieft hansns 50 3crhaps dozen
blood vessels bctore the lisating began. This
work was done by the surgeons assistant.
1t consisted in wing the ends of the vessels
Just above the point where they were gripped
by the forceps With strong catgut thread
Especially i'll lie case of the arteries i was
necessary hat this should be done with tho
greatest are, tor If for any reason one Of
these thr'a.!s should give way there would
be the g''4l'"Si danger Of the patients bleed
ing to 'a:h he.urc the hemorrhase could be
Checked Aftel all the blood vessels in sight
had 'eeu -lls tied up. the rubbe. cord which
bound tbs limb ear the body vas loosened.
and then occurred the only hemorrhare Of
the entire operation. There remained in the
exposed stump Of the limb fifteen or twenty
small blood vessels which could not be de
tected by the eye while the limb was blood
Inc opI no ,:.l
the flow Of the blood itself. When
the bandaGe had been loosened, tie
surgeon. standing ready with a hand.
full of artery forceps rapidly seized the ends
of the exposed bloodvessels as fast as the
location of them was indicated, and in two
or three minutes the hemorrhage was checked,
and the end OF the limb was hung with
great bunch of curious little steel implements.
These smaller vessels were taken up ono at
time by ligatures in the came manner that
the others had been, and when the last had
been tied, and the last pair Of artery forcers
had been removed, the wound was ready to
be closed u
1t was first treated with antiseptic solution
and powder in order to reduce to minimum
the danger of Inflammation and to increase
the chance of the wounds healing by first in.
tcntion Then the two flaps above and below
the bone were broo,ht together over it, and
the edges of the skin were carefully sewed
opposite to each other, and the operation was
over 1t bad occupied altogether about for,T-
five minutes The patient during this time
remained apparently asleep The operation
had been entirely painless, and when the
bandases had been applied and the ether conc
removed from the patients face, be was
carried from the smphltheatre just as he
began to show signs of consciousness. .-Bos.
ton Cor New York Sun.
He is a wise economist who does not waste