Wichita eagle., 1888-05-30
CUTTING OFF A LEG.
REALLY AN EASY AND
BLOOpLEsS OPERATION.

AMPUTATloN REALLY AN EASY AND
BLOoDLEss OPERATION
Practical Surgery In . Hospitsl-A Pa
tient on tho Surgeons Table-How
Hemorrhage T. Prevented-The Knife
At Work-The Forceps.
An amputation, while serious il really
very simple operation. A layman who sees
an amputation Of q leg for the first time is
surprised that there is about it so little that
is startling or shocking to his nerves. de
naturally expects to see serious henorrhage
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 amphitheatre OF the city
hospital for treatment two weeks before the
time of amputation- On the first occasion
be was not ready to submit to amputation,
although the doctor advised it, and the SUI
geon then operated upon the bare chance Of
saving the limb He found on 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 kmb The patient not having consented,
however, to lose the leg, the treatment at
that time was limited to merely cleansing the
80 fa1
then that even II 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 tho way Of arti
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 a
man in active life to spend in trying to save
badly damaged leg. At all events, this pa
tent 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 deemed
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 long
! belt of India rubber about two and half
inches wide. which is wound tightly about
limb, beginning at point below where the
amuputation is to be made, and extending
spirally, like the stripes of a BARRIERS pole
but overlapping toward the body for
eighteen inches or more, and then at the
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 where
the rubber cord remains The effect Of 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-
hind nothing but the bone and tissues.
Then the surgeon begins bis 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 bone
about three inches above the knee Joint. The
flesh was sound and healthy from the knee
Joint upward, and it was necessary in this
as in all cases of amputation, to SO cut the
tissues that there would remain flap, as if
ordinarily called. Of flesh which should COM
pletely cover the end Of the bone where il
was taken off. Taking a rather narrow
bladed scalpel OF surgeons knife, sharp
pointed. and with blade about 10 inches
long, he rapidly cut the flesh from the knee
pan diagonally upward to the point where he
proposed to sever the bone, and likewise IN
the opposite side Of The limb. making v
shaped tncis;on IN zach side IF the leg
through all she Issues TO The bone Not
drop Of blood toiiowsi 5he course If the
knife IN all is work The cutting IF the
TISSUES >ccu oisl scarcely ohree minutes, and
then 5hs surgeon vas readJ 20 Use .he sax
This instrument, Although. II course, If finer
maks. vas practically the same As that used
In An ordinary outch.r's shou and the
surgeon used Il IN about The <ame xay and
about IS rapidly As butcher would cut
through leg Of beef This finished the sx-
scutivs part IT the operation, and it bad
occupi ID scarcely five minutes
The more delicate and more tedious part
Of the operation followed This comprises
the taking up of the large and small blood
vessels and tying up or ligating them. The
important arteries and larger veins were
easily discovered and the ends Of hem ,eizey
with artery forceps. These torceps were Id
piled and left hanging to perhaps a dozen
blood vessels before the igating began. This
work was done by the surgeons assistant.
1t consisted in tying the ends of the vessels.
just above the point where they were gripped
by the forceps, with strong catgut thread.
Especially in the case Of the arteries 1t was
necessary that this should be done with the
greatest care, for If for any reason one Of
these threads should give way, there would
be the greatest danger Of the patients bleed
ing to Heath before the hemorrhage could be
checked After all the blood vessels in sight
had been thus tied up, the rubber cord which
bound the limb near the body was loosened.
and then occurred the only hemorrhaee 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
aess, and the location Of which was shown by
the flow of the blood itself. When
the bandage had been loosened, the
surgeon, standing ready with hand
ful Of artery ferceps, 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 a
great bunch Of curious little steel implements.
These smaller vessels were taken up one at a
time by ligatures, in the same manner that
the others had been, and when the last had
been tied, and the last pair Of artery forceps
had been removed, the wound was ready 70
Be closed up
: 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
tention. Then the two flaps above and below |
the bone were brought together ovsr it, and |
the edges OF the skin wore carefully sewed |
opposite to each other, and the operation was |