when it ought to be performed, are circumstances 
more deliberation than perhaps any other in surgery. | 
fore mention, the cases wherein it may be proper to amputate, before 
proceeding to describe the method of performing it. i 
“Phe causes whith may render amputation necessary, _ ‘in. “my 
view, are, : i +. 
Ist. Bad compound fractures. 
| 2d. Whena portion of the limb is carried off by a cannon , ball, or 
in any other manner, if the bones are unequally broken and not 
properly covered ; and, . 
3d. Particular ‘distortions of a limb, in which case am u 
hte pert of choice, rather than ‘of necessity. Me: 
en bad compound fractures ha) the army or navy, where 
the patient Sensor he propérly attended nlteiided vor tile pei d ‘rata 
and remoyed from place fo plies it may | ‘be proper to amputate im- 
mediately, as the only Gourse admissible under these circumstances, 
But in private practice, and in all cases, where the patient can be 
placed in an easy and comfortable situation, from which he need not 
be removed till the cure is completed ; where he can be kept quiet, 
and. have all'the advantages of good air,a proper regimen, and the 
Assistance of capable practitiotiers: very few cases will o¢cur in which 
imthediate amputation should be advised. The onl -cause_whic cli, it 
such circumstances, can render immediate amputation proper, 
bones of a limb, together with the wtscles and other soft parts, with 
which it is covered, bei g so shattered and. bruised that there will be 
no chance of the: linib being rendered useful ‘by a ny attempt to sav 
it: in such circumstances it should be removed immediate at 
this not being done, the operation should be delayed till the : 
ling, inflammation, and fever, induced by the accident, are removed. 
Although early amputation is seldom recommended in private 
practice, yet, in the afler treatment of compound fractures, it is some- 
times proper : fiamely, in profuse hemorrhages, which cannot be 
otherwise stopped; and when the ends of the fractured bonés re- 
main long disunited, and attended with the discharge of such large - 
quantities of matter that the patient runs some risk of sinking undsg 
it; and when tliis cannot be prevented by other means. . 
"The second case mentioned, as requiring amputation, was, the re 
moval of a portion of the limb. by a cannon ball, I, or other vi 
_ This is one Of those cases, which many contend can never, re- 
quire amputation ; for the limb being alread y removed, it will be 
better, they allege, to endeavor to heal the sore, than to add to the 
and anes of the Park by an operation. — ‘This argument, 
though plausibl se cig not bear examination. 
In wounds of this kind; the bones are ¢ommotily mich shaitered, 
and even splintered, and the muscles and tendons are left of 
lengths, and much contused and lacerated . , In this situation. it is 
allowed by all, that the separate pieces of bone, and the ragged 
tremities of the muscles, should be removed. Now all this cou 
n, I believe, be done in less time than the operation of 
; whilst by amputating above the injured part, and co 
with sound muscles and skin, we diminish | the sore so. 
c ably heal in a third part of the time that 
: 7 
Ji hs 
i 
