, The cure ofa stamp immediately below the knee, is always tedious, 
owing to the great extent of bone at this place, and the deficier 
of soft parts; while in the operation above the knee, the sore wil! 
heal in less than half the time required in the other, if well managed. 
And in regard to the use of the limb afterwards, perhaps the latter is 
equally as convenient as the former. Upon the whole, then, it may 
be advisable that amputation immediately below the knee should sel- 
dom be practised. However, as it may sometimes be judged proper, 
I will briefly describe its peculiarities. ; 
The patient being placed, as in the operation upon the thigh, the 
tourniquet should be applied a little above the knee, with the cushion 
upon the artery, in the ham. The skin should be drawn up as in 
the other operation, and the surgeon, standing ~on the inside of the 
leg, should make a circular incision down tothe muscles, so far down 
upon the leg that when as much of the skin is separated from the 
muscles as will cover the stump, the muscles and bones may be divi- 
ded immediately below the insertion of the tendons on the under side 
of the leg. The soft parts between the bones may he divided with 
some sharp pointed knife. The retractors, of leather or cloth, must 
now be applied, and the bone sawed through. What remains to be 
done is the same as directed in amputation of the thigh, and repe- 
tion is unnecessary... =: ology 5696 hae 
In the operation above the ancle, the spot should be fixed upon 
that will leave the stump of the most convenient length for being fit- 
ted with a cork Jeg, or machine, resembling the other leg ; and this 
place will be found about nine inches below the joint of the knee or 
atthe foot of the calf. If the stump were left longer, the artificial 
jeg would require to be made so large, in order to receive it, as to ap- 
pear disagreeable in comparison with the other leg. 
In addition to what I have said upon the method of amputating 
the leg below the knee, I may observe, that in operating above the 
ancle, it should be done exactly as I have advised in describing the _ 
amputation of the thigh ; only in this situation, instead of muscles, 
we find a portion of both bones covered merely with skin and cellu- 
lar substance ; but as the cellulcr membrane is here sufficiently lax, 
and in greater quantity than in the upper part of the leg, it is notonly 
more easily separated from the periosteum, but serves to give the 
bones a more complete covering ; by which, when tlie operation is 
properly done, the cure for the most part, is accomplished in less 
than three weeks, and the surface of the stump is equal, and every 
where covered with sound skirt, 
OP AMPUTATING AT THE HIP-JOINT. - 
This operation, at best, is extremely hazardous; and I cannot 
conceive a situation in which a person may be’ placed, that should 
render this operation advisable, or necessary, (unless, perhaps, from 
hot wounds ;) for it will generally be found, that when life can, 
y chance, be saved by this operation, it might, with proper means, 
have been saved with far less risk, without it: and that where these 
Proper means fail, the knife will also fail to a certainty. ‘The parts” 
impunity. TI shall, therefore, emit describing the operation: 
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