218 ANTHROPOLOGY. 



cular incision); a straight or bellied bistoury; knives for separating bone 

 and cutting periosteum; amputating saws (/g. 21, Pott's saw); bone nip- 

 pers for extracting spicula {fig, 20) ; bone scissors {fig. 19) and rasps ; a 

 chisel {figs. 22, 23); forceps {figs. 35, 36); artery tenaculum {fig. 37, Bell's); 

 and the necessary bandages. Good assistants, generally five in number, 

 will be required. The suggestion of Moore, to diminish the pain of an 

 operation by compressing the principal nerves {fig. 89, nerve compressor), 

 has not been much folowed. 



Various tables have been constructed for the suitable arrangement of the 

 patient {fig. 90, Kluge's table), but these are only applicable in hospitals. 



The principal modes of amputation, subject, however, to numerous modi- 

 fications for the different regions, are two in number. 



1. 21tc Circular Mtdhod. This may be either simple or double. In the 

 simple incision, all the soft parts are cut to the bone, then pushed up, and 

 the bone sawed off close to the muscle. Subsequently it was considered 

 preferable to cut first through the skin, then pushing this up to cut through 

 the muscle, and finally to separate the bone as before. 



2. Fla'p Operation. The flesh is grasped by the surgeon, and lifted from 

 the bone ; the double edged knife is passed horizontally through it, the point 

 carried over the bone, and pushed through the other side of the limb ; it is 

 then made to cut its way out upwards and forwards, so as to make the 

 anterior flap. The knife is again entered on the inner side a little below 

 the top of the incision, passed behind the bone, brought out at the wound 

 on the outside, and directed so as to make a posterior flap. Both flaps are 

 now drawn back, the knife swept around the bone to divide any remaining 

 muscular fibres, and the bone sawed through. 



PI. 139, fig. 33, amputation of the thigh : a, i, hands of the first assistant; 

 r, f/, do. of second assistant ; e, / operator. 



The following figures are intended to illustrate the respective positions of 

 the individual parts after an amputation. 



PI. 139, fig. 31, circular amputation of the upper arm, three and a half 

 inches above the middle: a, humerus; h. c, deltoid muscle; (7, long, e, short 

 head of the bice})s brachii ; /J latissimus dorsi muscle ; g^ /^, «, A-, /, triceps 

 brachii; ?n, 7^, o, j9, subcutaneous adipose and cellular tissue: ', brachial 

 artery; °, posterior circumflex artery; ', basilic vein; ^'\ deep seated 

 brachial vein; ", ce})halic vein; \ median nerve; *, ulnar nerve; ", middle 

 cutaneous nerve. Fig. 35, circular amputation of the thigh two inches 

 below Poupart's ligament: o, femur; i, rectus femoris; c, sartorius; ci, yastus 

 externus and tensor vaginas femoris; e, vastus internus; / adductor longus; 

 5^, gracilis; /i, /, /v, /. adductor magnus, adductor brevis, and semi-membra- 

 nosus muscles; ?)?, biceps crura?us; 7?, semi-tendinosus; o, adipose and cellu- 

 lar tissue between the adductors and gracilis ; jj, q^ r, U subcutaneous adipose 

 and cellular tissue; 5, intermuscular tissue ; ', cruneal artery; ^, deep do. ; 

 ', external circumflex artery; ', crur^al vein; '■'•', deep seated veins; 

 ", saphena major vein ; °'"", small and large muscular and cutaneous arterial 

 branches ; '""''', branches of the cruraeal nerve. 



924 



