HEY’S PRACTICAL OBSERVATIONS IN SURGERY. 
to be cured by opening all the. sinews, 
however tortuous or deep-seated they 
may be, through their whole extent. 
+ Chap. 21. Onamputation. It is al- 
ways desirable to procure an union of 
parts by the first intention, and this is an 
object which the author constantly bears 
in view in performing this operation. 
' In amputation of the thigh and arm, the 
author operates with a triple incision, in 
the following way. 
«* He first makes an incision through the 
integuments alone ; secondly, an incision 
through all the muscles made somewhat 
higher than that through the integuments ; 
_and thirdly, another incision through that 
part of the muscular flesh which adheres to 
the bone, made round that part of the. bone 
where the sawis to beapplied. When these 
incisions are made in their proper places, the 
integuments and muscles on the opposite 
sides of the stump will meet each other con- 
- veniently, and may be preserved in contact so 
as to produce a speedy healing of the wound, 
and a convenient covering for the extremity 
of the bone. 
<¢ The proper distances of these incisions 
from each other must be determined by the 
thickness of the limb upon which the ope- 
ration is to be performed, making allowance 
for the retraction of the integuments, and of 
those muscles which are not attached to the 
bone. : 
«« 1 will suppose the operation to be per- 
formed upon the thigh, and the circumfe- 
rence of the limb to be twelve inches, at that 
part where the division of the bone is intend- 
-ed tobe made. ‘The diameter of the limb, 
in this case being four inches, ifno retraction 
of the intezuments were to take place, a suf- 
ficient covering of the stump would be afford- 
ed by making the first incision at the distance 
of two inches from the place where the bone 
is to be sawn, that is, at the distance of the 
semi-diameter of the limb on each side. But 
as the integuments, when in a sound state, 
always recede after they are divided, it is use- 
ful to make some allowance for this reces- 
sion ; and to make the first incision half an 
inch below the semi-diameter of the limb. 
«* Supposing the thickness of the integu- 
ments to be half an inch, the diameter of the 
‘limb after the first incision would be reduc- 
785. 
ed to three inches; the second ‘incision 
might, therefore, be made at the distance of 
an inch and half below the place where the 
bone isto be divided: but it 1s useful tomake 
some allowance for the retriction of the 
muscles, particularly the posterior muscles 
of the thigh, which takes place in them to a 
considerable degree in the process of healing. 
These should he divided somewhat lower 
than the rest of the muscles, if it is wished 
that the muscular flesh should retract equally 
on all sides of the stump. ‘The division of 
the posterior muscles may be begun at half 
an inch, and that of the anterior at three 
quarters, above the place where the integu- 
ments were divided. The integuments will 
retract a little both above and below the place 
where they were divided ; but the distance 
from that place must be computed from the 
mark left upon the surface of the muscles in 
dividing the integuments. The edge of the 
knife should be directed somewhat obliquely 
upwards in dividing the muscles, and the di~ 
vision should be made through the posterior 
muscles at one stroke, and through the an- 
terior at another. 
** In order to make the third incision, the 
divided integuments and muscles must be 
drawn upwards by an assistant, who will ge- 
nerally do this Ve most conveniently with 
the aid of a retractor, and who should be 
cautious toavoid pulling the periosteum from 
the bone, when the muscles which adhere to 
it are divided. 
«© The most perfect union of the soft parts 
would be produced by.making an incision 
through them all in a conical direction 3 the 
apex of the cone being that part of the bone 
where the saw is to be applied. But such 
an incision is impracticable in the ordinary 
mode of operating ; nor is it necessary for 
the formation of a good stump.” 
In amputating below the knee, the 
author employs the fap operation, and_ 
manages’ so as to saw the bone about 
midway between the knee and ancle. 
Some observations are made in this chap- 
ter on the excision of the metatarsal 
bones, with which the author concludes _ 
his work, which has afforded us a great 
degree of satisfiction, and will prove a 
valuable acquisition to the practitioner. 
Art. XLIX. Remarks on the Constitution of the Medical Department of the British Army, 
with a Detail of Hospital Management ; and an Appendix attempiing to explain the Ac- 
tion of Causes in producing Fever, and the Operation of Remedies in effecting Cure. By 
* Rozerr Jacuson, M. D. 
THE medical department of the ar- 
‘my enjoys very extensive and valuable 
opportunities of practical observation, 
and it is with much satisfaction that we 
now have occasion to advert to the work 
-of a physician, who has spent his whole 
Ann. Rey. Vou. Il. 
8vo. p. 351. 
life in the public service, and has been 
distinguished, as well for the attachment 
which he bears to his profession, as his 
unremitting zeal in the prosecution of it. 
A military hospital, under proper re- 
gulations, is one of the best schools of 
