ON AMPUTATION 



[Holmes's System of Surgery, vol. iii, third edition. London, 1883.] 



Part I 



Amputation is often regarded as an opprobrium of the healing art. But 

 while the human frame remains liable to derangement from accident or disease, 

 the removal of hopelessly disordered parts, in the way most conducive to the 

 safety and future comfort of the sufferer, must ever claim the best attention 

 of the surgeon. Indeed, the progress of medical science, while furnishing the 

 means of curing some affections once regarded as hopeless, and thus in one sense 

 restricting the field for the application of amputation, has in another point of 

 view extended that field, by improving the mode of operative procedure, and 

 divesting it of much of its terror and danger ; so that whereas in former times 

 the removal of a limb was only resorted to in cases of the most serious nature, 

 it is now often practised when the unoffending member is merely a source of 

 inconvenience. 



It is instructive to trace the history of the improvement of this department 

 of surgery. 



Hippocrates (b.c. 430) recommended only a very rude kind of amputation, 

 consisting of cutting through mortified limbs at some joint, * care being taken 

 not to wound any living parts.* ^ 



On the other hand, Celsus, who seems to have lived at the commencement 

 of the Christian era, advised that the removal of gangrenous limbs should be 

 effected between the dead and living parts, and so as rather to take away some 

 of the healthy textures than leave any that were diseased ; and as he interdicted 

 amputating through an articulation, his operations must often have been per- 

 formed entirely through sound tissues. He directed that the soft parts should 

 be divided with a knife down to the bone, and then dissected up from it for some 

 distance, so as to allow the saw to be applied at a higher level. The rough surface 

 of the sawn bone was then to be smoothed off, and the soft parts, which, as he 

 tells us, will be lax if this plan be pursued, were to be brought down so as to cover 

 the end of the bone as much as possible. This method seems calculated to 

 afford good results ; particularly as it appears probable from his writings that 



' Hippocrates, de Articulis, p. 639 of the Sydenham Society's translation. 



