ON AMPUTATION 379 



Celsus employed the ligature for arresting haemorrhage after amputation/ and 

 dressed the stump in a manner favourable to the occurrence of primary union. 



Archigenes, who practised in Rome shortly after the time of Celsus, paid 

 special attention to the control of haemorrhage during the performance of the 

 operation ; and appears to have been the first to employ for this purpose a tight 

 band or fillet encircling the limb above the site of amputation. But while in 

 this he did good service, he applied the red-hot iron to the surface of the stump 

 and also neglected the dissection of the soft parts from the bone, advised by 

 Celsus, though compensating to a certain extent for this omission by retracting 

 the integuments before dividing them.- 



Galen, who was in truth more of a physician than a surgeon, declined still 

 more from the Celsian precepts, and reverting to the practice of Hippocrates, 

 advised amputating through the dead tissues and applying the cautery to the 



* On this interesting point in surgical history I am disposed to agree with the author of the article 

 ' Amputation ' in Rees's Cyclopaedia, in opposition to the prevalent opinion that Celsus employed the 

 ligature only in ordinary wounds, and used the actual cautery in amputations. The directions of Celsus 

 regarding amputation are contained in his chapter on the treatment of gangrene, in which the only 

 mention of haemorrhage is the statement that patients often die of it during the performance of the 

 operation [in ipso opere), referring doubtless to profuse bleeding resulting from ignorance of the circula- 

 tion of the blood, and of any means of controlling it in the limb. Certainly this expression is no proof 

 that the cautery was used rather than the ligature ; for the former is the more speedy method of the two. 

 Neither is the absence of allusion to the ligature in this passage any evidence against its employment 

 after amputation ; for the argument would apply equally to the cautery, and no one doubts that one 

 of these two means was used. Celsus, who is remarkable for liis extremely concise style, leaves us to 

 refer to his previous chapter on wounds, in which the subject of haemorrhage is very ably discussed. 

 In shght cases pressure with dry lint, and a sponge wrung out of cold water, is recommended, or if this 

 does not answer, hnt steeped in vinegar is to be used ; but any portion of dressing retained in the wound 

 is said to do mischief by causing inflammation ; and on the same principle caustics and other powerful 

 styptics, though very efficient in arresting the bleeding, are prohibited because they produce a crust, 

 which acts like a foreign body. In more severe cases the vessels are to be tied ; and finally, ' when the 

 circumstances do not even admit of this,' the red-hot iron may be used as a last resort. 



The only thing that seems to me to give any colour for doubt upon this subject, is the manner 

 in which the ligature is described, ' venae quae sanguinem fundunt apprehendendae, circaque id quod 

 ictum est duobus locis deligandac intercidendaeque sunt ' ; language which seems rather to apply to 

 a partially divided blood-vessel than to one completely severed ; but as the context shows that the 

 ligature, as used by Celsus, was applicable in the majority of cases, and to more vessels than one in the 

 same wound, it can hardly be conceived possible that the practice was restricted to the \er>- rare case 

 of partial division. 



Again, there can be httle doubt that in drawing down the soft parts over the bone after amputation, 

 Celsus aimed at primary union, the great advantages of which are strongly insisted on in the same 

 admirable chapter on wounds ; but it is certain that he knew that the use of the cauter\' would have 

 destroyed any chance of union by first intention. 



One argument that has been urged on the other side is, that if he had employed the ligature in 

 amputation, it would hardly have been neglected by his successors : but the slowness of the surgeons 

 of the sixteenth and seventeenth centuries to adopt it, in spite of the strenuous advocacy of Pare, with 

 all the advantages of a printed literature, show how Uttle weight is to be attached to tliis objection. 

 The utter neglect, during the Middle Ages, of the Celsian method of amputation, and of his simple mode 

 of treating wounds, may also be mentioned as analogous cases. 



' Sprcngcl's History of Medicine, French translation, \ol. ii, p. Si. and vol. vii, p. j;i.\ 



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