38o ON AMPUTATION 



residue of the mortified part ; ^ and for several centuries after his time either 

 this method or others equally rude and often much more barbarous continued 

 to be employed. 



During the Middle Ages, the ligature, though used for ordinary wounds, 

 was never thought of in amputation, and whatever may have been the practice 

 of Celsus in this respect, there is no doubt that the great French surgeon Ambroise 

 Pare, when he so applied it, in the middle of the sixteenth century, had all the 

 merit of originality. But, though he urged its superiority over the cautery 

 with able argument, supported by his extensive experience in both military and 

 civil practice, yet his teaching failed for a long time to influence surgeons generally, 

 either in his own country or in other parts of Europe. 



The principal reason for this appears to have been that the fillet, which was 

 the means still in use for controlling the bleeding during the operation, did not 

 answer its purpose effectually even in the ablest hands : so that the dread of 

 haemorrhage led most surgeons to prefer the cautery as a more expeditious 

 method than the ligature. We even find Fabricius of Aquapendente repeating, 

 in 1618, Galen's timid doctrine of the danger of amputating through living parts 

 at all ; '^ and in 1633 the celebrated Fabricius Hildanus, though describing the 

 ligature, states that the time which it occupies, and the consequent loss of blood, 

 make it suitable only for the robust and plethoric, and declares that he ' cannot 

 sufficiently extol the excellence ' of the cauterium cultellare, or red-hot knife, 

 by which the orifices of the vessels were sealed while they were divided.^ 



In consequence of this same fear of bleeding, the great object at this period 

 seems to have been to accomplish the work of severance of the limb as speedily 

 as possible, and this was often done without any attempt whatever to provide 

 a covering for the bone. Scultetus, in 1655, depicted the performance of ampu- 

 tation of the hand by chisel and mallet ; and Purmannus, in his Chirurgia 

 Curiosa, written as late as 1696, mentions having seen legs removed by two 

 different surgeons by modifications of a barbarous instrument of the Middle 

 Ages, a sort of guillotine, ' which, by its great weight and sharpness, cuts at once 

 the skin, flesh, and bones asunder ' ; but he states that it splintered the bone, 

 and therefore, ' all things considered, the ancient way of cutting through the 

 flesh with a knife, and through the bone with a saw, is more practicable, safe, 

 and certain.' * 



As an example of the ordinary practice of the seventeenth century may 



^ Galeni ad Glauconem, lib. ii, cap. xi. 



^ Hieronymi Fabricii ab Aquapendente Opera Chirurgica, pars i, cap. xcvi. 



^ ' Porro excellentiam hujus cauterii non satis extollere possum,' Gul. Fabricii Hildani Opera 

 omnia, lib. de Gangraena et Sphacelo. 



* Purmannus' Chirurgia Curiosa, English translation, book iii, chap. xii. 



