382 ON AMPUTATION 



a screw, so as to tighten a strap which was connected with them and also encircled 

 the limb : and it is upon this principle that the ordinary screw tourniquet is 

 still constructed. From this time forward, except in amputations performed 

 near the trunk, haemorrhage during the operation ceased to be an object of 

 dread, and surgeons were at liberty to consider other questions besides mere 

 rapidity of execution. 



The improver of the tourniquet, and our own great countryman Cheselden, 

 seem to have conceived independently of each other the idea of performing 

 amputation by ' double incision ' ; in which the skin and fat were first cut 

 through by a circular sweep of the knife and retracted for about an inch, when 

 the muscles and bone were divided as high as they were exposed.^ | 



But this, though a great improvement, had only the effect of diminishing 

 the cicatrix without covering the bone ; ^ and Louis, another eminent Parisian 

 surgeon, believed that in the thigh the objects sought might be better attained 

 by dividing all the soft parts at once, and sawing the bone at a higher level. 

 In order to allow the muscles to contract freely when divided, he avoided the 

 use of the tourniquet, and was the first to emplo}- in its place digital com- 

 pression of the femoral artery at the groin. He pointed out the important 

 circumstance that the muscles on the posterior aspect of the thigh, being divided 

 far from their origin at the pelvis, contract to a much greater extent than those 

 at the anterior part of the limb, which are connected with the bone where they 

 are cut ; and he showed that, the soft parts having been severed to the bone 

 by a circular incision and drawn up with a linen retractor, the saw might be 

 readily applied two and a half inches higher up, after the knife had been carried 

 through the attachments of the anterior muscles.^ This method was amputa- 

 tion by double incision on a different principle ; and though, in truth, a revival 

 of the practice of Celsus, was not less valuable than the plan of Cheselden and 

 Petit, and seems to have afforded results superior to theirs.* 



Louis, however, was content if the stump when healed was free from conical 



^ It is difficult to determine to whom the priority belongs in this matter. Petit in his posthumous 

 work states, ' Je suis le premier qui ait coupe les chairs en deux temps ' ; and also, 'J'ai imagine de couper 

 les chairs en deux temps ' ; and Dieffenbach, in his Operative Surgery, gives 171 8 as the date of the intro- 

 duction of the double incision by Petit. On the other hand, Cheselden as distinctly claims the original 

 idea in the following passage in his notes to Gataker's translation of Le Dran's Surgery : ' The thing that 

 led me to do this was what has too often happened — the necessity of cutting off the end of the stump 

 the second time. This operation I proposed to my master when I was his apprentice ; but he treated 

 it with neglect, though he Uved afterwards to practise it when he had seen me perform it in the same 

 hospital.' This proposal must have been made before 171 1, when, at the age of twenty-two, he began 

 to lecture on anatomy. 



^ This is well illustrated by the drawing of a stump given by Cheselden in Le Dran's Surgery, for 

 the purpose of showing the good effects of the double incision. 



^ Me'moires de I'Acade'mie de Chirurgie, vol. ii, p. 286. * Ibid., vol. iv, p. 60. 



