ON AMPUTATION 383 



projection,^ and did not aim at forming a complete covering for the bone. This 

 was effectually done about a quarter of a century later by Alanson of Liverpool, 

 by dissecting up the integuments for some distance and then dividing the muscles 

 obliquely, so that they formed a hollow cone, in the apex of which the bone was 

 sawn ' about three or four fingers' breadth higher than was usually done'. The 

 effect of this was to ' fully cover the whole surface of the wound with the most 

 perfect ease ' ; - but in the hands of other surgeons the oblique division of the 

 muscles proved to be a matter of considerable difficulty, and the object was accom- 

 plished as efficiently and more simply by Mr. Benjamin Bell, of Edinburgh,^ 

 and Mr. Hey, of Leeds, by a combination of the methods of Cheselden and Louis ; 

 or, as Mr. Hey expressed it, ' with a triple incision,' ^ in which the skin and fat 

 were first divided circularly and dissected up for some distance, then the muscles 

 were cut at a higher level, and these were retracted so as to permit the bone to 

 be exposed and sawn considerably higher. Mr. Hey added the advice to cut 

 the posterior muscles somewhat longer than the anterior, to compensate for 

 their greater contraction ; and thus towards the end of last century, ' the circular 

 operation,' as it is termed, may be said to have been brought to perfection. 

 Meanwhile a different principle had been long before suggested and acted 

 on. So early as 1678, Mr. James Young, of Plymouth, described ' a way of 

 amputating large members, so as to be able to cure them per symphysin in three 

 weeks, and without fouling and scaling the bone '. The directions given for this 

 method, the ' first hints ' of which he says he had ' from a ver\' ingenious brother 

 of ours, Mr. C. Lowdham of Exeter ', are as follows : ' You are with the 

 catling, or some long incision-knife, to raise (suppose it the leg) a flap of the 

 membranous flesh covering the muscles of the calf, beginning below the place 

 where you intend to make excision, and raising it thitherward of length enough 

 to cover the stump ; having so done, turn it back under the hand of him that 

 gripes ; and as soon as you have severed the member, bring this flap of cutaneous 

 flesh over the stump, and fasten it to the edges thereof b}' four or five strong 

 stitches.' ^ Eighteen years later, Verduin, a surgeon of Amsterdam, ignorant 

 apparently of what Lowdham had done, provided like him a covering for the 

 end of the stump from the calf ; but, instead of cutting from below upwards, 

 and only raising the integuments, he thrust a knife behind the bones at the part 



' ' L'amputation la plus parfaite est, sans contrcdit, celle dans laqucllc Ics chairs qui forment 

 I'extremitc du moignon conscrvcnt cisscz de longueur pour so maintcnir au niveau du bout de I'os.' 

 Op. cit., vol. iv, p. 41. 



" Alanson's Practical Observations on Amputation, Jnd edit., p. i6. 



' Benjamin Bell's System of Surgery, 7th edit., vol. vii, p. zix). 



* iley's Practical Observations, 3rd edit., p. 527. 



' James Young's Currus Triuwphalis c Terebintho, p. 108. A copy of this interesting book exists 

 in the library of the Koyal Mcdir.il .md Cliirurgical Society of LoniU)n. 



