388 ON AMPUTATION 



upon the end of the stump ; and even where this is not fully the case, the dis- 

 tribution of the pressure between the end of the stump and the bony promi- 

 nences which formerly alone sustained it greatly increases the comfort and 

 steadiness of locomotion. l| 



Nevertheless it must be admitted that Mr. Teale's operation has serious 

 drawbacks. Precise accuracy of execution being essential to its success, it 

 demands a degree of time and pains which, under ordinary circumstances, 

 would certainly not be grudged, if really necessary, but which most surgeons 

 would be glad to be saved, and which sometimes, as in the pressure of military 

 practice, could not well be given. Again, the cut surface is more extensive 

 than with ordinary modes of amputation, involving a larger number of vessels 

 to secure, and also, under some conditions of healing, a more profuse suppuration. 

 But the greatest objection to this method with a view to its general application 

 is the high division of the bone which would frequently be required in order 

 to form the long anterior flap. This defect is of course most marked when the 

 limb is of considerable thickness at the seat of amputation, and shows itself 

 in its most exaggerated form in the thigh of a muscular subject. Thus in a 

 particular instance, where the development was by no means extraordinary, 

 the dimensions were such that, supposing the anterior transverse incision made 

 at the level of the upper border of the patella, it would have been necessary, in 

 order to preserve Mr. Teale's proportions, to saw the bone eleven inches further 

 up, or full five inches higher than if the modified circular operation had been 

 performed. This would seriously have increased the danger, which is always 

 greater the nearer the seat of amputation is to the trunk, ^ while, in case of 

 recovery, the short stump would have been very inferior in usefulness on account 

 of the slightness of the leverage it could have exerted in controlling the move- 

 ments of an artificial limb. 



The same disadvantage would often be experienced in applying the method 

 to the leg. Near the ankle, indeed, where the limb is small and the anterior 

 flap short in proportion, the operation is comparatively free from this objection. 

 But if the circumstances of the case should render it necessary to amputate 

 higher in the limb, the rapid increase of the thickness of the calf would necessitate 

 a high division of the bone greatly out of proportion to the extent of the injury 

 or disease of the soft parts. In a leg of about average development the ampu- 

 tation at Mr. Teale's seat of election, dividing the bones just below the calf, 

 would require the integuments to be sound to the level of the tip of the internal 

 malleolus. But if the skin happened to be unsound to a quarter of an inch 



^ This principle has been pithily expressed by Dieffenbach in the words ' zoUweise steigt die Gefahr '. 

 [Operative Chirurgie, vol. ii, p. 822.) 



