ON a:\iputatiox 391 



a division of the bone as Mr. Teale's, and it therefore became an important 

 question whether its advantages might not be attained by some method free 

 from this objection. The essential object to be aimed at is that, while the 

 covering for the bone shall be ample, the tender cicatrix shall be placed suffi- 

 ciently far back on the end of the stump to be well out of the way of pressure 

 between the end of the bone and the bottom of the socket of the artificial limb. 

 And if, consistently with attaining this object, the anterior flap could be shor- 

 tened and eked out with a short posterior flap, it is plain that in exact proportion 

 to the extent to which this was done would be the length of bone gained, with 

 corresponding diminution of danger and increase of usefulness of the stump. 

 Now it fortunately happens, both in the calf of the leg and in the thigh, that 

 the bone lies far forward among the muscles, so that even its posterior surface 

 is considerably anterior in position to the longitudinal axis of the limb. Hence 

 a flap as long as two-thirds of the diameter of the limb would ensure the scar 

 being considerably^ behind the point of pressure ; while a posterior flap half 

 as long as the anterior one would be sufficient to complete the covering. The 

 posterior flap, being short, may be made of integument onl}-, without any risk 

 of sloughing, thus getting rid of the bulk, weight, and contractility of a posterior 

 muscular flap. On the other hand, the anterior flap, being still somewhat length}', 

 should be raised so as to contain a good deal of muscle, which will be useful not 

 only by ensuring sufficient vascular supply, but also by increasing the thickness 

 of the cushion below the bone ; while any tendency to retraction that it possesses 

 (small compared with that of the posterior muscles) will be counteracted by the 

 force of gravity, through which it will naturally tend to occupy its proper place. 



Such w^as the plan of amputating which I ventured to recommend for the 

 thigh and the calf in the first edition of this work, on theoretical grounds which 

 subsequent experience has only tended to confirm. The details of the method, 

 as applied to these two situations respectively, will be found described in subse- 

 quent pages. 



Before considering the operations best adapted for particular cases of 

 amputation, it will be well to allude in a general way to the necessary instru- 

 ments, and the mode of using them. 



The amputating knife should have a straight and strong back, and a sharp 

 point, near which the edge should present a gentle convexity. In the old circular 

 amputation, a curved knife with a blunt extremity was employed to divide 

 the integument at one continuous sweep ; but as the modified operation is always 

 preferable, in wliich the skin is cut in the form of short semilunar flaps, this 

 somewhat clumsy implement ma\' now be entirely- dispensed with, l-'or a flap 

 operation performed b\' tran^llxiun, the blade should be about half as long again 



