396 ON AMPUTATION 



a flat elastic bandage, the pressure of which is more diffused. The elastic tour- 

 niquet, whichever form is used, should be put well on the stretch, and wound 

 quickly three or four times round the limb to ensure efficiency of its action. 

 The elastic bandage is fixed by means of a pin ; the rod or tube by tying in a 

 bow pieces of stout tape previously well secured to its extremities. This may 

 be done very simply by tying the tape very tightly round the end of the tube 

 or rod bent into a loop, which cannot escape from the grasp of the ligature. 



The only inconvenience attending the elastic tourniquet as compared with 

 the old instrument is that it cannot be relaxed and tightened at pleasure to show 

 the bleeding-points, but must be removed once for all. In practice, however, 

 this difficulty is overcome by searching for the principal arteries in the places 

 indicated by anatomical knowledge, and, when these have been secured, tying 

 all points from which any venous blood oozes, by which means the vein and 

 its accompanying artery will be both included. When this has been done, 

 it will often be found that not a single vessel requires attention when the con- 

 stricting band has been removed. But to guard against the chance of any 

 having escaped notice, the main artery of the limb must be subjected to digital 

 compression. 



The strength of the assistant on whom this duty devolves is often early 

 exhausted by unnecessary exertion ; for the current through an artery lying 

 over a bone, or some other resisting texture, is completely arrested by a very 

 moderate amount of pressure directed exactly to the proper part. 



A stump after amputation is dressed on the same general principles as other 

 wounds. When there is much tendency to muscular contraction with its 

 attendant risk of protrusion of the bone, as in the lower part of the thigh, this 

 disposition is greatly checked and repose of the stump promoted by a bandage 

 applied smoothly and moderately firmly from above downwards, while an 

 assistant draws down the soft parts. In the thigh and also in the leg great 

 advantage is derived from bandaging upon the posterior surface of the stump 

 outside the dressing a trough of Gooch's splint on which the stump rests smoothly, 

 being rendered independent of movement or irregularity of the pillow. The 

 end of the stump should not be much raised, as too great elevation interferes 

 with free discharge, and increases through gravity the tendency to retraction 

 of the soft parts. 



Amputations in the Upper Extremity 



The upper limb, independently of its smaller size, and the consequent less 

 shock to the system from the operation, is more favourably circumstanced for 

 amputation than the lower, in consequence, apparently, of its possessing a better 



