ON AMPUTATION 413 



great trochanter, supposing the left side operated on, and passed in front of the 

 bone till it emerges near the tuberosity of the ischium, or in the opposite direc- 

 tion if the right limb be concerned. The knife is then carried longitudinallv 

 with a rapid sawing movement, followed by the fingers of one hand of an assistant, 

 which are introduced into the wound so as to compress the femoral artery 

 securely between them and the thumb, previously placed over it in the groin, 

 his other hand being employed to lift up the large anterior flap as soon as it is 

 completed. The limb being now extended and abducted, the surgeon opens 

 the capsule of the joint by cutting firmly upon the head of the bone ; and as 

 this starts from its socket, he divides the round ligament and the posterior 

 part of the capsule ; and lastly, the thigh having been adducted, to draw the 

 trochanter down out of the way of the knife, he completes the severance of 

 the limb by cutting downwards and backwards through the muscular mass 

 at the back of the thigh. 



Attention is now at once directed to the bleeding vessels of the posterior 

 flap, fed by the internal iliac, which are covered in the first instance with a 

 folded cloth, or, what is better, by the tips of the fingers of an assistant ; and 

 when they have been tied the femoral trunk and any of its branches which 

 may require it are secured in the anterior flap. 



But though I have described this mode of operating, captivating as it is 

 by its brilliant swiftness of performance, I do not desire to recommend it. Many 

 years ago I was much impressed with a circumstance that I witnessed in the 

 practice of one of my colleagues in Glasgow. He amputated below the tro- 

 chanters by antero-posterior flaps for malignant sarcoma of the lower part 

 of the femur ; but the part of the bone removed being examined after it had 

 been sawn longitudinally while the vessels were being secured, the disease was 

 found to extend up to the part where it had been divided in the amputation. 

 The surgeon therefore seized the remainder of the femur with powerful forceps 

 and dissected it out from its socket. This was done with great facility and with 

 scarcely any loss of blood ; and it occurred to me that, if the same procedure 

 were adopted when it was intended from the flrst to disarticulate, shock, which 

 is one of the great dangers of amputation at the hip-joint, would surely be 

 greatly diminished ; for we could not suppose that the powerful impression 

 produced upon the nervous system by that operation performed in the usual 

 way could be due either to the removal of the head of the bone or to the mere 

 extent of the cut surface as such. The correctness of this \-iew has been since 

 strikingly demonstrated by the practice of Mr. Furneaux Jordan, of Birmingham, 

 who, in cases suitable for such a procedure, flrst divides the soft parts circularly 

 low down in tlie thigh, and then dissects out the bono from among Xhc muscles 



