414 ON AMPUTATION 



and from the acetabulum through a long incision on the outer aspect of the 

 limb, where the soft parts are comparatively thin and the blood-vessels incon- 

 siderable ; a long boneless stump being the result. Now such an operation 

 involves both disarticulation and the formation of an exceedingly extensive 

 wound ; 37et Mr. Jordan's anticipations of increased safety of this method as 

 compared with the old one seem to have been fully realized. Ever since the 

 Glasgow experience to which I have referred, I have myself proceeded on the 

 principle which it suggested ; and while it does not seem to me necessary to 

 push it to the extreme degree advocated by Mr. Jordan, I would advise the 

 following as the method to be generally adopted. 



Supposing the right Hmb operated on, the knife is entered at the posterior 

 part of the great trochanter and carried down longitudinally for about eight 

 inches (if the patient be an adult male), and then drawn across the limb in front 

 and behind through skin and fat, in the form of two crescentic incisions which 

 meet at the inner side of the limb at a point an inch or two lower down than the 

 extremity of the outer longitudinal cut. The semilunar flaps mapped out by 

 the crescentic incisions are then dissected up as in a modified circular operation, 

 the integument being raised about two inches higher than their angle of union 

 at the inner side of the thigh ; after which the muscles are divided where they 

 are exposed and the head of the bone dissected out. 



Such a mode of operating, besides the diminished danger from shock, has 

 the great advantage of making truly aseptic treatment easy, instead of almost 

 impossible, as it is when the copious sero-sanguineous discharge which takes 

 place from so large a wound is poured out within a very few inches of the anus, 

 which is the case after the ordinary operation, with the dependent angle of the 

 wound close to the tuberosity of the ischium. After the operation which 

 I have advised, the inner end of the wound having been closely stitched and 

 drainage-tubes introduced at its outer part, there is sufficient space for an 

 effectual antiseptic dressing, which will often be a matter of life and death where 

 so large an extent of irritable and absorbent surface is concerned. 



The longer time occupied by the operation is of no consequence now that 

 we have the means of dealing efficiently with the once dreaded haemorrhage. 

 For this purpose I advised in former editions of this work the use of the aortic 

 tourniquet. This instrument, however, has two defects. In the first place, 

 when the aorta deviates to any considerable extent from its normal median 

 or nearly median position, the tourniquet is somewhat difficult of adjustment, 

 and instead of retaining its position by the clamping action of the screw which 

 presses down the pad, it tends to slip to one side on the rounded body of the 

 lumbar vertebra, and must be held in place by a very careful and steady assistant. 



