4i6 ON AMPUTATION 



the limb when in the relaxed condition, and with tapes securely connected 

 with its ends, is placed with one end of the elastic part under the sacrum, while 

 the tape of that end is brought round the pelvis between the crest of the ilium 

 and the great trochanter of the side opposite to that to be operated on, and 

 held perfectly firmly in the vertical position by an assistant. The surgeon then, 

 standing on the side for operation, puts the band fully on the stretch in a direction 

 transverse to the body and brings it up into the vertical position immediately 

 below the iliac crest. Holding it in his left hand (if the right limb is concerned), 

 he next passes his right hand round behind the limb, which has been previously 

 placed in the vertical position to expel its blood, and, changing hands, encircles 

 the thigh as near to the perineum as possible, the scrotum being held well to 

 the other side by an assistant. The surgeon's end of the elastic band being 

 now over the groin, he takes the other tape from his assistant and ties the two 

 tapes together in a reef-bow over the sound side. Another point requires 

 attention. Two pieces of bandage, each about two feet in length, are placed 

 longitudinally upon the skin before the elastic band is applied, one of them over 

 the groin, the other well behind the great trochanter ; the middle of each piece 

 of bandage being in the situation where the elastic band is to go. And when 

 the elastic band has been applied, the lower end of each of these pieces of bandage 

 is drawn up so as to convert them into two loops by means of which, in the hands 

 of a steady assistant, the elastic tourniquet is kept drawn well up both at 

 Poupart's ligament and behind the trochanter. If this arrangement is well 

 carried out, the whole operation, including disarticulation, may be done un- 

 interruptedly. Nevertheless, I think it prudent to retain the resistance of the 

 head and neck of the femur so long as the tourniquet is in operation, by sawing 

 through the bone below the trochanters, and at once securing all the vessels 

 that show themselves on the cut surfaces. The tourniquet is then removed 

 while an assistant compresses the femoral at the groin : and when any branches 

 still requiring attention have been tied, the remainder of the bone is seized 

 with strong forceps and dissected out. With the incisions which have been 

 recommended this will be found a matter of the utmost facihty and attended 

 with little if any haemorrhage.^ 



^ The article on Amputation was first published in the ist edit, of Holmes's System of Surgery, 

 vol. iii, 1862. It afterwards appeared in the 2nd edit., vol. v, 1871, and in the 3rd edit., vol. iii, 1883. 

 In its later appearances, while retaining its original features, it was altered in various details in 

 accordance with the progress of knowledge. 



