1 06 SURGERY. 



bone, and a groove made; by steady strokes tbe bone is divided, 

 care being taken to prevent splintering and roughness : in case there 

 should be any, it may be removed by bone-nippers. The large ves- 

 sels can now be tied, and the stump sponged with warm water, in 

 order to detect orifices of smaller ones. Alter hemorrhage is com- 

 pletely arrested, and the tourniquet somewhat loosened, the end of 

 the bone is to be covered by the muscles and skin, so as to form a 

 rounded stump ; the edges are to be retained by adhesive strips, and 

 the ligatures brought out at the corners of the wound. The stump is 

 now covered by Imt spread with cerate, and over this a thin pledget 

 of charpie or tow ; the whole is supported and covered by a roller, 

 which should be carried once or twice around the patient's pelvis. 

 Having been carefully placed in bed, the stump is supported upon a 

 pillow, and secured to it by pins ; over the stump is placed a frame, 

 to take off the weight of the bedclothes. During the winter, the dress- 

 ings may remain on seven or eight days ; in summer only two or 

 three : a poultice previously applied may facilitate their removal. 

 The after dressings may be repeated once in forty-eight hours. 

 About the tenth day the ligatures may come away, and, generally, 

 the wound is healed in three or four weeks. Some suppose that the 

 stump maybe better covered by the Jlap 02^6 ration, es\)ec'm\\j should 

 the integument be thin. 



1^^/ap Operation. — The original plan of Vermale was, to introduce 

 a knife perpendicularly to the anterior surface of the thigh, and to 



Fig. 37. 



cut a lateral flap on either side. Listen and others prefer an 

 anterior and posterior (lap, which prevent the end of the bone rising 

 at the upper angle of the wound, and protruding forwards. These are 

 made by inserting the knife by the side of the thigh, as in Fig. 37, 

 instead of upon its anterior surface. The objections to the flap ope- 



