SURGERY. 
of the way of the saw, by means of a re- 
ti-actor, wliich is a piece of linen somewhat 
broader than the stump, torn at one end, in 
its middle part to the extent of about eight 
or ten inches. It is applied by placing the 
exposed part of the bone in the slit, and 
drawing the ends of the linen upward on 
each side of the stump. Besides defending 
the surface of the wound from the teeth of 
the saw, the retractor will undoubtedly en- 
able the operator to saw the bone higher 
up than he otherwise could do. The femo- 
ral artery should be drawn out by means of 
a pair of forceps, and tied separately; other 
large arteries should also be secured, with- 
out including any ot the surrounding soft 
parts. Smaller branches must be taken up 
with the tenaculum. It is necessaiy to 
slacken the tourniquet, in order to discover 
the vessels. The wound should then be 
thoroughly cleansed from all coagulated 
blood, by means of a soft sponge and wa- 
ter, and one end of each ligature removed. 
The skin and muscles are now to be placed 
over the bone, in such a direction that the 
wound shall appear only as a line across the 
face of the stump, with the angles at each 
side, from which the ligatures should be 
brought out. The skin is supported by 
long strips of adhesive plaister, applied at 
right angles to the line of union of the 
wound, the ligatures are guarded by lint 
spread with spermaceti cerate ; and a linen 
roller is carried round from above down- 
wards, two cross pieces having first been 
put over the end of the stump. The dress- 
ings should not be moved for four days. 
In amputating the leg, the bones should 
be sawn through, about four inches below 
the patela. The tourniquet is applied in 
the lower part of the thigh. After cutting 
through the skin, which should be drawn 
upwards, it must be reflected from the flat 
surface of the tibia, and front of the leg, so 
as to cover those parts which could not be 
covered by any large muscle. The calf is 
then to be cut through, by an oblique inci- 
sion slanting upwards ; the rest of the mus- 
cles, and the interosseous ligament, should 
be divided by a double-edged knife, called 
a catlin, and the bones sawn, after the pre- 
vious application of a double-tailed re- 
tractor. 
In ar/tputating the arm, or fore-arm, we 
should preserve as great a length of the 
limb as the case will allow. 
Amputation of the shoulder-joint has 
been done in various ways. An incision 
should be carried through the skin and del- 
VGL. VI. 
toid muscle, down to the bone from the 
front of the joint, a little below the clavicle, 
obliquely downwards and outwards. The 
deltoid should tlien be turned up so as to 
expose the head of the bone, which must 
be brought entirely into view, by dividing 
the orbicular ligament all round. One cut 
of an amputating knife will then separate 
the limb. The axillary artery should be 
immediately tied. This vessel must be 
firmly, compressed, by an assistant, above 
the clavicles, during the whole of the ope- 
ration. 
The fingers and toes should be removed 
at their joints. Make a circular incision 
through the skin, about one third of an inch 
below the articulation; draw the integti- 
ments up, and cut through one lateral liga- 
ment of the joint, which y ovi can then dislo- 
cate. The remaining connections are ea- 
sily divided. Bring the skin together over 
the end of the bone. If you amputate at 
the first joint, make two cuts, one at the 
back, and the other towards the front ; 
these must meet when the bone is removed. 
It is sometimes necessary to tie the arte- 
ries. 
Paronychia, or whitlow, is an abscess oc- 
curring about the nails, or still more deeply 
under the soft parts of the fingers. In the 
latter case, swelling of the arm, inflamma- 
tion of the lymphatics, and considerable 
constitutional disturbance frequently at- 
tend. The complaint is always very pain- 
ful, attended with great throbbing ; and 
often terminating in the loss of the nail. 
We should, if possible, prevent suppuration, 
by the employment of local antiphlogistic 
means. If these do not succeed, a soft 
poultice may be used, and the collection 
should be opened as soon as possible. 
Venesection. When a vein is to be open- 
ed in any part of the body, pressure must 
be made on the vessel, between the place 
where the puncture is to be made, and the 
lieart. This prevents the return of blood 
through the vessel, makes it swell, and be- 
come conspicuous. As the supply of blood 
is still continued through the arteries, the 
vein bleeds freely when it is opened ; but 
care must be taken, particularly in the arm, 
not to apply the ligature so tightly as to 
stop the ptilse. The bandage should be 
placed a little above the elbow, and the 
most prominent and conspicuous vein may 
be opened ; excepting that, if equally con- 
venient, one would avoid the vessel lying 
over the brachial artery. The vein may be 
fixed by placing the thumb of the left hand 
Y 
