Calomel mixed with starch, and strewed on a pledget of lint, is perhaps the best application to the stump of an amputated limb.

9. A retractor.

10. A roller of five ells in length; the many-tailed bandage, or a woollen cap.

11. Pledgets of sponge.

12. Cordials to raise the patient's spirits, and proper attendants.

Previous to amputation, a large dose of the tincture of opium is sometimes given to lessen pain; and we have sometimes ordered, with advantage, the tourniquet to be placed and screwed moderately tight for an hour previous to the operation.

Amputation of the Arm.

In most amputations, the operation should be a finger's breadth, or more, above the sphacelated, or otherwise injured part.

Apply the tourniquet so, as that it may press upon the chief artery of the limb to be taken off. When the arm is the part to be amputated, some recommend a pressure on the artery as it passes over the first rib.

Then let an assistant draw the skin back, while the operator binds the fillet round where the incision is to be made. This fillet both guides the knife, and keeps the flesh tight, so that it more easily yields to the knife; or more exactly to make the circular incision, a slip or two of plaster may be preferred to the fillet for directing the knife; two slips may be laid, the one upon the other; and if another slip is placed about three-fourths of an inch higher, its effect will greatly assist those of the lower. - On the exact cutting the skin, muscles, etc. the speedy cure of the stump very much depends.

Having proceeded thus far, give the patient a cordial, and cheer him.

Two assistants holding the limb in a straight line, an incision must be made quite round through the skin and fat to the flesh; then take away the fillet or slips of plaster; and the assistant, who holds the upper part of the limb, must draw the skin as far back as he can; after which, as near the edge of the retracted skin as 'possible the flesh must be divided, at twice, to the bone; and if there are two bones, divide the flesh between them with the point of the same knife. That the bone may be sawed off as near to the edge as possible, it is necessary to cut the skin, etc. to the muscles first, that you may draw it back, and cut the flesh as far under the skin as possible, in order to having the skin to reach over the flesh and the bone of the stump as soon as it is dressed. To assist this intention of bringing the skin over the end of the stump, the retractor is contrived, which must be put on after the incision is made through the muscles, to draw them up, as forcibly as the patient can easily bear: thus the bone can be sawed off more closely to the edge of the flesh, and with less danger of tearing it with the teeth of the saw. When there are two bones, as in the fore-arm, after having cut through the muscles, and divided the interosseous ligament, some recommend, instead of the retractor, to pass a compress between the bones, and therewith to draw back the divided parts, until the bones are sawed through.

When there are two bones, apply the saw in such a manner that both may drop together, to prevent making splinters, and also to avoid the painful jar which the patient feels when this is neglected. While the saw is working, the assistant who holds the lower part of the limb should gently depress it, that the saw may have room to pass; and the operator should make his strokes with it as long as possible.

If, after amputation, the larger arteries are not easily seen, the tourniquet may be slackened, and by the discharge of blood they will be discovered; then with the curved needles secure them, as directed in wounds of the arteries. When the tenaculum can be used for drawing out the artery, it will always be the best method; and, having so done, tie .the end of the artery with a narrow flat tape. If an ossified artery is cut through, a cautery, either actual or potential, must be applied. In the fore-arm, compresses generally suffice for checking the haemorrhage.

When the arteries are secured, bring the skin over the end of the bone as far as possible; then apply a pledget of soft lint, and over it another of soft tow, or more if required; over these lay a pledget of tow spread with the common cerate, and then with two long slips of sticking plaster, placed across each other, confine the whole by fixing the ends of these slips along the sides of the stump; after this finish the dressing, by turning a worsted night-cap over the whole. It is properly observed by some surgeons, that dry lint, as an extraneous body, in which light it should be considered, and as which it always acts, when clotted with blood, occasions pain, swelling, and inflammation, therefore should be laid aside, and in its place a large quantity of flour should be strewed over the whole stump. This forms a natural cataplasm with the blood and serum. Over this apply dry lint, or what other dressings you like, which may all be removed the next day, if necessary, without pain to the patient, or trouble to his assistants.

The custom of finishing by a roller from below upward, or indeed any way applied, is now omitted by the ablest surgeons, as its pressure causes inflammation, pain, and sanies, instead of a well digested matter.

In the 2d vol. of the London Medical Obs. and Inq. Mr. Kirkland proposes the use of sponge for a part of the dressing, as soon as digestion is begun in the stump, after an amputation. He observes, that the greatest danger after this operation, is from an absorption of the matter from the wound after the inflammation is gone off, particularly if the digestion proceeds not very kindly; and to prevent this inconvenience, as soon as the state of digestion is well advanced, he directs a thin layer of fine lint to be applied to the stump, and, immediately upon that, some thin pieces of fine sponge, which have just then been made wet, but are squeezed as dry as can be by the grasp of the hand. The thinner matter of the discharge from the wound being absorbed by the sponge, the fever, diarrhoea, and other symptoms which it occasions when taken up into the circulation, are prevented; and where, from the thinness and acrimony of the discharge, sponge pledgets are necessary, he orders antiseptic diuretics to be administered internally, and, if needful, the bark.