When the dressing is finished, the patient should be laid in bed, and an assistant should gently and constantly hold his hand on the stump during some hours, not only to guard against a haemorrhage, but also by the gentle pressure to make the dressings adhere more firmly.

The tourniquet may be gradually raised to admit the circulation of the part more freely; and if no danger seems to threaten, it may be removed the next day.

As soon as the patient is in bed, some blood, to pre-ent a fever, may be taken in plethoric habits.

On the third or fourth day remove the dressings, and proceed as in a common wound. If any part of the lint adheres, leave it to separate by digestion.

The amputation of the arm, and of the fore-arm, are the same, except that in the fore-arm the brachial artery, dividing into branches, sometimes demands the use of the needle, more than when the operation is in the arm. In general, when the arm is amputated above the elbow, the same procedure will be necessary as is directed for the amputation of the thigh just above the knee.

See Bell's Surgery, vol. vi. 425. White's Surgery. 200, 201,202.

The Amputation of the Arm at its Joint with the Scapula.

Mr. Morand, the elder, first took off the arm at the shoulder, and Mr. Bromfield performed it with success in London. Here the tourniquet cannot be applied; but Dr. Hunter observes, that, when we consider the situation of the blood vessels as they pass over the first rib to the arm, it evidently appears, that by turning the shoulder outwards, and making a proper pressure with compresses, we can check the circulation in amputating the humerus, at its articulation with the scapula. which is the most intimidating circumstance in the operation.

The patient's arm being held horizontally, make an incision through to the flesh, from the upper part of the shoulder, across the pectoral muscles, down to the armpit; and, to save as much skin as you can, begin it about two inches below the joint, then turning the knife with its edge upwards, divide that muscle, and part of the deltoid. The great artery and vein are thus ex-posed, and should immediately be secured by ligatures, at least two fingers' breadth below the axilla. For this purpose, carry the arm a little backward; then divide these vessels at a considerable distance below the ligatures, and pursue the circular incision through the joint, cutting first into that part of the bursal ligament which is nearest to the axilla; for, by beginning on the upper part of the shoulder, the projection of the processus acromion, and processus coracoides, will, very-much embarrass the operation. Having discovered the true situation of the acromion, draw back the skin, and in dividing the flesh introduce the knife two or three fingers' breadth under it, for much of the deltoid muscle is thus saved, which will fill up the wound, and expedite its healing. Then raise the arm, that the head of the biceps muscle may be more easily found and divided; divide the ligament on the upper part, next on the sides, after which, the head being lifted out of the socket, cut away all that detains it, taking care not to divide the artery above the ligatures. The remaining flesh at the arm-pit should be nearly of a triangular figure, the broad part being next to the axilla. Apply the remaining flesh immediately to the socket of the scapula, and lay over them dry lint and pledgets, which may be secured by a plaster of the shape of a Maltese cross. To prevent the force of the artery, lay a bolster in the arm-pit, to press upon it; secure the whole with the bandage called the spica descendens.

See Bell's Surgery, vol. vi. p. 41".

Amputation of the Breast. The patient being placed on a high chair, hold her arm horizontally backward, and a very little downward; thus the pectoral muscle is more expanded, and the disordered part more easily separated from it; then make O 2 a circular incision through the teguments, and dissect-out the morbid part. The compress and bandage are generally sufficient to prevent haemorrhages, the needle being seldom required; though the branches of the mammary arteries, especially one larger than the rest from towards the arm-pits, near the edge of the pectoral muscle, will be sometimes troublesome. The management in other respects is the same as in wounds in general.

If, in the course of the cure, a fever comes on, with pains about the praecordia, and a difficulty of breathing, death is the consequence. Proper and timely bleeding may prevent these symptoms. Bell, vol. ii. 434.

Amputation of the Fingers and Toes.

Sometimes a finger or toe that is nearly cut through with a sharp instrument, if brought together while warm, will unite; at least it is better to make the attempt. When cut obliquely, their re-union may be more certainly expected.

The fingers and toes are best amputated in their articulations; a straight knife must be used, and the incision of the skin should be made not exactly upon the joint, but a little towards the extremity of the finger or toe, that more of it may be preserved for the easier healing afterwards: it will also facilitate the separation of the joint, when the finger is cut from the metacarpal bone, to make two small longitudinal incisions on each side of it first. When the lower joints are separated, the first incisions should be from a little above, to a little below the joint on each side, and so deep as to divide the ligaments. The skin grows over the cartilage very readily. If the cartilage is removed by the knife's point, or by any accident, the skin heals better, and unites speedily to the bone; but this is not necessary. If the patient is plethoric, let the blood run from the amputated joint, and no haemorrhage will happen thereafter. It is never necessary to take up an artery.

In case of supernumerary fingers or toes, if troublesome, cut them off: sometimes there is no bone where they are to be cut off; in this case a knife may be used: but if there is any bone, a strong pair of scissors may be used, for in infants these bones are not hard.