Amputation, (from amputo, to cut off ). It is the cutting off a. limb. Ectome, excisio, and extirpatio, are used in the same sense. Excisio may indeed be applied to the operation where one part is cut out of another, as some encysted tumours.
Hippocrates says, when speaking of a mortification, that what is putrified must be cut off, but does not men-von the taking off limbs. Celsus is the first who de--cribes this operation. Till the sixteenth century, we have no account of any method to prevent the haemorrhage which happens in this sort of operation, except
Celsus's, of making a ligature about the vessels. Pare tells us, that, previous to making this incision, a ligature, with a thin fillet, must be made above where the amputation is to be performed, which, he says, first. keeps up the skin and muscles in a raised posture; secondly, prevents an haemorrhage; and, thirdly, lessens the sense of feeling. He is the first who clearly speaks of preventing the haemorrhage, when these operations are performed. In 1674, Mr. Morel, a French surgeon, introduced the tourniquet, as it is now used: but the first mention of this instrument is in the Currus Triumphalis e Terebintho, published in London by an English surgeon in 1679. About the end of the seventeenth century, Messrs. Verduin and Sabourin, one a Dutchman, the other of Geneva, left a label of the flesh and skin to wrap over the stump, and called it 'loperation de lamputation a lambeau;' but they probably learnt it from an Englishman, who published this practice in 1679; see Currus triumphalis e terebintho. Paulus AEgineta used the actual cautery; but Ambrose Pare secured the vessels by drawing them a little out with the forceps, then making a ligature round them, as is often mentioned by Celsus, though neglected by so many of his successors. In the present (eighteenth) century, improvements are both many and important in this branch of surgery; the erooked needle, and most other parts of the apparatus, being now introduced or unproved.
Cases requiring the Limb to be taken off. Mr. Bilguer, an eminent practitioner in the armies of the king of Prussia, during his late wars, reduces them to six, as follow:
1. A mortification, which spreads until it reaches the bone.
2. A limb so hurt, that a mortification is highly probable.
3. A violent contusion of the flesh, which at the same time hath shattered the bones.
4. Wounds of the larger blood vessels of the limb, when recourse is had to amputation, as the only method of stopping the haemorrhage; or through an apprehension that the limbs should perish for want of nourishment.
5. An incurable caries of the bones.
6. A cancer or humour in danger of becoming such.
Perhaps Mr. Bilguer may have restrained this operation rather too much; but his ingenuity renders his instructions deserving of attention.
In cases from mortification, Mr. Sharpe hath well established the propriety of waiting until it ceases, and granulations of new flesh show a better state of the constitution. He observes that gun-shot wounds are best. if the necessary amputation is immediately performed: and that the disorders of the joints, ulcers of long standing, and all scrofulous tumours, generally return on other parts after amputation.
Mr. Pott observes, that in the instances generally demanding amputation, if the rule is adhered to, a limb will now and then be taken off that possibly might have been restored; but the number is so small, in proportion to those who, under the same apparent circumstances, would end fatally, that it can make no
O difference in the general treatment. Selection of one case from another is what constitutes judgment in surgery; and happy is the man who, amidst the following demands for amputation, singles out the circumstances in which he will succeed, and save the threatened part. In general, then, amputation is necessary 1. In some compound fractures. See Fractura.
2. A wound in the principal artery of a limb; in some aneurisms; a large wound with loss of substance, from arteries not contained within the cavity of the body, as those of the thigh, leg, or arm. It is true, every instance of a wounded humeral or crural artery does not demand this operation; but if the wound is such, that the collateral branches in their neighbourhood arc prevented from carrying on the circulation, a speedy amputation will be necessary. See Arteria; Femo-ralis arteria; Poplitea arteria; Tibialis arteria; humeralis arteria, &c
3. When joints are wounded, violently injured, or otherwise diseased. When the heads of bones are diseased, or their ligaments lacerated, in most instances amputation is necessary. See Vulnus, Sclopetopla-ga, Spina ventosa, etc.
4. A caries of the whole substance of a bone, or of the bones which compose a limb. See Caries.
5. Some mortifications. See Mortificatio.
6. Many instances of gun-shot wounds. See Sclopetoplaga.
7. Cancers. See Cancer. Extensive foul ulcers, and some deep-seated encysted tumours.
8. Swellings of the bones or deformed limbs.
9. A disease resembling the œdema described by Richter.
Large bones should not be amputated in the joint, on account of the extreme thinness of the flesh in those parts, which cannot easily be brought to cover the bone, whence many inconveniences may arise; but if there is a probability of succeeding in this respect, the objection vanishes.
If amputation is determined on, the following should be in readiness:
1. A tourniquet.
2. A smooth fillet, an inch broad, and half an ell long.
:>. The amputating knife.
4. A catlin.
5. Saws of different sizes, particularly a small one made of a watch spring for splinters.
6. A forceps - a small pair of scissors with long handles.
7. Crooked needles, armed with wax thread.
8. Lint and tow, made into compresses ready for use; (apes and adhesive plaster in slips.