Amputations

Not a pleasant subject but one our historical characters dealt with on a fairly regular bases.

Amputation of the Arm.
Operation.— Give the patient ninety drops of laudanum, or let him breathe ether from a large ■ponge till sound asleep, and seat him on a narrow and firm table or chest, of a convenient height, so that some one can support him, by clasping him round the body. If the handkerchief and stick have not been previously applied, place it as high up on the arm as possible (the stick being very short) and so that the knot may pass on the inner third of it. Your instruments having been placed regularly on a table or waiter, and within reach of your hand, while some one supports the lower end of the arm, and at the same time draws down the skin, take the large knife and make one straight cut all round the limb, through the skin and fat only, then with the penknife separate as much of the skin from the flesh above the cut, and all round it, as will form a flap to cover the face of the stump; when you think there is enough separated, turn it back, where it must be held by an assistant, while with the large knife you make a second straight incision round the arm and down to the bone, as close as you can to the doubled edge of the flap, but taking great care not to cut it. The bone is now to be passed through the slit in the piece of linen before mentioned, and pressed by its ends against the upper surface of the wound by the person who holds the flap, while you saw through the bone as near to it as you can. With the books or pincers, you then seize and tie up every vessel that bleeds, the largest first, and smaller ones next, until they are all secured. When this is done, relax the stick a little; if an artery springs, tie it as before. The wound is now to be gently cleansed with a sponge and warm water, and the stick to be relaxed. If it is evident that the arteries are all tied, bring the flap over the end of the stump, draw its edges together with strips of sticking-pi as tor, leaving the ligature
hanging out at the angles, lay the piece of linen spread with ointment over the straps, a pledget of lint over that, and secure the whole by the bandage, when the patient may be carried to bed, and the stump laid on a pillow.
The handkerchief and stick are to be left loosely round the limb, so that if any bleeding happens to come on, it may be tightened in an instant by the person who watches by the patient, when the dressings must be taken off, the flap raised, and the vessel be sought for and tied up, after which, every thing must be placed as before.
It may be well to observe that in sawing through the bone, along and free stroke should be used, to prevent any hitching, as an additional security against which, the teeth of the saw should be well sharpened and set wide.
There is also another circumstance, which it is essential to be aware of: the ends of divided arteries cannot at times be got hold of, or being diseased their coats give way under the hook, so that they cannot be drawn out; sometimes also, they are found ossified or turned into bone. In all these cases, having armed a needle with a ligature, pass it through the flesh round the artery, so that when tied, there will be a portion of it included in the ligature along with the artery. When the ligature has been made to encircle the artery, cut off the needle and tie it firmly in the ordinary way.
The bandages, etc., should not be disturbed for five or six days, if the weather is cool; if it is very warm, they may be removed in three. This is to be done with the greatest care, soaking them well with warm water until they are quite soft, and can be taken away without sticking to the stump. A clean, plaster, lint, and bandage are then to be applied as before, to be removed every two days. At the expiration of ten or fifteen days the ligatures generally come away; and in three or four weeks, if every thing goes on well, the wound heals.

Amputation of the Thigh.
This is performed in precisely the same manner as that of the arm, care being used to prevent the edges of the flap from uniting until the surface of the stump has adhered to it.

Amputation of the Leg.
As there are two bones in the leg ,which have to thin muscle .between, it is necessary to have an additional knife to those already mentioned, to divide it. It should have a long narrow blade, with a double-cutting edge, and a sharp point; a carving or case knife may be ground down to answer the purpose, the blade being reduced to rather less than half an inch in width. The linen or leather strip should also have two slits in it instead of one. The patient is to be laid on his back, on a table covered with blankets or a tnatresi*, with a sufficient number of assistants to secure him. The handkerchief and stick being applied on the upper part of the thigh, one person holds the knee, and another the foot and leg as steadily as possible, while with the large knife the operator makes on oblique incision round the limb, through the skin, and, beginning at five or six inches below the knee pan, and carrying it regularly round in such a manner that the cut will be lower down on the culf than in front of the leg. As much of the skin is then to be separated by the penknife as will cover the stump. When this is turned back, a second cut is to be made all round the limb and down to the bones, when, with the narrow-bladcd knife just mentioned, the flesh between them is to be divided. The middle piece of the leather strip is now to be pulled through between the bones, the whole being held back by the assistant, who supports the flap while the bones are sawed, which should be to managed that the smaller one is completely cut through bj the time tbe other is only half so. The arteries are then to be taken up, the Bap brought down and secured by adhesive plasters, etc. as already directed.

Amputation of the Forearm.
The forearm has two bones in it, the narrow bladed knife, and the strip of linen with three taiis. are to be provided. Tbe incision should be straight round the part, as in the arm, with this exception, complete it aa directed fur the preceding case.

Amputation of Fingers and Toes.
Draw the skin back, and make an incision round the finger, a little below the joint it is intended to remove, turn back a little flap to cover the stump, then cut down to the joint, bending it so that voo can cut through the ligaments that connect the two bc.nes, tho under one first, then that on the side. The bead of the bone is then to be turned out, while you cut through the remaining s«a parts. If you see an artery spirt, tie it up, if not, bring down the flap and secure it by a strip of sticking-plaster, and a narrow bandage over the whole.
Source: Mackenzie's Ten Thousand Receipts ©1867