AMPUTATION, in Chirurgery, the Operation of cutting off a Limb, or other Part of the Body, with an Instrument of Steel. See CHIRURGERY, OPERATION, etc. In Cases of Mortification, recourse is frequently had to Amputation. See MORTIFICATION, GANGRENE, SPHACELUS, etc. The Method of performing it, in the Instance of a Leg, is as follows—The proper Part for the Operation being four or five Inches below the Knee; the Skin and Flesh are first to be drawn very tight upwards, and secured from returning by a Ligature two or three Fingers broad: above this Ligature another loose one is passed, for the Gripe, which being twisted by means of a Stick, may be straitened to any degree at pleasure. Then, the Patient being conveniently situated, and the Operator placed to the inside of the Limb; which is to be held by one Assistant above, and another below the Part designed for the Operation; and the Gripe sufficiently twisted, to prevent too large a Hemorrhage, the Flesh is, with a Stroke or two, to be separated from the Bone with the Dismembering-Knife. Then the Periosteum being also divided from the Bone with the Back of the Knife, saw the Bone asunder with as few Strokes as possible—When two parallel Bones are concerned, the Flesh that grows between them must likewise be separated, before the use of the Saw.
This being done, the Gripe may be slackened; to give an opportunity for searching for the large Blood-Vessels, and securing the Hemorrhage at their Mouths, either by the actual Cautery, the Ligature, stitching them up, applying Vitriol Buttons, or the like. After this a dry Pledget of Lint, or one dipped in Spirit of Wine, and sprinkled with Diapente, may be applied to the Stump. Then loosen the first Ligature, and pull both the Skin and Flesh, as far as conveniently may be, over the Stump, to cover it; and secure them with the Cross-stitch made at the depth of half, or three quarters of an Inch in the Skin.—It remains, to apply over the whole Stump two large Pledgets, dipped in Digestives and dried, and afterwards charged with Astringents; and on these to apply a Plaister of De-minium, or simple Diachylon; and over these, an Ox-bladder, wetted in Oxycrate; and over all, a Cross-cloth pretty tight, secured with Rollers. After all this, the Gripe may be slackened, so as to be made easy for the Patient; or even entirely taken away, after he is put to Bed; in which he must lie with the Stump somewhat raised; an Assistant for 12 or 14 Hours keeping fast the Dressing with his hand, to prevent any violent Hemorrhage.—In three or four Days the Dressing may be removed; and proper Digestives, mixed with Astringents, applied: having an actual Cautery, or some powerful Styptic, in readiness, in case of a violent Hemorrhage at the first opening.
M. Sabouin, Surgeon of Geneva, is recorded in the History of the Royal Academy of Sciences, A. 1702, for an Improvement in the Method of Amputation, proposed to that Academy.—The whole Secret consists in saving a piece of Flesh and Skin, a little lower than the Place where the Section is to be; wherewith the Stump is to be afterwards covered.—The Advantages hereof, are, that in less than two Days time, this Flesh unites with the Extremes of the divided Vessels, and so saves the Necessity either of binding the Ends of those Vessels with Thread, or of applying Cauterics or Astringents; which are Methods very dangerous, or at least very incommodious. Add, that the Bone thus covered up, does not exfoliate.
