Note 75 — Chapter LVII · AMPUTATIONS.

The following is taken from the article of Professor Matas in the third edition of “Surgery by American Authors.” It furnishes a brief but admirable introduction to the general study of amputation methods:

“From Hippocrates to the time of Celsus the surgeon simply followed in the wake of Nature, never venturing to apply the knife for the removal of a limb except within the limits of the mortified tissues; and this seems to have prevailed for at least four hundred years. Celsus, the prince of Roman physicians, who lived shortly after the time of Christ, introduced the first innovation by cutting down to the bone between the living and the dead tissues. It is probable, according to the evidence furnished by his writings, that he was aware of the value of the ligature and that he applied it to control bleeding vessels. Archigenes, following closely after Celsus, was the first to attempt prophylactic hemostasis by applying a cord or band around the limb to control the hemorrhage during the amputation. With the fall of the Roman empire and the advent of the long night of the middle ages the Celsian method was lost in the general darkness and the old Hippocratic doctrines survived, and were maintained by the all-potent influence of Galen and his Arabian commentators. As late as the middle of the seventeenth century the only hemostatic was the actual cautery and boiling oil, though Guy de Chauliac had revived the teaching of Archigenes by constricting the limb, on a level with a joint, with a cord which was allowed to remain in situ, to ensure not only hemostasis, but a certain mortification of the stump. In cutting limbs huge chisels and mallets were used. At this period Botalli invented his guillotine, consisting of a sharp, heavy, axe, which, being allowed to fall from a height upon the limb, severed it instantaneously at a single blow. The revived or independent rediscovery of the ligature by Ambrose Paré in 1579, and the discovery of the circulation of the blood by Harvey, in 1628, led to the invention of Morel’s tourniquet (1674), more commonly known as the Spanish windlass, and to the familiar instrument, Pettit’s tourniquet, which (introduced in 1718) perfected the means of securing prophylactic and direct hemostasis. From this time onward the treatment of the stump began to receive more systematic attention. Instead of merely chopping off a limb, the soft parts were detached from the bone, so that this could be sawed off at a higher level, in order to avoid the conical projection of the stump which invariably resulted when the primitive methods were adopted. All the methods of amputation that followed—and these were numerous—aimed chiefly at celerity, to reduce the pain of the operation to a minimum; hence the rapid, circular section of the soft parts or the rapid transfixion methods which were so much popularized by the brilliant work of Liston, Lisfranc, Desault, Dupuytren, Langenbeck, and others. These finally yielded, in this modern period, to less rapid but more conservative and perfected methods, which aim chiefly at the preservation of useful tissue and at securing the very best functional prosthetic stump for the patient. Such methods could only be perfected after the advent of anesthesia and antisepsis.”