Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

Amputation below Knee, No. 2.

a, wooden bucket to receive the whole of stump;
b, fixture to foot;
c, rolling foot;
d, straps for knee.

101. M. de Beaufoy has invented a foot for the wooden pin used by the soldiers in the Invalides, at Paris, who had suffered amputation above or below the knee; this, Mr. Bigg, of Leicester Square, has tried on some old soldiers at Chelsea Hospital; one of them reports that he has not only found his step to be steadier, but that he could walk twice the distance in the same time that he could with his ordinary pin-leg.

The advantage of the invention is, that whereas a common wooden pin only gives one point of support, and consequently the body is obliged to raise itself so as to describe an arc, of which the end of the wooden pin is the center, the curved foot acts like a series of levers, each successive point of it being a fulcrum. The precaution should be taken to have the aperture at a, fig. 2, for the insertion of the pin, made square, to prevent its turning when in use.

LECTURE VI.

PRIMARY AMPUTATION, ETC.

102. An upper extremity should not be amputated for almost any accident which can happen to it from musket-shot; and there is scarcely an injury of the soft parts likely to occur which would authorize amputation as a primary operation.

103. If the head or articulating extremity of the bone entering into the composition of the shoulder-joint be merely or slightly injured by musket-shot, the arm ought to be saved with some defect of motion in the joint. The wound should be enlarged in the first instance, to allow of a sufficient examination with the point of the finger, and any loose pieces of bone should be removed. Inflammation is to be restrained within due bounds until suppuration has been established, when, if a clear depending opening should not exist for the discharge of the matter poured out, it should be made, and any loose portions of bone removed. The principal points to attend to are, the prevention of sinuses around the joint, by the formation of dependent openings, position, perfect quietude, due support, the methodical application of bandages, and occasional mild stimulating injections into the wound. A simple incised wound penetrating the joint, and even injuring the bone, does not call for any immediate operation. An attempt should be made to effect a cure by the first intention, which can only be managed by means of proper position and support.

104. If the head of the bone be much splintered, or if a ball have gone through it, that portion should be sawn off; for a part thus injured has often been a source of great inconvenience and suffering for many years afterward—during, in fact, the remainder of the life of the sufferer; which misery would have been avoided by the excision of the head of the bone in the first instance—an operation which ought in fact to be done even at a later period, if it had not been performed at the time when the injury was received. Secondary operations of this kind are never so successful as primary ones, and great discrimination should be exercised in attempting to save the head of the bone, or, in other words, to avoid the operation for its removal.

105. When the splinters extend far into the shaft of the humerus, it may be proper to amputate the whole extremity, especially if the great artery be also wounded; but the shaft is seldom broken in such accidents to any great extent, and amputation should be confined almost to injuries from cannon-shot or shells, or heavy machinery, destructive of the soft parts as well as of the bone.