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67 2 s u II G E R Y.
rcration, difc,:i\"er ro rcaJily ~he punllure ; or ir lhe ca:\ts
of lIJe Jrtery made it, we CO:.lld no~ fc?aratc it.d¡/!intlJy
fronl lhe ve[d, whkh \\'ould be ahvay' dib'od abel'e .oél
bclow lhe cyft, 35 \'le Le In Olher aneu1"i(lIu.
Ther~ are fome fc:w ¡nfllnces of flllall oJJm rifulI 31ld
pun{\"ures of t!,e art:ry froOl bleedinti. doing \Vdl by bJn·
dage ~ bur lhey ;tlmoll all require (he opcn.tioD al
whkh is lO be performcJ oeJrly i ~ lhe (ame m;;nner in
ert:.ry pan; and fuppofing it in lhe b~nd of (he arm, is to
be uO'"c a!r:r th:: follow"lng Int'thod.
Ihring ap?!:ed [he tourniqu~t ocar lhe íhoul,ier, and bid
Ih: a,m in a coo\'eniCDl fi[u<llio:), make an inci(¡on On (he
¡orioe of rhe h:uIJJ' murcie, above aDd bclow the c:Ibow a
cor.!id.:rablc lcngth, which, beiop. in th~ courre of the arte
r / • wili difc::>v..:r it :l" foon as you have ukcn away the
cU30ulate,.d blood, whirh mun be a1l remov~d \'Iith the Gn·
s:er;. the wou:"d b~: nti diltted furFic:cntly for lhAt purpo!c.
I f ~hc orifi.:e do~s I~Ot r~Jdily appcar, let the tourntq\let be
!oofcn~d, and Ihe dFlJ!ion of blood \'Ji!1 dird't yOIl to i[;
tben c..rcfully c~rr}'ing a cr o.)!::~·rl neeclie with lligílture un·
de:- ir, tic lhe vcn~1 jun a::'oO'e the orífice; and pa:ling lhe
n!!dle ae::!;I'l, m: a fecond li,¡aturc b.:low it, lO prtvent
the rtruro or tho! blooJ , aod lcave lhe intermcdlil~e piece of
the n{f: l lO n:J-=~h :iV/ay Wi lho~l di"iding il . To avoid
wounding or tying the nerve in !1lakins lhe ligaturc, the
may be cle:lred away fro m il fi rn, and hdd up wilh
a hook ; hUI fhould lhe nerve be ticd with the arrer)'. no
¡reat inconvenience woul~ enfue from il . . Aftt~ the opera·
lioo, Ihe;\I m mufl oe lald eafy', on a Flllow In bed, and
t ~e \':o'Jnd be tre.lled :n the common melhod, keep;nti il in
.hAt ;:oOurc a fOrlnight or three \Ve~ks, efp!ci,dly if it
fl":1IJ (wdl muoh, aoJ no, digdl kiodly.
In c.1~ing lhis operation, it \'IIH U! prop~r to h:we Ihe
:n;pu~.Hin~ innrum'!nu r:ady, leO i: fhould be: impraét;cahle
tO tie Ihe t!.rterYi and tven ...fte r 'hl ving tied it, lhe arro
mu!l: be carcfullv watched ; and iD c.lfc of a mon ifiCr.tion, it
~.y u: taken oÍ!.
01 AMPUTAT ' ON .
A fpr:ading mortifica,ion has beco eneem:d fo
p~incip'.1 a ed,\l'rc: fer 2mput3tion, thal it ii a fanlion with
w,iltrS tO tr! H of th: nature of a gangrene prcvicus to
t ::e def:ription of this op('ration. However. this opcratioD
i. fp,·'''" of ". frequeody u~(uecef,rul; and in leng,h of
tir.l';, ils want of fu cccfs has becn ro unql1ef1iCln:lhly c~·m·
firmed by r~Fe.l·trd expcrim.nts, lh3 t Come of lhe caon ,cmi·
nent pr4[tidoncrs m',ke lIlil1 very circumfiance au exception
tO lh: op~rJtjcn . which fo fcw years Gnce was the great
io.:illce:nr:n t j and the m:l.xim is, nevcr (o extirp:lte till the
morti ti catlon is abfolutcJy fiopped, and even advanced io
ii!. fep:lfi\ tion.
G .1ns:rcn~s maybe produccd two w~ys ; either by ¡ndiC·
pof"ion of bo.)y, or by .cciden, in. hca llh ful Ihte: for as
lhe Lfe of ~ p\r1 G-cpends upon the circulation of in fluids.
wh"lever fu~lI mak-c Ihe circul.nioDceare, \ViII inevitahly oc·
cafion a gaD{!renc. Thlls a nlere comprefs prcventing lhe
c!)urfe: of Ih,: blooJ. ~s c!Fté'lually e lofes a morti6cJ.tioD as
-¡,;:y indirpofition in the 6uids or vdTels,
lt fl et.¡ Dcntly lurp!!ns io old agc, that the aneril!s of lhe
!ow!r ~xlrcmi(i(, (,ffify; which tJdlroying lheir clafiicilY.
mutl in conrc'Iuence prodllce a gangrcne in lhe toes lirll.
, oj ¡::e,,':a:Cs in ,he liOJb D<arly al high as "hero ,he ofij·
ficuion termihatl!s; fo that in arifi ng frtlfn
,h:s c...ufc. \Ve at once Cee v.thy am¡>ulation. during Iheir in.:
creafe, is of fo littl: fe:rvice, unlefs perfornled 1.bove the
ollificltiOIl j but \Ve t.3ve r.O WrJ.y tp judge \\h~re th: om,
liColllon c:nds, bm hy tbe infúence wc m. ke from the gan·
gron"', Hopping: Hence we may learn ,he propriety of our
modero praébcc in thlS cafe.
Ir by any accldt:nt the limb has becn injured to tbat 't'io..
Jent dt:gree as tO begin to moni(y. it wiil -be. no more fiuo
operale he re: ,iJl it nops. IhJn in the other innance i becau'c
all pHtS are moni fit:d have h:.ci lhe difpofition tO be·
COI11::: fo, before the df=él: is produced: and cIltting off a
limb, h. lr.o ineh .uove ,h, abfolu,e cle.d n:in, i, gener.l·
Iy leaviog a p:trt bebind, wa h the reeds of a moniricat ion
in 1t ; fo, unitfs we can be fure lhe vdrt:Js are nOl ar·
fetled iD the pl~ce of 30lpUlatioo, 'ol.'hich wiJl be hard tO
k~o ..·: b'Jt from (he conf:qIotence, the operl lion \ViII be ufe.
icf,.
S om: times the lltlid, of tbe body are fo yiti:u ed, as 10
lefe: th:ir propcr nutritiuus qualilies: and lh~ Jim~ becomcs
g~n&rened, n:)t from any :dtoirdtion in it~ n{fds, buqbirf~
Iy [roOl iu fitu.n ion . which being at a greal d!lhoce: from
.he he.", wiJl be more prone lO feel ,he iJl df!él, of • b. d
blood {han any other pArf, as Ihe circuladon is more la....
guiJ 'in the e:xlremitics ; 'and il feems DOt .very improbabl~.
that in fome difpofitions of the blood , a mortihcation ma,
alfo be a kin~ of crilic,.Idifcbarge. ' Vhen gan–
gre ne ;;rifin;: from ~i th~r of thcre: caufes; is running 00, 'am·
p"ratioo .bove it wiJl (or lhe' moH .pa.' be ufelefs: fi"ce
ir is only rcmo\'ing Gne dcgree oI the errclts of the batl
j tlie(~. :lnd leaving thc:n in the f:lome (hte lO produce rhe
I:ke mifchief in oth!r parts. T hus we Cee, a(ter aOlpuralions
on Ihis OlcCOunt, lhe: gangrenc fomelirues fall1>n lhe bowcls,
or the other extrcmities: froro which obfervation \Ve may
conc!ude ir oot rafe to ampu lat~, (iJl the Auids are altercd¡
aod ,hi, alter.,ion lI'ill prel<ntly di(eo«r ¡lfeif by lhe flop_
ping of the monification.
G ,,010' lI ound., compound f"élu«" ar.d .JI fudden
arcidt:nts rcquirinc ampl1t,uion, ..re attenc.!ed w;lh ,he
b<fI (ucc,f, ir immedi.:c1y pcrfonned. D,ford!rs of ,ilo
joints. ulcers of lona: Claouing, and ~11 rcrophulo~s lU·
moUlS, do fometinie:s return 00 o:hH pJrts a(,er Lhe ep!ra·
lion. \Vhen a leg is LO b~ ~mputatcd, the mancer of doinC
it is this.
LJy your pati!:nt on a t:l.ble t\'Jo fe:t fix inches high,
\Vhic~' is much bc uer thcll a low (eat, bOlh for fecunne
hion Jleddy.•nd giving yourfdf ,he ad" o"G< of op :.g
witlloUt l1ooping, which is nOl oDly painful, but in:or.veni·
em in the other filU~tion . While ene of the affilla n's hold,
,he leg, you muH roJl a flip of .ine rag half .n incb broad,
thrce or four times Hlund ie, "boue fouf or Gve ¡nches l-e·
Jo 11 :h~ inferior extremity of thepe/ella .' This beí:lC pinned
on, is 10 ferre as a gu'de for the koife. w!lieb WílhoUl it
p:rh. p' would Dol be di,eéled fo deltteroufly : The nunoer
of rolling ha, .Iw"ys been perpendicular lO lhe leng,h of
the lec; hUI havir~ (ometi:nu ohferv!9' that thoug,h tbe
amput:llion al' firll be even. yrt aftenvards Ihe g:JJ!r~,,:(.
7niuI murcie contr:-..lling. dr:l\vs back lhe ¡n¡'trior p:ut of
lhe ltt,llIP more Uronel,. thiln lhe olher murcies can do 1111:
ren oE it ; in ord,r lO prcfen'e ,he rr~ularity of the c'i·
eatrix-; allow for this excefs of conu aaion. are r113ke lh:
circular ineifion iD fl1ch a lhat the part of Ihe
wour.d