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wound whieh is on !he e,lf of !he IcS is a little f'!lhe,
f,om the ham thao that 00 tbe lbiu IS f,om lhe n,iddle of
the pQltll.z.
lb the Olean time, one of your affifiants muft carry 8
{lrong Jigalure round tite thigh. abeut mrce or fouT ¡nches
Qbove thepaltlla, whieb pnllins th,ough ~ couple ofOi.. in
• fquare piecc of lelilher, he muH ¡",l'in with a tourr.iquet,
till tbe .!le,..,. Is fuffieiently comp,efi,d, tO prevent .ny
g,e" effufhm of blpod; aod to do " mo'e effcélu. l!y, he
trlay laya botfier of tow ar lin~n under [be hgature. upon
that pan ",befe [he artery creeps. It will aIro be a Jittle
more ea(y to [be patient, to carry a comprtes of lineo three
or fouT times double. round che thigh, on [hat pan where
t he ligature is applied, iD a rder to preTent it from cuuin&
the fkio .
The eou,fe of the blood beiog flooped, you mufl begi.
your ¡aeifioo jufi below lhe Hoco Toller, 00 the uoder pan
of (he limb, bringing your knife towards you , which al one
fweep m:\y Cut more thlO the femici rcle i then beginntng
your fecond wound on thé upper part, it muO: be contioutd
from the one exttemity to the other o( the tirll wouod, ma~
king tbem bu! on. line . Thef. ioeiGons mu(f be made
q llite through the mtmDrOnQ «dipe/3, 15(ar as the mufcl ts;
thtn u\dng off the lineo roJler, and ao afliO:aot dr.¡wing
baek tlle fkiD as fa, as it will go, you make you, woood
from the edge. of it when d,.wn baek, th'<>l1gh the nelb
to the bone, iD «he fame manner as you did through the
Ckio.. Before you faw t!te boots, you mufl cut [be ligament
betwetn them, with lhe point of you, knife; And the . IIiH–
ant v-!no holds the leg ""hile ir is fawing, . mutt obfene nOl
to lift it upwards, which wOllld clog the IOllrument; and al
t he fame time, not tO let it drop, len lhe weight of the
limb nlould fraélure the bone, btfore it is qaite f¡wed rhro·.
In amputatÍbg hdo\V lhe !toee, it is of tdvantage to HaDd
on the inGde of the leg; becaufe ,he tihi.z aodjibu/o lie in
~ pofition ro be ra w~:(d al 'the faOle lime. if Ih~ lofi.rument
be app¡'cd eXt<rnally: whe,eas, i( VI' hy it on the iDGde
of the leg. the libia ",il! be diVlded firlf, ,aod the jihll/a .f–
terwtrds: which DOt onl1 lellgthens the operatioll, bllr is
.Ifo 'pt tQ 'fpl intc' lhejibJ1/.z when it i. almoO f"\Ved ,h,o',
unJ"Cs lhe "ffiHant be ver>' cuerul iD fupportíng it.
\oVht(! tr.t leg is raken off, the next regard is .co ue had
'0the IfopPlnt the blood; \Vhieh mufl be elfeélually dooe
btCore Ihe palient is put lO bcd, or there \Viii be creat dan·
ger of ble~din:! agaín, .when the rever is ~xcired , acd the
,-errel, o( the flUOlp dilated, bUlh whleh happen a very litde
while :lftcr lhe op:!!a~ion. T here is no me:hod for rhi5
perpofe fa fecure, as taking up Ihe extrcmities of lhe velfels
",,¡th ¡ji needle and lig:uure in lhe- followi nr, nu noC'r. As
foog as [he amputation is pe,formed. rhe aOi.lant ms.lfi: loofen
the touroiquet for a moment, upon which lhe oduces of
the arteries will appetl.r by rhe lfiüe of the blood. T h40-
per:nor h~víog then fi xed his ' ye upon one of lhe largtÍt
ve{fels, p.{fes a erooked needle th,ol1gh the fielh, a linle
more lhao a qU1.rter of an ineh aboye lh: oritice, olnd about
t he fame depth, iD fuch a dirféhon as lO make nearly one
tlllrd .Jf ~ clrcle rOtlnd the "erre!: then wit hdl2wing ,he
ncedlc, he a fl!cond time p.tfT\!Sit ioto the lId h 2nd om a–
g~in, iD (be f::tme m"one r and abouf the C¡¡me difiance be l" w
the ori~" e oC Ihe vC(ie l. Bv this ml!;,ns. die thread \Vii i al·
mon encom p,lfs the vdfel, nlld when it is ti:od (which (honld
be done bv tht furgeon's knot) \,,:íI J ntCdf.Hily ¡ndore it
within the Uriélu,e. AjI the confid rab!" arte! ¡es arno be
E H. Y.
takfn up in ~he Carne man~er ; that ¡s, t~c tourniqutt i¡ to
be Joofencd In arder to dlfcover the vccrd, and thelJ the
netdl~ is to be pc:(fed routtD . T his is a Oluch \\'!-y
t ~an uGng th'! 2~tery. forccps, whfre the vdfels are apt to
fl,p a.way out oC lhe 1t2ature: and:ls to n)'ptlck appl!c~tlons
theír w~U1t of fa:t:ty is Ca well kno\l,Io, tha{ the ufe of them'
in hzmorrhagu froO} large ve(fels, is almult uoi'JerEdly re:
jeétcd; thou~h it i, thought by {everal fur¡:~on, who ha\'c
.experienced lhe virtue of agaric, that it wlll be found to be
l mOre powerful aflringent Ihan any hilh~rto dircofered.
It Cometimes happens in a large fiump , that ten or more
.e{fels ,eqnire tl'iog; "hieh done, you rollO apply loofe d,y
Jiot lO the wound; or in cafe the: Cmall vefi"c1s blecd pJenti~
(ully, you m.y th,olOl a handful o( fiour "mongfl th< linl,
whi<h will eont ribute tO the more effeélual ll opping up the}r
orifices. Befare you lily 00 the plc'dgit, you Rlull: bind the
flu mp, aDd b'giD to ,011 (,om the 10IVe, P'" of the ¡high
down tO the extremilY of the Uump. T he uCe ot thlS roller
is to keep the fkin forwards, which. nOtwilhílandlog the
flep' already taken to prevent jtS Jall1ng , would ia
fome mearure do fo, unlers fuft.ined in this manner. The
d,effing may be f<Cll,ed by the erofs cloth 2nd gentle band:
Qg~ j and the method of trcadng lhe wouod may be Jcarne
frorn whu has becn faid with refpeét to recent incired
woundi.
In amputating the lbi,h, lhe firfi incilion is tO be made
• Jiule more Ih<lO two ihchd ahove ¡he midole of lhe pa'..
leila. After the operadon. a roller !hould be carried round
the body. and down lhe thigh, lO fupport lhe Ik~o ,nd fielh,
this is :lfo (be moll proper b.lnd~ge, 15 ab(ce{fc:; ""ill fome–
times form iD t!le upper patt of lhe thigh, which canoot
di rcharge thc:mrt:lvt', fo conveniently ",,¡th anyother, it being
I lmon imp,atlicable tO ,011 .bove lhe abrcefs, unlefs \Ve bc–
gin (,om ,he bod y.
The ampu tation of lhe arOl or cubit ditfers fa liule from
the (oregoing ópemtions, {hu it will be bU( ¡ T~pctitioft to
defcribe tt . H owc:vc:r, it rnufl be laid do"'n as a~rule. to
pre(enre A9 much o( the 1i00b in poffible, and, in .11 ampu·
tation. of the upper nmb5, to plJce your patient iD a
chair.
The amputation of the 6ngers and toes isbetter pe.rform–
td In their articulation, lhan l,y any of tl:e other wethods:
for this purl'0fe, a Uraight koif'c mun be ufed, "nd the in!
ci(¡on of rhe fkin be Inade nOl exaétly the: joint, bULa
Hule towa r~s th~ eXl remity of lhe fingers, that more of it
may be prerl!rv~d fu" the eafter heQllOg aft~nvards : H will
airo facilirate the fC -on io lhe joint, ",hen you CUt the
finger (ro-m the 1IJetacnr/,al bone, 10 ml\ke t\Yo fmall longi:..
tudin21 inc!Íions on eaeh "de ofit 6rfL In thefe ampulalions,
there is generc: lly a v,dfcl or t\Vo Ih:1I re(lulI~ tying, . and
which oflen prove troublcfoOlc whcn du; IJg.uure 15 o"
mitted.
1< may h.ppen ,hat .he bon,s o( lhe toe" and pa" ooly
of ,he 1IJtlRlnr¡;'¡ bones, CHft>US ; in which care, theJeg
need not be cut off, but o~ly fo much of the foot u is dit:'
orde red :' a fmiill fpring·f.\\v. is beu cr to di ...idt: \Vith here,
than a I:u r,e one \Vht'n th15 opendon is perrol'll.lcd, the
heel and renl.linder of the foot wil1 b! of great f~1 VIce. aDd
.he wouod Iftall1p f.fdy.
E"PLHAT I ON o( Fig. 7 Pla:e CLVIll.
Al T ite rigure or Ih~ am?utating kni r.e. TIH! I("n~th of
ti:. blJde acd h. ndle Olould be aboul ,!lincen ioch".
D,.