Report of a committee of the associate medical members of the Sanitary Commission, on the subject of amputations through the foot, and at the ankle-joint.

  • United States Sanitary Commission.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Report of a committee of the associate medical members of the Sanitary Commission, on the subject of amputations through the foot, and at the ankle-joint. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    1st. Of tlie tljree above-inentioned operations, wliicli gives the most nsefnl stump for progression witliout ai<l ? 2d. Which affords the best stnmp for artificial appliances? In regard to Chopart’s amputation, it has been seen that the testimony of surgeons is very conflicting as to the usefulness of the stnmp. It cannot, we think, be denied, that it has frequently required subsequent interference, such as division of the tendo Achillis, a support under the anterior part of the stump, &c., in order to prevent such a degree of retraction of the heel as would bring the cicatrix to the most dependent part. Indeed, no one can examine the normal relations of the tarsal bones without being struck with the fact, that by this operation more than half of the anterior part of an arch is removed, leaving the remaining portion to sustain the entire weight which before belonged to the whole. It could scarcely result otherwise than that, in a w^ell-formed foot, the posterior half of the arch would fall under the superincumbent weight. If we add to this, the constant elevation of the heel by the powerful and feebly anta- gonized muscle of the calf, we can only be surprised that in time every stump of this kind is not turned with its face down- wards. And it must be admitted by the most ardent advocates of this operation that in some instances it has been found im- ». possible to remedy these defects, and patients have remained permanently unable to bear their weight upon the stump. It has been alleged, as already noted, that in Sjnne’s operation the stump is often so tender that the patient cannot bear his weight upon it. Such an opinion would seem to be rather theoretical than practical. We do not know of any well- founded proofs that such a result follows. On the contrary, Mr. Syme’s testimony, as we have already stated, coincides with our own experience, that the stumps are capable ot great endurance. Of Pirogoff’s operation we cannot speak as confi- dently, from want of suflicient evidence; but it will be seen in the preceding pages, that so far as we have obtained the opinions of those who have had the most experience, the stumps, when