Amputation, an historical sketch : being the subject of the introductory lecture delivered at Netley, in commencing the thirty-first session of the Army Medical School, 1st October, 1875 / by T. Longmore.

Longmore, Sir Thomas, 1816-1895.

Date:: 1876

Credit: Amputation, an historical sketch : being the subject of the introductory lecture delivered at Netley, in commencing the thirty-first session of the Army Medical School, 1st October, 1875 / by T. Longmore. 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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$performed in remote times, and the successive improvements made in the performance of it down to the present time, will form the chief topics of my remarks; and I hope that the survey, with the comments which it will lead to, may not he without some points of interest as well as instruction. When we regard the performance of an amputation, we can scarcely believe that any surgical proceediug can be simpler. We can hardly understand that there can ever have been any difficulty about it. It is evident that no particular knowledge of anatomy is required in mere dismemberment, in which every anatomical structure that is brought in opposition to the knife and saw has only to be cut across. It is easy to see that one surgeon may perform the amputation more quickly, more expertly than another; that if it be a flap amputation, without due care the flaps may be a little too short or too long; if a circular operation, the division of the skin and layers of muscles may be ill or well done, leaving the stump well or indifferently covered; that the bone or bones, from want of due caution, may be unevenly sawn or even splintered; but these and some similar circumstances of minor importance, all quite under the control of ordinary handicraft and care, being excepted, it seems as if the cutting off a limb might and would have been done in the very earliest times of surgical art as readily as it is now done. How far from the truth would be such a supposition you will see, when I point out some of the difficulties which the ancient surgeons had to contend against in amputating a limb; when I quote from surgeons of comparatively modern periods of time their descrip- tions of the mode of performing the operation; and when I shew you, lastly, that it is really only within comparatively recent dates that it became possible for an amputation to be done, and for the wound left by it to be healed in the manner which is now common among surgeons of the present day. The earliest plan adopted for the removal of a portion of a limb which had been subjected to destructive crushing injury, was, as far as is known, to leave the limb until the crushed parts became gangrenous, and then either to cut through the mortified portion, or to allow it to drop away spontaneously. Hippocrates, writing in the fifth century before the Christian era, has left on record that in cases of fractured limbs which became gangrenous, his practice was not to amputate, but to wait till the gangrened por- tions dropped off, which he says they will do quickly, as the bones have yielded beforehand (are already separated); while in a case where gangrene occurred from any cause without a bone or bones having been fractured, then, as soon as the parts were quite dead and had become insensible, he removed the limb at the joint below$