11s operation,
vas ever done
Celfus, who
De Re Me.
s a thort de-
limbs. It has
inftruétiong
has not beep
unds, he di.
f the veflels;
intermediate
e advifes the
be met with
be inferred,
nes practifed
thened by a
on the {ub-
r fewing the
n of all the
- Galen, and
1ed between
The firft in-
but not over
cut off, ra-
[he mufcles
the bone, to
g bone clofe
rough edges
mteguments
>what extra-
s important
e of Celfus,
me. If am-
, ¢ {epzin
vant of fome
flels during
might, per-
tourniquet.
d Hmmor-
s renders it
confined or
the ftump;
hion of fkin
nd as to the
it to be co-
nge dip‘t in
the ancient
of healing.
ds, fuggelts
) retraét the
one ; he re-
e orifices of
reek practi-
ery than the
] from the
of amputat-
tages of the
10 apply
be contro-
d to tell the
e Arabians
T blood-vef-
y fewing 2
-oportion to
the
the bleeding.”” He fays, « burning irons were ufed by
the ancients, merely becaufe they knew of no OI/J.L’T means of
fupprefling the bleeding.”” Again, « In ’t,he times before
Paré, not being able to take up an artery,” &c.
We fhall elfewhere have opportunity to treat of the Lica-
rure of bleeding veflels; and therefore can only obferve, by
way of anticipation, that thof(? who ( with Mr. John Bel]/)
impute the firft difcovery of this prattice to Ambrofe Paré,
are greatly miftaken, and not fufficiently familiar with the
writings of the old furgeons, whether Greeks, Romans, or
Arabians. ¢ Itis not only entertaining but ufeful,”” fays the
late Dr. Hunter in his Commentaries, p. 62. to fee. by
what purfuits and fteps an improvement was made ; it gives
clear ideas of the fubje@, makes a ftronger impreflion upon
the memory, fhews the moft probable road to improvement
in fimilar inquiries, and raifes emulation. Bat,” fays .he,
<« if a man writes freely upon any fubjeét, without knowing
what has been faid by others, he rifks being made the
obje& of ridicule or cenfure.”” Ibid. p. 6o.
Guido de Cauliaco, who revived the languifhing ftate of
furgery in Europe during the 14th century, agrees with
Avicenna and Albucafis, that it is better to cut off a morti-
fied extremity than to let the whole body perifh. He ad-
vifes, when the gangrene is near a joint, to feparate'the
articulation. In other cafes he direéts us to apply a tight
ligature on the edge of the healthy part as well as on the gan-
grenous part 3 cutting betwcen them <_iown to the bone, and
then {fawing through, with a retractor interpofed. But fqme-
times Guido would wrap up a mortified limb, and allow it to
fall off of itfelf ; by which means he avoided the odium of
amputating members that his patients might haye thought
capable of prefervation. After the example of his predecef-
{ors, he had recourfe to hot irons, boiling oils, and aftringent
powders, to ftop the hemorrhage ; although he difapproves
the pradtice of Theodoric and others, who gave narcotic
‘remedies to prevent or mitigate the fuffering of their
patients.
Methods of amputating, fomewhat like that of Guido,
were ufed by Bartholomew Maggius, Vefalius, and moft {ur-
geons in the 15th and 16th centuries; till Botallus and Regius
propofed to lop off the limb by a fort of GUILLOTINE, at one
{troke, after the manner in which criminals, formerly of
Scotland, and lately of France, were decapitated. This
fummary treatment, however, caufed fo much contufion and
{plintering, that it was very foon oppofed as unfcientific and
butcherly. The moft important innovations, made about
this time in amputating, were introduced by the celebrated
Ambrofe Paré, a French furgeon ; to whofe induftry, good
fenfe, and fkill, we are chiefly indebted for the abolition of
cauterifing inftruments, and the general ufe of a needle and
ligature to {fupprefs the bleeding, after this operation.
Parc.é recommended to cut off the whole of the gangrenous
part, if the limb be mortified ; but to encroach as little as
poflible on the living fleth. At the fame time he laid it down
as a rule, not to leave a very long ftump to an amputated
leg ; becaufe the patient could more conveniently, he fays,
rzzakc ufe of a wooden leg, having the ftump only five
fingers long below the knee, than if much more of the flefh
were to be preferved. In the arm, however, he left the
whole of the living and healthy portion of the member, only
feparating the difeafed part from the found.
In preparing for amputation, he dire&s the {kin and
mufcles to be drawn upwards, and bound tight with a broad
bandage, a little above the part where the incifion is to be
made. This fillet was intended to anfwer a threefold pur-
pofe: 1ft, To afford a quantity of flefh for covering the
bore and facilitating the cure; 2dly, To clofe the extremi-
&
4
AMPUTATION.
ties of the divided blood-veffels ; 3dly, 'T'o dull the patient’s
feelings, by preflure on the fubjacent nerves. When this
firm ligature has been applied, Paré direés an incifion to be
made down to the bone, either with a common large {calpel,
or a curved knife : then, by a {fmaller curved knife,"we are
carefully to divide the mufcle or ligament remaining between
the bones of the fore-arm or leg ; after which we may pro-
ceed to faw off the bone as high as poflible, and to remove
the afperities occafioned by the faw.
With the affiftance of a curved pair of forceps, he drew
out the extremities of the bleeding arteries, either by them-
felves alone, or with fome portion of the {furrounding flefh,
to be firmly tied with a itrong double thread. He now
loofened his bandage, brought together the lips of the
wound over the face of the ftump, and kept them as clofe as
he could, without actual ftretching, by means of four ftitches
or {futures. If the larger tied veflels fhould accidentally be-
come loofe, he defires the ligature or bandage to be again
pafled around the limb ; or elfe, which is better, to let an
afliftant gripe the limb firm with both hands, and prefs with
his fingers over the courfe of the bleeding veflel, fo as to
ftop the hwemorrhage; then, with a {quare-edged needle
about four inches long, and a thread four times doubled,
the furgeon muft fecure the artery in the following manner :
Thruft the armed needle into the outfide of the flefh, half a
finger’s breadth from the veffel which bleeds, and bring it
out at the fame diftance from the bleeding orifice ; then {ur-
round the veflel with the ligature, pafs it back again to within
one finger’s breadth of the place where it firft entered, and
tie a faft knot upon a folded flip of linen rag, to prevent its
hurting the fleth. Paré, by this means, f'ays the orifice of
the artery will be agglutinated to the adjoining fleth {o firmly,
as not to yield one drop of blood : but, if the hamorrhage
were not confiderable, he contented himfelf with the applica-
tion of aftringent powders.
The limb was afterwards treated according to the old
plan, with ¢ defenfatives, repurcuflives, and agglutinatives.’’
The firft drefling was not removed for three or four days;
but, when a fuppuration came on, the ¢ digeftive, deterfive,
and mundificative remedies’’ were employed, until the liga-
tures might be fafely removed, and exfoliation of the bone
took place. As the furgeon faw proper, it was alfo recom-
mended by Paré to haften the exfoliation by the actual cau-
tery applied to the extremity of the bone only; and to
keep down fungous flefh by the ufe of burnt alum, blue
vitriol, or red nitrated mercury.
Thus did this famous furgeon endeavour, by his fingle
example and precepts, to exclude the barbarous ufe of hot
irons in amputation. He fays, he knew not of any fuch
praltice among the old {furgeons ; except that Galen recom-
mended us to tie bleeding veflels, towards their origin, in ac-
cidental wounds, and he thought proper to do the fame in
cafes of amputation: but in an apology at the end of his
book, Paré has quoted, in his own defence, a dozen authors,
who employed or recommended the ligature before him ;
and he might have cited many more. ;
From the ftatement we have here given, it may be {feen
how far our beft writers, of every country almoft, have erred
in afcribing the original invention of tying arteries to Amb,
Paré. Great merit, indeed, was due to him for the part he
took in extending, and even reviving this incomparablc_a prac-
tice; nay, it is not certain whether any one before him had
ever applied the needle and llgatl'ire in fimilar cafes, i. e
after amputation : but how very wide of the truth Mr. John
Bell’s recent account of this matter is, will appear to every
perfon who will enquire into the fa&s themfelves; for
not only were needles and ligatures in ufe among the an-
cients,
