In amputating the leg, the bones should be sawn through, about four inches below the patella. The tourniquet is applied in the lower part of the thigh. After cutting through the skin, which should be drawn upwards, it must be reflected from the flat surface of the tibia, and front of the leg, so as to cover those parts which could not be covered by any large muscle. The calf is then to be cut through, by an oblique incision slanting upwards; the rest of the muscles, and the interosseous ligament, should be divided by a double-edged knife, called a catlin, and the bones sawn, after the previous application of a double tailed retractor.
In amputating the arm or fore-ann. we should preserve as great a length of the limb as the case will allow.
Aninstation of the shoukles4oint has been done in various ways. An incision should be carried through the skin and deltoid muscle down to the bone, from the front of the joint, a little below the clavicle, ob liquely downwards and outwards. The deltoid should then be turned up so as to expose the head of the bone, which must be brought entirely into view, by dividing the orbicular ligament all round. One cut of an amputating knife will then separate the limb. The axillary artery should be immediately tied. This vessel must be firmly compressed by an assistant, above the clavicles, during the whole of the ope. ration.
The and toes should be removed at the joints. Make a circular incision through the skin, about one third of an inch below the articulation ; draw the integuments up, and cut through one la teral ligament of the joint, which you can then dislocate. The remaining connec tions are easily divided. Bring the skin together over the end of the bone. If you amputate at the firstjoint, make two cuts, one at the back, and the other towards the front; these must meet when the bone is removed. It is sometimes necessary to tie the arteries.
Paronychia, or whit/ova, is an abscess oc curring about the nails, or still more deeply under the soft parts ofthe fingers. In the latter case, swelling of the arm, in flammation of the lymphatics, and con. siderable constitutional disturbance, fre quently attend. The complaint is always very painful, attended with great throb. bing ; and often terminating in the loss of the nail. We should, if possible, prevent suppuration, by the employment of local antiphlogistic means. If these do not suc ceed, a soft poultice may be used, and the collection should be opened as soon as possible.
Venesection. When a vein is to be open ed in any part of the body, pressure must be made on the vessels, between the place where the puncture is to be made and the heart. This prevents the return of blood through the vessel, makes it swell, and become conspicuous. As the sup ply of blood is still continued through the arteries, the vein bleeds freely when it is opened; but care must be taken, particu larly in the arm, and to apply the ligature so tightly as to stop the pulse. The ban dage should be placed a little above the elbow, and the most prominent and con spicuous vein may be opened; excepting that, ifequally convenient, one would avoid the vessel lying over the brachial artery.
The vein may be fixed by placing the thumb of the left hand a little below the place where it is designed to introduce the lancet. That instrument should be pushed obliquely into the vein, and when its point is a little within the cavity, the opening may be rendered sufficiently large by carrying the front edge forward and up ward, so as to bring it out of the part. In many cases, where we wish to make a sud den impressionon the vascular system, we make the opening longer than usual, that the blood may be withdrawn more sudden ly, andcause fainting. The stream may be accelerated, by putting the muscles of the fere-arm into action. It stops when the ligature is removed, or at least, if the sur geon press with his left thumb below the vein. The sides of the incision should be placed in contact, and maintained in that condition by a small compress of linen, bound on with the bleeding fillet applied in the form of the figure of eight. In opening the external jugular vein, the pressure must be made with the surgeon's finger; and the compress should be fas tened by means of sticking plaster. The temporal artery may be opened by a sim ple puncture; and the bleeding may al ways be stopped by a compress fastened by means of sticking plaster. The ope ration of bleeding may be followed by various unpleasant consequences ; as ec chymosis round the vein, inflammation of the integuments, absorbents, firscia, or vein itself. The former symptom generally disappears of itself in a week or ten days; the others may be treated according to the general principles of surgical practice.