A Surgical Operation.

Manawatu Standard, Volume 4, Issue 97, 2 April 1883, Page 2

A Surgical Operation.

AMPUTATION OF A LEG.

We will take a quiet post of observation m the area of the operating theatre nt Jefferson College, Philadelphia, m this yar of our Lord 1882. Notice is posted that amputation of the thigh *ill be performed at 2 o'clock p.m. , and we occupy our seats ten minutes before the hour. The area itself is small, of a horseshoe form, and surrounded by benches rising on a steep incline oneabove another to the number of eight or nine tierp. About one hundred ami fifty students occupy these, and pack pretty closely, especially on the lower rows, whence the best view can be obtained . For an ssemb'age of young men between 18 and 28. who have nothing to do but to wait, they are tolerably well behaved and quiet. Three or four practina' jokers, it is evident are distributed anong them, and so the time passes all the quicker for the rest. The clock has struck 2, when the folding doors open and *n'er three of the leading surgeons of the College hospital, including the renowned Dr. Cross, followed by a staff of Jressers and a few professional lookers-on, the latter occupying seats reserved for them on the. lowest and innermost tier. A small table covered with instruments occupies a place on one si^e of the area ; water, spongen, towels, and lint are paced on the other side. The surgeon who is going to operat* ropidly glances over the table and soes that his instruments are all there and m readiness. He quietly requests a colleague to take charge of the tourniquH. and with a word deputoß one assistant to take the ' flaps/ another to-bold th« limb, a third to hand the instruments, and the last to rake charge of the sponges. ihis done and while the patient is inhaling chloroform m an adjoining apartment under the oare of a gentleman who wakes that his special duty, the operator giv a s to the now hushed anrJ list ning auditory a brief history of the CTcnmstancs which led to an incurable disease of the left knee joint, and' the reasons why he decides on the operation about to be performed. Ho has s n arcely closed his address "^hpn the unconfHons patient is brought mby a couple of starry porters arid laid upon the operating table — a small but strong and steady erection four feet long by two feet wide, which stands m the centre of the area. The left being the doomed leg, the right is fastened by a bandage to one of the supports of the table, so as to be out oi harm's way ; while the dreaser, who has special charge of the case, is seated on a low stool at the foot of the table and supports the left leg. The surgeon who is assisting places the tourniquet round the upper part of the thigh, with the pad over the femoral artery (the chief vessel which supp ies the limb with blood) and prepares to screw up the instrument, thus to make sure that no considerable, amount of the vital fluid can ba lost The operator s.ahding on th° left of his unconscious patient, and holding m hia hand a narrow, straight knife, of which the blade is at least ten inches long, directs his eye to him who gives the chloroform, and awaits the signal that tho patient has become insensible. All is silence profound. All the assistants stand m their places which are carefully arranged so as not to intercept the vitw of those around. The words 'quite reedy' are no sooner whispered than the operator, grasping firmly with his left hand the flesh which forms the front part of the patient's thigh, quietly and deliberately thrusts the sharp blade horizontally through the limb, from its outer to its inner side, so that the thigh is transfixed a little above its central axis and m front of the bone. He next cuts directly downward, m the plane of the limb, for about four inches, and then obliquely outward, so as to form d flap, which is seized and turned upward by the appointed assistant. A similar transfixion is again made, commencing at the same spot, but the knife is this time carrier! behind »h> bone • a similar incision follows, and another flap is formed and held away as before. Lastly, with a rapid circular sweep he divides all uncut, and then, handing 1 the kni f e to an assistant, who takes it and gives a saw m return, the opera*or divides the bone with a few workmanlike strokes and the leg is severer! from the booV. A rustling sound of general movement and deeper breathing is hea d among the lookers on, who havo followed with st-aining and critical eves evpry act which has contributed to the accomplishment of th« task, and Rome on ■» of the younger students is heard to whisper to bis neighbour:— 'Tbirty-five seconds — not bad for him.' The operator now se*ts himself on the stool just vaca'ed by the dresse , (who has carried away the leg), and seeks m the cut surfaces before him the end of the main artery on which to place a ligature. There is no fl <w of blood, only a little oozing, for the tourniquet holds life's current hard and fast. Only five minutes' uncontrolled flow of the current from that great artery now so perfectly com pressed, and our p ttient's career m this world would bs closed for ever. Ho«v is it permanently held m check ? and what have we to substitute how for the hissing, sputtering iron, and the boiling pitch ? The operator takes a hold of the cut end of the artery with a slender, delicately made pair of forceps, and draws it out a little, whi'e an assistant passes round the ends of the so drawn out a ligature of exceedingly fine whipcord, fine but strong, and carefully ties it there |wifch doub'e knot, thus effectually closing the vessel. A similar process is applied to perhaps six or seven other but smaller vessels, the tourniquet is removed, and no bleeding ensues. Altogether the patient has lost little, more than half a pint of blood I The flips are placed m apposition, the bone is well covered by them ; a few stiches are put through their edges, some cool, wet linen is applied all around the stump, and then the patient, slumbering peacefully is carried off to a comfortable bed ready prepared m some adj icent ward, i Half an hour hence that patient will ' regain consciousness, and probably the [first observation he makes will be

•When is that operation going to begin I }' And it take* no little repetition of the assurance that all is over to make him realize the happy truth. So it is that he who loses the limb knows less about the process than any one concerned ; infinitely less than we who have sat m the quiet corner and have seen all without losing consc : ousne3B or fainting. It was an early day m the medical session, an ' many new men were there ; one, at least; was observed to turn very pale, and then slowly disappear— no one knows where, for neither we m the area nor those elsewhere had leisure or cared to inquire.