On amputation at the hip-joint / by Richard G. Butcher.

  • Butcher, Richard G. H., 1819-1891.
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On amputation at the hip-joint / by Richard G. Butcher. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    of the flaps; then the limb was depressed to a suitable angle, the thigh slightly flexed upon the pelvis, so as to permit the fair travel of the knife behind the vessels. Standing on the right side of the patient, well over her—and pressure being now safely made effective on the main artery, just above the pubes, the assistant using a large key, well guarded with rolls of flannel round its handle, for the purpose—I entered a long double-edged knife, fully twelve inches in the blade, and three-quarters of an inch in depth, midway between the spine of the ilium and upper edge of the great trochanter, about three-quarters of an inch nearer to the former, the flat surface of the blade looking forwards, and a little downwards, parallel with the plane of the muscle; striking the knife steadily inwards, till it touched lightly the neck of the bone, high up, and so accurately giving evidence of its position, it was glided over the bone, and so safely beneath the great vessels; still onward the blade was passed till it appeared on the inner side of the thigh, and protruded about an inch and a-half between the point of junction between the descending ramus of the pubes, and the tuberosity of the ischium ; the knife was then carried rapidly downwards, close to the bone, for four inches, and then obliquely forwards, cutting loose a flap about six inches long; as the knife made room I passed the fingers of my left hand beneath the flap, making steady pressure, and followed the knife until about to turn it forward to sever the femoral artery, and cut its way out, thus making certainty of effective pressure; the flap being so formed the assistant took charge of it, and in a similar way commanded its vascular supply. During the formation of this anterior flap, while the knife was traversing as it were in a semicircular course, the limb was not only slightly flexed but a little rotated inwards; after this the limb was forcibly abducted, and at the same time depressed. Then the heel of the knife was laid determinedly upon the capsule, over the neck of the bone, and its head unhesitatingly started from the socket of the acetabulum, and then as rapidly as thought, the blade of the instrument was carried behind the bone and great trochanter—severing the round ligament, and completing, by a slight downward movement and then backward, the posterior flap; as the knife formed it, and it became detached, it was firmly grasped both within and without by the assistants kneeling on either side. When the head of the bone was disarticulated, and the knife rapidly passing behind, the assistant who held the limb depressed the knee, and lifted at the same time the head of the bone forwards and B