History of a successful case of amputation at the hip-joint : (the limb 48 inches in circumference, 99 pounds weight) / by J. Sampson Gamgee.

  • Gamgee, Sampson, 1828-1886.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: History of a successful case of amputation at the hip-joint : (the limb 48 inches in circumference, 99 pounds weight) / by J. Sampson Gamgee. Source: Wellcome Collection.

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    (pi. 2), and the limb suspended in the sling, Mr. W. Jones, our junior medical officer, was entrusted with the pulley-rope, Mr. T. Thompson, house surgeon, holding and directing the foot. My colleagues, Mr. Sands Cox, Mr. Furneaux Jordan, and Mr. J. St. S. Wilders, respectively took charge of the anterior and the posterior flap and the aortic tourniquet. In the unavoidable absence in the country of my colleague, Mr. J. F. West, I was favoured with the additional assistance of Mr. George Yates, To avoid misunderstanding in the following description, I beg to recall the extent of the tumour towards the trunk. Anteriorly, the limits were as follows,—the points being accurately measured to the upper edge of the tumour at its base: from the antero- superior spinous process of the ilium, inches; from the centre of Poupart's ligament, 4 inches, and from the right spine of the pubis, 5 inches,—the central measurement being the shortest, whereas it required to be the longest for making a well-shaped semi- elliptical flap. This, however, was out of the question, for I was clearly short of cover in front, especially in the middle line and just on its inner side. To compensate, the state of things was more satisfactory at the back, where the upper boundary of the diseased mass corresponded nearly to the level of the natal fold; but the tissue of the latter was loose and abundant, especially just where I was in need of material to make up for the anterior deficiency. I selected a straight and stout backed, narrow, and long bladed knife. The limb being raised in the pulley-sling, a little higher than is shown in plate 2, to relax the parts at the groin, I introduced the point of the knife only just in front of, and quite close to, the tuberosity of the ischium; felt my way deliberately outwards and upwards for the head of the bone, transfixed the capsule, and then thrust the point quickly upwards, to come out as high as the antero-superior spine of the ilium, and just behind it. With the anterior half of the knife, holding the handle as a pivot, I cut the arc of a circle from the point of issue downwards to nearly the middle line, close to the tumour, and necessarily nearing Poupart's ligament; I now depressed the point of the knife, and with its heel cut the segment of a smaller circle to join the' former one, dividing the great vessels at the point of union. This line may supplement my description of the anterior incision :