ed, otherwife much injury may arife from it. Some advantage, however, in certain cafes, has been derived from the ufe of the common collar, (fig. 111. Pl. 327.) or the ftays and machinery adapted to them, (fig. 112. Pl. 328.) invented in France, and afterwards brought into ufe in this country by Mr JONES of London, are found to be ftill better fuited to this purpose. 789. The fame caufes which produce diflortions of the fpine, may likewife produce diftortions of the limbs. Sometimes the distortion takes place with the original formation of the bones; at other times it occurs in infanes, and now and then at a more advanced period of life. In early infancy the bones are fo pliable as to be readily affected by the potures of the body. When a child is too foon allowed to attempt to walk, its legs are apt to become crooked from their inabi. lity to fupport the weight of the body, Certain difeafes likewife, efpecially rickets, foften the bones fo much, that they yield to the pofture of the body, and to the common action of their muscles. 790. When the distortion of a limb is owing to a curvature in a bone, if the cafe be recent, and efpecially if it occur in childhood, it may fre. quently be removed, without much difficulty, by making a gradual but conftant preffure, by the ufe of the machinery, on the convex fide of the limb, till it recover its natural appearance. When the deformity occurs in the leg, a method has been used, in feveral ingauces, which is to fix a firm fplint of iron, lined with leather, in the fhoe, on the concave fide of the leg, the other end of the fplint to reft against the under end of the thigh, when, if a broad ftrap or two be applied round the leg and fplint, an eafy gradual preffure may be made, and confiderable advantage derived from it. See fig. 113. Pl. 328. 791. Along with the curvature above men. tioned, it commonly happens that the feet and ankles are affected. When the bones of the leg are bent outward, the fore part of the foot is turned inward, and the inner edge upwards; and the reverfe, if the leg be bent inward. In thefe cafes, the affections of the feet are generally owing to the curvature of the bones of the leg. By remov ing the curvature of thefe, the foot will commonly regain its natural fituation, and the splint above mentioned will for the most part be fufficient for the purpose. But in cafes where the fole of the foot is turned much out of its natural direction, it may be neceffary to fix the flint and fhoe to a frame, (fig. 114.) which will render the cure still more effectual, 792. Besides the inftrument already mentioned, fome have used a kind of bost, cut lengthwife, made of hardened leather or of metal, &c. which may in fome cafes fufficiently aufwer the purpofe. 793. In cafes of club feat, where the distortion is in the middle of the toot, a pair of hoes, fuch as are reprefented in fig. 115. Pl. 377. have been found ufeful. After the feet are fixed in the foes, the fore part of the feet may be feparated by means of a screw in two plates, which are fixed to the fole. VOL. XXI. PART II. CHAP. XXXIII. OF AMPUTATION. SECT. I. Of AMPUTATION in GENERAL. 794. IN AMPUTATION, or cutting off a limb, the great end to be aimed at is, the procuring of a handsome flump, in which the bone may not protrude, but be well covered with flesh, fo that an excoriation or rawnefs may be apt to take place. As long ago as the year 1679, it was propofed by JACOB YOUNG, an English furgeon, in a treatife intitled Currus Triumphalis ex Terebinthino, to preferve a flap of fleth and fkin, which was to be folded over the bone, and which, unting to the parts of the wound, after amputation, would effectually cover the bone, and prevent the inconveniences above mentioned. No traces of the fuccefs of this method, however, can be found till 1696; when a Latin differtation was published upon it by P. ADRIAN VERDUIN, an eminent furgeon in Amfterdam. The most fanguine expectations were formed of its fuccefs; and it was even thought that the flap would prevent the neceflity of tying up the blood-veffels. However, it does not appear that the method as at that time practifed either did or could fucceed; and accordingly it was entirely laid afide; but it has been lately revived with confiderable improvements. 795. Amputation is neceffary when a member is fo much difesfed as to be ufeleis, or put life in danger. 796. The caufes in general rendering this operation aeceffary are, bad compound fractures; cxtenfive lacerated and contufed wounds; part of the limb being carried off by a cannon ball or otherwife, the bones being unequally broken and not properly covered; extenfive mortification; white fwellings of the joints; large exoftofes; ulcers attended with extenfive caries; cancer or other incurable ulcers; varicofe kinds of tumors ;particular distortions of the bones. 797. Amputation may also be fometimes necef. fary from violent hemorrhagies of fome principal artery during the cure of a fractured limb, or from fuch a profute difcharge of matter taking place that the strength of the patient is exhaufted. Lacerated and contufed wounds may require amputation, on account of hemorrhagy enfuing which cannot be ftopped. Extenfive amputation may take place, and fuch large quantities of matter be formed, that the patient will be unable to bear up under the difcharge. 798. Where part of the limb is carried off, it is neceflary to amputate higher up, fo as to cut the bone, as well as the foft parts, in fuch a manner as may admit of a much speedier and fafer cure. When mortification occurs, every thing ought to be done for the fupport of the patient till the difeafe be flopped; the first fign of which is, the appearance of an inflamed circle between the difeafed and found parts. As foon as the difcated begin to feparate from the found parts, amputation of the limb ought to be performed, and po time ought to be loft, left the patient fuffer from the abforption of putrefcent matter. 799. No part of furgery is brought to greater X X X X perfection 1 perfection than the manner of performing amputation Before the invention of the TOURNIQUET, and the method of fecuring the veffels by ligature, the operation was feldom undertaken; and a great proportion of thofe upon whom it was performed died foon after. In the prefent improved method, one death does not happen in 20 or even 30 cafes. In performing the operation, particular attention is to be paid to the spot where the incifion is to be made; the quantity of fkin and cellular fubitance neceffary to be faved, fo as to cover the mufcles and bone completely, without being stretched; cutting the muscles in fuch a manner that they may unite with each other and entirely cover the end of the bone; the prevention of hemorrhagies during the operation; the tying of the arteries alone, without including the nerves or any of the contiguous parts; fecuring the integuments fo as to prevent them from re. tracting after the operation, and a proper subsequent treatment of the cafe. 800. The following are the general steps of the OPERATION: The patient being properly placed, with affiftants to attend, and the apparatus in proper order, the flow of the blood to the limb is to be fropped by the TOURNIQUET, (fig. 16. Pl. 324. The first incifion is to be made through the fkin and cellular fubftance by one, or rather by two strokes of the amputating knife reprefented in fg. 116. Pl. 328. Thefe are next to be feparated from the mufcies, as far as may appear fufficient for covering the ftump. The feparated fkin or flap fhould be strongly drawn up, or, what perhaps anfwers better, turned up all round the linh, leaving this part of the mufcles quite bare. The flap is to be kept in this fituation by an affiftant, while the operator makes the next incifion at the edge of the reflected fkin, and cuts till he comes to the bone. This incifion fhould be begun on the lower fide of the limb, that the blood may not prevent the eye from readily following the edge of the knife during the whole cut. The mufcles are now to be separated from the bone as high as may enable them afterwards completely to cover it. The foft parts in general are then to be drawn up by retractors, which may be either of leather, as in fig. 117. Pl. 328, or metal, as in fig. 118. a and b. The periofteum is to be divided at the place where the faw is to be applied; but no part of the bone is to be denuded of this membrane, which is afterwards to cover the ftump, otherwife troubletome exfoliations may enfue. At this place the faw (fig. 119.) is to be applied, and the bone divided with long fteady ftrokes. In this part of the operation a good deal depends upon the fteadiness of the affiftant who holds the limb; for if it be held too high, the motion of the faw will be impeded; while the bone may be splintered, if it be not fufficiently raifed. Any points or fplinters which may be left, fhould be immediately removed with any pincers (fig. 120.) The retractors are now to be laid alide, and the principle arteries separated from the nerves, and fecured by the tenaculum (fig. 17. Pl. 324.) or forceps (fig. 124. Pl. 328.) and ligatures. 801. The tourniquet fhould next be a little Mackened, to allow the different branches to be dif covered; the clotted blood is to be cleared away with a warm fponge. The patient should get fome warm cordial drink, and all the arterial branches which can be difcovered ought to be taken up. The ends of the ligatures are then to be cut of fuch a length as to allow them to hang without the lips of the wound. The mufcies and fkin are now to be drawn down, and brought into close contact, that the ftump may be completely covered. The parts are next to be fecured by proper bandaging; and if the operation has been properly performed, the cure will common. ly be made by the first intention, and may be completed in the courfe of three or four weeks, and fometimes in a fhorter period. This, however, must depend much upon the conftitution of the patient, as well as the inanner of performing the operation. SECT. II. Of AMPUTATING the ARM. 802. AMPUTATION of the arm is performed according to the rules already laid down. No more of it fhould be removed than is difeafed; for the longer the ftump is, the more ufeful it proves. The tourniquet is to be applied a little above the part where the operation is to be performed: as much of the integuments fhould be faved as may be perfectly fufficient for covering the fore. In taking up the artery, after the bone has been divided, the operator ought to be attentive not to include the radical nerve, which may be readily discovered and feparated, as it lies clofe upon the fore part of the artery. The arm is to be amputated nearly in the fame manner as the leg; only that the ftump may be covered by amputating with the double incifion without the affiftance of a flap, which it is necessary to form in the leg. SECT. III. Of AMPUTATING the THIGH. 803. In performing this operation, the patient ought to be placed upon a table of ordinary height, with the difeated limb fupported and fecured by an affiftant feated before him, while other affiftants take care of the other leg and the arms. The courfe of the blood is to be stopped by applying the tourniquet over the trunk of the femoral artery, near the upper part of the thigh. No more of the thigh ought to be removed than is rendered neceffary by the disease, as the more of it is left, the more ufeful it will be to the patient. An affiftant should grasp the limb with both hands a little above the place where the fkin is to be divided, and draw it up as far as poffible; while the operator,.ftanding on the outfide of the limb, makes a circular incision down to the mufcles by one or two strokes of the knife. As much of the integuments is then to be diffected with a fcalpel from the muscles as may cover the ftump completely; and this part of the skin may either be turned back, or drawn tightly up by an affiftant. The muscles may then be divided quite across to the bone by the edge of the skin, in the common way, or cut obliquely upwards, according to the method of Allanion, fo as to lay the bone bare two or three fingers-breadth higher than is done in the common way. The mufcles are next to be separated from the bone with a fcalpe! fipel a little way, that a fufficient quantity may be left for covering the end of it. The reft of the operation is to be performed exactly according to the general rules laid down in the firft fection of this chapter. The mufcles and integuments are to be drawn over the end of the bone, and applied clofely together, that the fkin may completely cover the stump, and retained in this fituation by an iftant till a flannel or cotton roller, according to the feafon of the year, which has been previously fixed round the body, be applied in fuch manner as to fupport and fix them. For which purpofe it fhould be paffed two or three times, in a circular direction, round the top of the thigh, and fhould afterwards, with fpiral turns, be brought down near to the end of the fump and fafened with pins; and it fhould not be tighter than may be fufficient to affift the plafters in preventing retraction. 804. The ends of the divided mufcles are now to be laid exactly over the bone; and the edges of the skin are to be brought into contact, either fo as to form a straight longitudinal line, according to the method of Mr B. Bell, &c.; or they are to be placed horizontally, " that the wound may appear only in a line with the angles at each hde," as advised by Allanfon. The ligatures may either hang over the edges of the wound, or be brought to the angles. After the edges of the kin are in this manner exactly applied to each other, either a few flips of adhesive plafter are to be laid across the face of the flump, or two large pieces of adhefive plafter, with feveral pieces of tape fixed to them, are to be applied to the furface of the kin. The tapes are then to be tied with a running knot immediately over the wound; by which the parts will be kept fo clofely together as to prevent any collection of matter from being formed. The whole furface of the ftump fhould next be covered with a large pledget fpread with an emollient ointment, over which a comprefs of fine tow is to be put, and retained in its piace by a broad crofs ftrap of old linen, paffing fome way up the thigh, so as to be fecured by the roller, which is now to be paffed two or three times round the ftump, and the prefiure formed by the cross ftrap may afterwards be increafed or diminished at pleasure, by drawing it with more or lefs tightness, and fixing it with pins to the rolier. While the ftump is dreffing, the tourniquet is removed, but replaced again loofely to enable the attendants to check any hemorrhagy which may afterwards entue. 805. The patient is now to be laid to reft, and the limb is to be placed upon a little tow covered with linen, or upon a thin fott pillow; and to prevent the patient from involuntarily moving the limb, and to guard againft fpafmodic ftartings, which frequently happen after this operation, it may be fixed to the bed by two ftraps. A basket or hooped frame ought to be placed over the Stump to protect it from the bed clothes. The patient fhould immediately get an anodyne draught which will generally procure ease through the reft of the day. For this purpose, no more light fhould be let into the room than is merely neceflary for allowing the attendants to pay attention to the Hump. As hemorrhagies fometimes appear feve ral hours after the operation, the person who takes the charge of the patient fhould watch this circumitance with the greateft attention. If there be only a flight oozing of blood, there is no occafion for being alarmed; but whenever it appears to proceed from a large artery, it must be iccured. The fpafmodic affections which frequently occur after amputation are feldom troublefome, uiefs fome nerve has been included in fecuring the arteries; but when they do appear, laying the limb in the eafieft pofture, and giving opiates, are the principal means of procuring relief. 806. To prevent inflammation as much as poffible the patient is to be kept upon a ftrict antiphlogistic regimen, and his bowels kept open by laxative clyfters, till the inflammatory ftage is c ver, which will generally be in a few days. If, notwithstanding this treatment, the ftump wells, and the patient complain of pain and tightnefs, we ought to endeavour to difcover from what caufe the unealinefs originates. If it be owing to the traps being too tightly fixed, they mutt be nackened. It the ftump be found much fwelled, a faturnine folution should be applied by means of feveral folds of Jinen; and it the patient be young and plethoric, he ought to lole a few ounces of blood from the arm; but if he is weak and emaciated, a different mode of treatment must be followed. 807. At the end of the 3d or 4th day at fartheft, the ftump fhould be examined; and if it appear fomewhat open and flaccid, the paris mult be brought closer together and fecured more firmly. After this time dreffings thould be renewed every day, or every 2d day. In about a week after the operation the ligatures may generally be removed with cafe; but if they do not feparate readily they may be gently pulled at every drefling, when they will, in a fhort time, be brought away, and the wound will be foon healed by the firft intention. The roller fhould be cleaned and renewed as often as it is found fullied; nor fhould it be laid entirely afide till the end of the third or fourth week after the operation. When the roller is removed, we may depend upon the ftraps or tapes for keeping the parts together till the cure be quite accomplished. When the inflammatory symptoms are entirely gone, no medicines ought to be given which would debilitate the patient, nor is any thing more neceffary than to keep the bowels gently open till a complete cure be made. SECT. IV. Of AMPUTATING the LEG. 808. THE leg may be amputated for a difeafe in the foot at two different parts; the one a hand-breadth under the knee, the other a little above the ankle. The former makes a fufficient fupport for the body to rest upon an artificial leg ; but the latter does that equally well, and likewite preferves the motions of the knee, 809. In performing the operation a little way under the knee, the patient is to be placed and iccured in the fame manner as in operating upon the thigh. The tourniquet is to be placed a little above the knee, with the cut upon the artery in the ham. The furgeon piaces himtelf upon the infide of the leg, and makes a chcular incifion through the integuments down to the XXXX* the wound. The parts are to be retained by adhefive plafters, or twifed future, or both; and proper bandages applied in fuch a way that a cure may be made by the firft intention. 813. Amputating the arm at the fhoulder-joint has always been confidered as a dangerous as well as a difficult operation. It fhould never be attempted, when the fame purpose can be accomplified by operating lower down. But cafes occafionally occur, where the life of the patient cannot, in any other manner, be faved. Amputation may become neceffary here in confequence of abfceffes of the joint; caries of the humerus reaching to the joint; compound fractures, efpecially thofe from gun-fhot wounds extending to the head of the bone; and mortification. mufcles. The place where the incifion should be made muft depend upon the length of the limb; but in general it may be between fix and feven inches under the top of the tibia in an adult, or far enough down upon the limb to fave as much integuments as will cover the ftump. After the integuments are cut through in the manner already directed, as much of the mufcles are to be divided by the knife as can be done by a circular incifion; and the interoffeous parts are to be divided by a fcalpel or catline, (fig. 100.) The retractors are then to be applied, and the bone fawed off immediately below the infertion of the tendons of the flexor mufcles. In fawing, the operator ought to begin upon both bones at the fame time, that he may finish upon the tibia, left fplinters fhould be formed. The veffels are next to be fecured; the foft parts drawn over the bones; the adhe five plafters and other bandages applied in the fame manner as directed for amputating the thigh, only that here the roller nced not be applied fo high as in the former operation. Two or three turns above the knee, however, are necessary to prevent the dreffings from flipping down. 810. In amputating at the ankle, the operator fhould fix upon that spot which will leave the flump of fuch a length as may be moft convenient for being fitted with an artificial machine refernbling the other leg. Nine inches from the joint of the knee, in a leg of ordinary length, was found by Mr Gavin Wilton, a late ingenious artificial limb-maker in Edinburgh, to be the best part fuited to this purpose, on account of the e. qual preffure it makes upon the furface of the leg, without making any upon the end of the tender ftump. The operation is performed in the fame manner as that a little below the knee. SECT. V. Of AMPUTATION of the JOINTS of the EXTREMITIES. 811. THE circumftances moft to be attended to in performing amputation at the joints are, first to stop the circulation by the tourniquet; or, where that is impracticable, to take up the trunk of the artery by a ligature; to make a circular incifion in fuch a place as may, after the operation is over, be fufficient to cover the wound. Then a longitudinal incifion is to be made upon the oppofite fides of the limb, extending from the joint to the circular cut, and as deep as the bone, by which two flaps will be formed to cover that part of the joint which remains after the operation is finished. The ligaments of the joint are next to be divided, and the affected limb or part of the limb removed. After this part of the operation, it was formerly a frequent practice to fcrape off the remaining cartilage, to unite the parts mere firmly together. But this is now found to be unneceffary; for when the flesh is applied properly to the bone, if it do not grow to it, the union at leaft is so close that it afterwards gives no inconvenience to the patient. 812. Any branches of arteries which may have been cut during the operation are now to be fecured; clotted blood is to be removed; and the mufcies and skin are to be brought into clofe contact with the ends of the ligatures hanging out of 814. In performing the operation, the patient should be laid upon a table of convenient height, covered with a mattress. He is then to be brought as near to the edge of it as poffible, and fecured by affiftants. The circulation of the blood in the arm is next to be stopped, by an affiftant preffing strongly with a firm comprefs over the fubclavian artery where it paffes over the firft rib; or an incifion may be made along the courfe of the artery, which may be fecured after feparating from it the contiguous nerves. When the artery is comprefled, it wi!! readily be known whether the compreffion proves effectual, by obferving when the pulfe at the wrift is entirely ftopped. As foon as this is the cafe, a circular incifion is to be made through the integuments at the infertion of the deltoid mufcle into the humerus. An affiftant then draws the fkin a little back, and at the edge of the retracted skin the mufcles are to be cut in a circular direction to the bone. If the artery has not been taken up at the beginning of the operation, it is now to be fecured, as well as any branches which come in the way. 875. The knife is now to be laid afide, and the rest of the operation finifhed with a strong fcalpel. A perpendicular incifion is next to be made at a little diftance from the outside of the artery, beginning at the acromion, and terminating in the circular incifion, cutting as deep as the furface of the bone. A fimilar incifion is to be made upon the back part of the arm, fo that the flaps may be nearly of an equal breadth. The arterial branches are here to be fecured; the flaps are to be feparated from the bone, guarding againft wounding the trunk of the artery; the flaps are to be fupported by an affiftant; and the capfular ligament of the joint is to be cut from the fcapula: and thus the arm will be entirely feparated. 816. After the arm has been ieparated, any arteries which appear about the joint are to be tied, and all the ligatures brought over the edges of the wound. The parts are to be cleared of clotted blood, and the two flaps drawn over the wound, and fecured by the twifted future. A pledget of any emollient fhould then be applied, and a fufficient cushion of lint, with a comprefs of old linen, put over the whole. A moderate preffure is next to be applied by a flar.nel roller; by which the parts will be supported, their union facilitated, and matter most likely prevented from being lodged. The treatment is then the fame with that after amputation in other parts parts of the extremities. For two or three days after the operation, it is necessary that an affiftant fit with the patient to comprefs the artery in cafe a bleeding fhould enfue. 817. When it is necessary to amputate the whole hand, the operation may be performed at the wrift, fo as to leave as much of the member as poffible; and the fame rules hold here as in amputating at any of the reft of the joints. The tourniquet is to be applied to the artery in the arm, and the cure is to be completed by the firft intention. When any of the carpal bones are affected, the fore will not heal till they either work out by fuppuration, or are cut out by the knife. When the middle of any of the metacarpal bones is diseased, while their extremities are found, the trepan may be applied, and the difeafed parts removed, while the remaining found parts are preferved. But if the whole bodies of one or two of these bones be affected, while the reft remain found, all the affected bones ought to be removed. In performing the operation, an incifion is to be made along the courfe of the part affected; and if the operator have it in his choice, the incifion fhould be made upon the back part, fo as to fave the great veffels and nerves fituated in the palm. The integuments are then to be diffected and turned to each fide; after which the diseased bones or parts of bones are to be removed, guarding as much as poffible against wounding the principal arteries or nerves which lie near them. 818. The difeafed parts are next to be feparated; any arteries which happen to be cut are to be fecured; and, on account of the free communication which they have with neighbouring branches, they ought to be tied at both cut ends. If after this a bleeding ftill continue, comprefs, ftyptics, and other remedies proper for ftopping blood, are immediately to be used. The fides of the wound are to be brought together, and an attempt made to cure them by the firft intention. 819. In amputating the fingers, it was formerly the practice to operate upon the bodies of the bones in the fame manner as in the larger extremities; but at prefent the removal at the joints is more frequently practifed. In performing the operation, it is neceffary to fave as much fkin as may cover the stump, and this ought to be done upon the fide next the palm, fo as to guard against the effects of friction. The general fteps of the operation are the fame with thofe for amputation of the larger joints. 820. A circular incifion is to be made on the finger by a crooked biftomy, about the middle of the phalanx, and it may be carried at once to the bone. 'Another incifion is to be made with a common scalpel at each side of the finger, begin. ning at the circular one and continuing it to the joint, by which two flaps will be left to cover the ftump. The ligaments of the joints are now to be divided, and the bone removed. The bloodveffels are to be fecured by ligature, and the flaps exactly applied to each other; but in order to protect the end of the bone completely, a fmail portion may be cut from the uppermoft flap. The flaps are to be retained by adhesive plafter, or by the twisted future; but if the latter be used, the tendons ought to be avoided. Over the fore an emollient pledget is to be applied, and then a comprefs and roller. If the diieafe be fo fituated, that inftead of amputating at the cavity of the joint, the furgeon fhall think proper to operate upon the body of the bone, flaps are to be formed as above, and the bone is to be divided by means of a fmall spring saw. Plote 328. fig. 122. 821. The amputation of the thigh at the bip joint has always been confidered as one of the most formidable operations in furgery; fo much fo, that very few cafes appear on record of its having ever been put in practice. In the Medical Commentaries of Edinburgh, an inftance is recorded where the thigh was amputated at this joint, and where the patient furvived the operation 18 days, and then died from a different caufe, when all risk of hemorrhagy was over, and when the fore had even a favourite appearance, which shows at leaft that the operation has been done with fafety. It certainly ought never to be done, however, unlefs as the laft refource, and when the life of the patient is in abfolute danger; and then only when as much fkin and muscles can be faved as will cover the fore, and when there is also a probability of being able to ftop the hemorrhagy, and prevent it from returning. 822. When the operation is to be performed, the patient is to be laid upon his back upon a table, and properly fecured by affiftants; one of whom fhould be ready with a firm cuthion to prefs, if neceffary, upon the top of the femoral artery, juft after it paffes from behind Poupart's ligament to the thigh. A longitudinal incifion is now to be made through the skin, beginning immediately under the ligament, and continuing it downwards along the courfe of the artery for about 6 or 7 inches. The aponeurosis of the thigh is then to be divided by gentle feratches till a furrowed probe can be introduced, when the opening is to be dilated by means of a fcalpel, till 2 or 3 inches of the artery be laid bare. A strong ligature is now to be put under the artery by the affiftance of a curve blunt-pointed needle. 823. The parts where the ligature fhould be paffed is immediately above the origin of the arteria profunda; for if that artery be not affected by the ligature, the patient might fuffer by the lofs of blood during the reft of the operation. The liga ture is now to be fecured by a running knot; another ligature is to be introduced a little below the former, and likewife fecured; the artery is then to be divided between the ligatures. A circular incifion is now to be made through the integuments of the thigh, about fix inches from its upper end. The retracted skin is then to be pulled at leaft an inch upwards; and at the edges of it the amputating knife is to be applied fo as to cut the ufcles down to the bone. This being done, a cut is to be made upon the pofterior part of the thigh, beginning a little higher than the great trochanter, and continuing it down to the circular incifion, and as deep as the joint. A fimilar cut is to be made on the anterior part of the thigh, at a fmall diftance from the artery, and this reaching likewife done to the bone. The two mufcular flaps are to be feparated from the bone |