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bgent
04-09-2009, 04:12 PM
ideally a surgeon would have prefured to sever a leg, arm or foot at the joint am I correct? so how would they have removed the patella? are there any diagrams of this?

retter
04-09-2009, 05:17 PM
If you "google" amputations you will find more than you ever wanted to know. That is how I started my reference files. Plus there are a myriad of original period manuals you can download That describe each step although not all of them have plates to go along with them.

hanktrent
04-09-2009, 05:31 PM
Good topic! Amputation by disarticulation at the knee was discussed quite a bit in the period. CS Surgeon General Moore reported, in his Manual of Military Surgery, 1863:

The statistics of both French and English armies in the Crimea would seem to demonstrate [disarticulation at the knee] to be a less successful operation than section in the lower third of the femur; indeed, it is almost as fatal as amputation at the middle of the thigh. A more extended comparison, however, of the results of European and American practice, military and civil, gives a per centage of six and a half in favor of the knee-joint operation. Its advocates claim that the liability to hurtful retraction of the soft structures, to ulceration of the cicatrix, and to pyaemia, is not so great as when the femoral condyles are removed; and that, when successful, it gives a longer and more useful stump.

Both the circular and flap methods of amputation were used, though in general, the consensus appears to be that the patella should be left if possible, to create a surface for the prosthesis as if the knee were flexed.

However, not everyone agreed. Here (http://books.google.com/books?id=JgT2G7TJsokC&pg=PA49&dq=amputation+patella+date:1860-1865&lr=&as_brr=0&as_pt=ALLTYPES&output=html)are instructions, with illustration, for amputating just above the patella with the flap method, sawing off the condyles. Of course in this surgery the patella is removed, as it's retained with the lower part of the limb. Though the author says he prefers a long anterior flap, the illustration seems to show a long posterior flap, based on the dotted line.

This author (http://books.google.com/books?id=eYGMBz5w4-8C&pg=RA1-PA120&dq=amputation+patella+date:1860-1865&lr=&as_brr=0&as_pt=ALLTYPES&output=html)makes note of the above procedure, but says, "as the operation came to be repeated, it was deemed preferable to dispense with the large posterior flap, and also to leave the femur untouched." He mentions a surgery with an anterior flap, where the patella is retained. He also mentions a surgery where the patella was removed, the condyles were retained, and flaps of equal length were used. That seems like the worst of all options, as far as making a comfortable stump, but what do I know? The patient died, so there's no report on the long-term outcome.

This author, (http://books.google.com/books?id=3cwDAAAAYAAJ&pg=RA4-PA507&dq=amputation+patella+date:1860-1865&lr=&as_brr=0&as_pt=ALLTYPES&output=html) notes that amputation through the knee joint was unusual, and he never saw a case until the Crimea. He discusses why surgeons had prejudices against disarticulating the knee and why they chose to saw off the condyles and remove the patella when they did amputate in that area. On the next page, he explains the advantages of disarticulation leaving the patella, especially as it helps with the use of artificial limbs.

So that gives a few different views, and a few instructions, from the available literature.

Hank Trent
hanktrent@voyager.net

Micah Trent
04-09-2009, 07:39 PM
There was a book written by Robert Druitt in 1850 called The Modern Principles and Practice of Modern Surgery. Nicky Hughes had bits from it that was edited in the Civil War Historian July/August 2006 Volume 2 Issue 3.
It might be worth checking out if you can get access to it.

hanktrent
04-09-2009, 08:07 PM
There was a book written by Robert Druitt in 1850 called The Modern Principles and Practice of Modern Surgery. Nicky Hughes had bits from it that was edited in the Civil War Historian July/August 2006 Volume 2 Issue 3.
It might be worth checking out if you can get access to it.

The full text of the 1858, 1860 and 1867 editions (http://books.google.com/books?lr=&as_drrb_is=q&as_minm_is=0&as_miny_is=&as_maxm_is=0&as_maxy_is=&q=inauthor:Robert+inauthor:Druitt&as_pt=ALLTYPES&as_brr=1)are online at google books, as well as another 1865 surgery manual by him.

Honestly, as someone noted above, there are more surgery manuals online (http://books.google.com/books?lr=&as_brr=1&as_pt=ALLTYPES&q=intitle%3Asurgery+date%3A1860-1865) today than the average surgeon would have had access to in the period.

Hank Trent
hanktrent@voyager.net

Micah Trent
04-09-2009, 08:41 PM
Thanks for the link there Hank. I tried myself a while ago to post the link I found, but my server went down.
I agree and I am amazed at the amount of early practice manuals and books that can be pulled up on the net. Now if I only had the smarts to obtain what I read and apply it somehow.;)

bgent
04-10-2009, 09:16 AM
so my guess would be about even and left up to the discressin/ schooling of the individual thanks for the links the so called flap method was common.

It's amazing how they learned these proceedures especially since many never saw or treated a gunshot wound prior to millitary service. Then again as hank pointed out the patient died anyway. Ah yes no wonder they called this war a grand experment