Amputation
Collier's New Encyclopedia (1921)
the cutting off of a part which, by its injured or diseased condition, endangers, or may endanger, the safety of the whole body. The amputation of a limb was in ancient times attended with great danger of the patient's dying during its performance, as surgeons had no efficient means of re- 7 シン AMPHITHEATER IN THE NATIONAL CEMETERY AT ARLINGTON straining the bleeding. The desired power of controlling the hemorrhage was obtained by the invention of the tourniquet in 1674, by a French surgeon, Morel, and its improvement early in the next century by his countryman Petit. The ancient surgeons endeavored to save a covering of skin for the stump, by havthe skin drawn upward by an assistthe ing ant, previously using the knife. In 1679 Lowdham of Exeter suggested cutting semicircular flaps on one or both side of a limb, so as to preserve a fleshy cushion to cover the end of the bone. Both these methods are now in use, and are known as the "circular" and the "flap" operations; the latter is most frequently used in this country. The question when amputation of a limb is necessary, is often, especially after an accident, one of the most difficult in surgery. The chief indications for it in these cases are very extensive destruction or laceration of the skin; injury to the large vessels or nerves; severe splintering of the bones. The diseases most commonly requiring it are disease of bones or joints, especially when the discharge from it threatens to exhaust the the patient; tumors, especially cancer and sarcoma, which cannot other wise be removed; and gangrene.
What Has Changed in the Last Century
Collier's in 1921 framed amputation chiefly as a response to accidents, bone and joint disease, tumours and gangrene, and treated the control of bleeding — Morel's tourniquet of 1674, Petit's improvement — as the great enabling advance. Antibiotics, blood transfusion and modern vascular surgery have since removed most of that urgency: infected wounds and diseased joints are now usually saved rather than cut off, and bone cancers such as osteosarcoma, which the entry lists as an indication, are commonly treated by chemotherapy with limb-sparing surgery. Severed limbs can now sometimes be put back: the first successful replantation of a human arm was performed by Ronald Malt in Boston in 1962, and microsurgery has made finger and hand replantation routine. The commonest reason for amputation in wealthy countries today is not trauma or tumour at all but diabetes and peripheral arterial disease, and stumps are increasingly fitted to myoelectric limbs or to metal anchors implanted directly into the bone.
Written for this edition, 2026.