Amputation—cutting off all or part of a leg or arm—has been practiced since earliest times, but only out of desperation in cases of crushed or mangled limbs. It was a desperate measure because the patient was highly likely to die from bleeding after the amputation was performed. From the time of Hippocrates (460-370 B.C.) until the 1500s, the reluctant amputations that were performed usually cut through dead rather than living tissue because the dead tissue did not hemorrhage. Stumps were then cauterized with red-hot irons or boiling oil or tar, which stopped most bleeding and was also considered to help prevent rotting. The German surgeon Fabricius Hildanus ( Wilhelm Fabry; 1560-1634) used a red-hot knife for amputations, which accomplished both removal of the limb and control of bleeding at the same time. Cauterization was, of course, terribly painful to the unfortunate patient. A giant step forward in amputation was made by the French surgeon Ambroise Paré in the 1500s. Paré, an unschooled provincial, gained his surgical knowledge in service on the battlefield. By Paré's time, gunpowder had made battlefield injuries so devastating that amputation was now commonplace, at least for soldiers. Even amputation at the thigh, which previously had been very rare because of the extremely heavy (usually fatal) bleeding, was now often necessary. Paré's great improvement in amputation surgery was ligature--tying off of the blood vessels rather than cauterizing. Earlier surgeons, such as Celsus (30 B.C. -50 A.D.), Avicenna (980-1037), Guy de Chauliac (1300-1368), and Giovanni de Vigo, had advocated ligature, but it was Paré who developed a successful technique to carry it out.
He also devised a curved instrument he called a crow's beak to draw out the severed blood vessels. Paré began using ligatures in 1552 and described the technique in his Ten Books in 1564. Although Paré's method was effective, it was impractical because of the large number of blood vessels involved in major amputations. A method of controlling bleeding until the surgeon could tie off all the vessels was needed. This control was finally provided by the effective tourniquet designed by J. L. Petit (1647-1750) in 1718. Earlier versions of the tourniquet had been used by, among others, Fabricius and then Morel in the 1600s. Petit's screw tourniquet was fixed to the lower abdomen and put direct pressure on the main artery. With bleeding controlled by Petit's tourniquet, Paré's ligatures were now practical. Amputations on the battlefield were carried out swiftly and in great number. The French surgeon Dominique-Jean Larrey performed 200 amputations in one day during the Battle of Borodino in 1812. Unfortunately, while patients no longer died routinely of bleeding during an amputation, many--often most--died of infections afterward. It remained for Joseph Lister (1811-1886) to introduce antiseptics for amputation to become a successful procedure, and as modern physicians learned new, effective ways to treat illnesses and infections, amputation steadily became less necessary.
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