Elective Amputation: From the 18th Century to 1846

"The amputation of a limb is an operation terrible to bear, horrid to see, and must leave the person on whom it has been performed, in a mutilated and imperfect state; but still it is one of those which becomes, in certain circumstances, absolutely and indispensably necessary."

Pott, 17791

In Chapter 6 we traced the introduction of elective amputation, hastened by revolutionary and destructive gunshot injuries, due principally to navy and army surgeons, and emphasised its haphazard and empirical evolution. From the 18 th to 20th centuries, the contribution of military surgeons remained important but, concurrently, civilian practitioners, medical science and technology advanced more rational and humane solutions which escalated decisively during the late 19 th and 20 th centuries.

From the beginning of the 18th century until the discovery of general anaesthesia in 1846, patients continued to undergo amputation without satisfactory pain relief in what some have called the heroic era of surgery. If attempts to improve techniques took place, these were restricted by primitive surgical science based principally on detailed studies of anatomy, combined with gross pathology post mortem and simple chemistry. John Bell commented in 1801:

"Anatomy... is indeed the basis of medical education, the only one which will be acknowledged by any sensible and well informed man. Chemistry, physiology, pathology, all look back to the structure and functions of the human body, and twine themselves round this great trunk."2

As microscopes improved and pathological studies intensified, diagnosis became more accurate, resulting in improved operative techniques, equipment and instrumentation. If as a consequence advances were made to counter major haemorrhage and to improve the quality of amputation stumps, no permanent measures evolved to reduce the equally dangerous complication of lethal wound sepsis nor to abolish the pain of surgical operations. Of the positive contributions to amputation surgery, most involved new operative techniques devised by 18th-century surgeon-anatomists such as Dionis, Jean-Louis Petit, Heister, Cheselden, Le Dran, Benjamin Bell and Hey, whereas from midcentury agitation to change the timing of amputation or to avoid amputation became a particular debate of military surgeons such as Faure, Ravaton, Bilguer and Larrey. In addition, this period witnessed the first attempts to establish alternative operations to avoid the mutilation of amputation completely.

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