Abutment

“ After the amputation, of a foot or a finger, it has frequently happened, that an injury being offered to the stump of the amputated limb, whether from cold air, too great pressure, or other accidents, the patient has complained, of a sensation of pain in the foot or finger, that was cut off. Does not this evince that all our ideas are excited in the brain, and not in the organs of sense? ”

“ In ordinary surgical language the name Amputation is applied to all cases of removal of limbs, or portions of limbs, by the knife, though in strict accuracy it should be restricted to those cases in which a limb is removed in the continuity of a bone, its removal at a joint being called a Disarticulation. ”

“ Almost always when the will is exerted to move the toes, actual contraction may be perceived in the muscles of the stump. One might, therefore, expect that where the toe-moving muscles were cut off, the sense of the toes being moved might disappear. But this is not the case. I have cases of thigh amputation, in which all the foot-moving muscles are gone, and yet in which the feet or toes seem to move at will. And I have cases of lower-leg amputation in which, though the foot-moving muscles contract in the stump, the toes or feet feel motionless. ”

“ In other words it is necessary that there should be a drop or fall, or at least the weight of the body, to produce the characteristics of hanging. The jerk of the fall or sudden dependence of the body upon the ligature causes a much greater constriction of the ligature on the neck, and in a different direction, than in strangulation; and also a much greater pressure on the blood-vessels and nerves of the neck. ”

“ A nineteen-year-old girl and a man in the forties, who had each but one normal hand, the other, instead of fingers, having only little prominences of skin without bones or muscles, thought they bent their absent fingers when they bent the deformed stump. Tickling these eminences, or binding a string about the fore-arm, caused the same sensations as in amputated persons, and a pressure on the ulnar nerve made the outer fingers tingle. ”

“ In an amputation, we often see in the stump the end of the divided fibres alternately lengthen and contract; a double motion both of which appears to be equally vital. 3d. In many kinds of convulsions in which the extremities stiffen, in those, for example, which accompany most hysterical fits, it appears that there is a very evident active dilatation; by placing in fact the hand upon the muscles which should then be relaxed, from the disposition of the parts, we perceive a hardness as great as in feeling of the contracted muscles. ”

“ He said to my father, whom he knew to be a man of an uncommonly firm mind, "I know you will not be alarmed, Sir, but we must have good advice and assistance, or your leg is in such a state that I fear amputation may be necessary. ”

“ The place made choice of for the puncture, is commonly at a middle distance between the navel and the pit of the stomach, but often as much nearer to, or farther from either as the operator, after a due scrutiny, thinks most proper; and in this, and the judging rightly how deep the needle must be thrust below the skin, so as to reach the seat of the morbific matter, and giving it a proper vent, consists the main skill of the artist, and the success of the operation is said to depend. ”

“ The imp jumps upon the man’s knee, and the heart—it has lost its red colour, and its flesh-like look, and as though all the blood had been discharged from it, is white as a rag, save that the veins show through it all black—yes, black as ink; the heart, nicely fitted by the imp, beats again in its place inside the sleeper. ”

“ It is the joint that cannot be moved, not the muscle which has lost its power. I prefer, therefore, in doing this operation, in cases of some standing, to make a short crescentic flap by an incision across the anterior part of the shoulder, as in the operation of amputation, which, on being turned up, leaves the joint exposed. ”

“ I found one man in my rounds who had suffered an amputation of an arm, close to his shoulder, and in his sleep afterward had fallen from his narrow bed on to the bare, unhealed stump, and was in great agony of body. ”

“ To a philosopher such questions as this must arise: Has the appendix at its entrance a sphincter muscle similar in action to that of the rectum and œsophagus? Has it the power to contract and dilate?—contract and shorten in its length and eject all substances when the nerves are in a normal condition? And where is the nerve that failed to execute the expulsion of any substance that may enter the cavity of the appendix? Has God been so forgetful as to leave the appendix in such condition as to receive foreign bodies without preparing it by contraction or otherwise to throw out such substances? ”

“ The same thing is to be done when two hands fall down into the vagina; and in like manner, when the feet come down, and the rest of the body does not come along, we must amputate at the groins, and then endeavour to turn the rest of the body. ”

“ With every nerve keyed up and his reflexes answering his keen brain, he swayed backward and forward, rolled from side to side until his shoulder-blades were thrown completely out of joint. The pain was intense, but he summoned every ounce of strength at his command and finally succeeded in getting one of his arms free by gradually working his body toward a settee, where, with his elbow on the seat, he pushed his disjointed arm over his head. ”

“ When adhesions are present, abduction beyond 10 degrees is impossible. Demonstrable effusion is not uncommon, but is disguised by the overlying tissues. If left to himself, the patient tends to maintain the limb in the “sling position,” and resists movements in the direction of abduction and rotation. ”

“ That a blow struck when a man is thrown or down, shall 207 be deemed foul. That a man with one knee and one hand on the ground, or with both knees on the ground shall be deemed down; and a blow given in either of those positions shall be considered foul, providing always, that when in such position, the man so down shall not himself strike or attempt to strike.
16. That a blow struck below the waistband shall be deemed foul, and that in a close, seizing an antagonist below the waist, by the thigh, or otherwise, shall be deemed foul. ”

“ Slippered if not booted, blanket-wrappered if not coated, shaven at least, if not shorn, he had established himself fairly comfortably, late in the afternoon, at his big study-table close to the fire, where, in his low Morris chair, with his books and his papers and his lamp close at hand, he had started out once more to try and solve the [88] absurd little problem that confronted him. Only an occasional twitch of pain in his shoulder-blade, or an intermittent shudder of nerves along his spine had interrupted in any possible way his almost frenzied absorption in his subject. ”

“ Amputation Stump Aches.—An interesting example of the influence of mind over body, when circumstances favor its exercise or emphasize it, and at the same time a striking illustration of the potency of suggestion in the cure of discomfort, is found in the stories that are so common of cases of pains in amputation stumps. ”

“ Amputation of the Upper Extremity.—The extreme importance of the human hand, its tactile sensibility, its grasping power, and the irreparable loss sustained by its removal, render the greatest caution necessary, lest we should remove a single digit or portion of one that might be saved. ”

“ I only saw one case of a man who had been so punished, but many are those who have the tendons of arms and legs cut—a favourite punishment which gives the most dreadfully painful appearance to those who have undergone it. ”

“ Remembering these points, we find that certain things require our attention, and certain difficulties are present in amputation of the fore-arm, from which amputation of the arm, with its single bone and copious muscular covering on all sides, is completely free. ”

“ Amputations are always necessarily{114} nearer the centre than the corresponding excisions, and statistics show that the fatality of operations increases in exact proportion as they approach the centre.
A successful excision, especially in arm, saves a limb nearly perfect; an amputation at best is only the stump for a wooden one. ”

“ Amputation, at any point between the wrist and elbow-joints, requires, in all, the same method of incision, but the nearer to the elbow the better is the stump; at the wrist the flaps are composed principally of integuments and tendons, and the cushion so formed for the bones is very inferior to one of muscle. ”

“ If I move my arm slowly and attend to my feelings, I am conscious of a peculiar impulse immediately preceding each muscular contraction, which I feel to be the cause of the latter. If I temporarily paralyze my arm by compression of the nerve and repeat the experiment, no muscle contracts, but I distinctly feel the impulse referred to. ”

“ Henry then pointed to the place upon the bandage, underneath which the cut lay, and she showed also the direction and length of the cut.
“Exactly,” said the doctor. “You could not have cut your ankle, Phonny, in a better place. A half an inch more, one side or the other, might have made you a cripple for life. [Pg 163] You hit the right place exactly. It is a great thing for a boy who has a hatchet for a plaything, to know how to cut himself in the right place.” ”

“ Acupuncture is performed first in the hollow of the elbow of each arm, and is regarded as successful if blood flows from the wound. If the blood does not appear, the case is regarded as grave, and the operation is repeated in the abdomen, with drawing back and forth of the needle. ”

“ And it is said that what a woman shrinks from—in the early days of her marriage—she shakes down to with comfortable indifference in half a dozen years. But that is much like saying that the amputation of a limb is no affliction, since a person gets comfortably accustomed to the use of a wooden leg or arm in the course of time! ”

“ He heeded me not, but holding me fast by the thighs commenced shoving in and out furiously. A sensitive woman never receives an insertion of this kind with impunity. The friction began to excite feelings that first deadened the pain of entrance, and then began to awaken the delicious sensations of lubricity. The enjoyment I began to experience was delicious, and I could not refrain from heaving up to meet his thrusts. ”

“ Tentative bankruptcy acts afford good illustrations of the manner in which organisms have been developed. The ligaments which bind the tendons of our feet or the valves of our blood vessels are the ingenious enterprises of individual cells who saw a want, felt that they could supply it, and have thus won themselves a position among the old aristocracy of the body politic.
The most incorporate tool—as an eye or a tooth or the fist, when a blow is struck with it—has still something of the non-ego about it ”

“ Amputation is usually called for if there is complete absence of pulsation in the distal arteries and if the part beyond is cold. If at the same time important nerve-trunks are lacerated, so that the function of the limb would be seriously impaired, it is not worth running the risk of attempting to save it. If, in addition, there is extensive destruction of large muscular masses or of important tendons, or comminution of the bones, amputation is usually imperative. ”

“ Deftly with little soft, darting touches, interrupted only by rubbing her knuckles into her own tears, she reached out and eased successively the bruise of a buckle or the dragging weight on a little cramped hip. ”

“ If you can find a good, stout, willing butt—a butt who lends himself to nicknames, and has a temper as even as a billiard-table and as long as a tailor's bill—secure him at once and make him the nucleus of your crew. ”

“ He had been thrown from a vehicle and had broken his arm, which was so unskilfully set that it became inflamed and swollen, and the clumsy surgeon talked of amputation. Imagine the feeling of such an artist at the idea of losing his right arm! ”

“ Naturally the results thus attained must always be imperfect; but however little perseverance and ingenuity he may possess, the patient finds that he is able to educate the remaining arm, even when it is the left, to replace the amputated one in a way that is often remarkable. ”

“ Abduction is the relative power of the external muscles to turn the eyes outward. Prism power base in and apex out is employed. To determine abduction, or the amount of divergence of the external rectus muscle of the right eye, prism power with base in or toward the nasal side should be employed. The rotary prism will therefore remain in the same relative position as in making the adduction test (Fig. 22) , with the two cyphers (0) or zero graduations vertical, but the indicator or red line should be rotated inward from zero, or towards the patient’s nose. ”

“ All in contracting have to overcome the resistance of the antagonists. 3d. As in each motion there is always a fixed point, the effort which, after contraction, is carried upon this fixed point, is entirely lost. 4th. Various frictions injure also the motion. 5th. The obliquity of the insertion of the muscles upon the bones, an obliquity that approaches nearer a horizontal than a perpendicular direction, an obliquity not less remarkable for the fleshy attachments upon the tendon or aponeuroses, offers a double cause of weakness. ”

“ For, painted upon the back of the man's perfectly bald head, painted with the most consummate skill, giving the startling illusion of depth and relief, and all the hideous expression that had terrified one man at least out of the world, was the face of the abbot. ”

“ December 24.—The patient's condition is more than ever deplorable. On the slightest provocation—indeed, on no provocation at all—furious torsion movements force the head backwards and to the right, while the right shoulder rises. ”