The practice of surgery . essel between the compressing agentand the first rib. The patient may be either seated or recumbent. Theformer position is the more convenient for the operator, as well as forthe compressor; but, if it be adopted, it is necessary to secure thepatient against changing his position, through fainting or restlessness,by lashing him to the back of the chair by means of a sheet or towel, aswell as by a suitable arrangement of supporting assistants. And nowthat chloroform is almost invariably employed, this posture is generallysuperseded by that of recumbency. In cases of in
The practice of surgery . essel between the compressing agentand the first rib. The patient may be either seated or recumbent. Theformer position is the more convenient for the operator, as well as forthe compressor; but, if it be adopted, it is necessary to secure thepatient against changing his position, through fainting or restlessness,by lashing him to the back of the chair by means of a sheet or towel, aswell as by a suitable arrangement of supporting assistants. And nowthat chloroform is almost invariably employed, this posture is generallysuperseded by that of recumbency. In cases of injury, the selection offlaps, as to position and form, may not be left to the surgeons choice;but may have been already indicated by the nature of the space and opportunity for selection are afforded, however, theoperation may be accomplished in a variety of ways. The method by transfixion, and by the formation of an outer andinner flap, is so generally preferred and practised, that to it alone need Fig. Amputation of tlio Shoulder. attention be directed. The steps of the operation vary according to thelimb operated on. In the right shoulder it is effected thus: A longknife is entered on the top of the shoulder, about an inch below theacromion; and, passing round the joint, on its exterior, is brought outimmediately within the posterior border of the axilla. By cutting out- AMPUTATION OF THE TOES. 695 wards and downwards, a large outer flap is formed. The arm is thencarried across the chest; and the head of the bone, thus made promi-nent, is cut down upon by a sweep of the knife. The capsule is opened,and disarticulation effected; and the blade of the knife, laid on theinside of the head of the bone, is carried rapidly inwards and down-wards, so as to form an internal flap, considerably smaller than theother. The main artery is immediately secured by ligature; and thenpressure on the subclavian is removed, lest, by its continuance, venoushemorrhage should be
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