. The science and art of surgery, embracing minor and operative surgery. Comp. from standard allopathic authorities, and adapted to homoeopathic therapeutics, with a general history of surgery from the earliest periods to the present time .. . t maybe altogether removed, with thethumb. The flaps must be brought together by sutures, anddressed as directed heretofore. Disarticulation of all the Fingers at the Metacarpo-phalangeal Joint.*—The main point to be borne in mind is therelation between the heads of the metacarpal bones and the softparts of which the flaps are to be made, viz.: that the
. The science and art of surgery, embracing minor and operative surgery. Comp. from standard allopathic authorities, and adapted to homoeopathic therapeutics, with a general history of surgery from the earliest periods to the present time .. . t maybe altogether removed, with thethumb. The flaps must be brought together by sutures, anddressed as directed heretofore. Disarticulation of all the Fingers at the Metacarpo-phalangeal Joint.*—The main point to be borne in mind is therelation between the heads of the metacarpal bones and the softparts of which the flaps are to be made, viz.: that the line of thejoints is about one inch above that of the webs between thefingers. Operation.—The hand is steadied in the prone position, andthe thumb held out of the way, by an assistant; the surgeonmakes a semilunar dorsal incision, beginning outside of themetacarpo-phalangeal joint of the little finger in the righthand, or of the forefinger in the left, and going close to theroots of the fingers. Dissecting up the skin and superficialfascia, as far as the joints, he next divides the extensor tendons,flexes the fingers strongly, opens each joint, and by touches ofthe knife divides all the lateral ligaments. Now, getting the Fig. Amputation at the metacarpo-phalangeal articulation of all the fingers. 1,2,3,anterior flap; 4, handle of knife making posterior flap. blade of the knife, as in Fig. 440, across the line of the joints,he turns its edge forward, and makes it cut its way out so as toform the longest possible flap from the palmar tissues. *See Amputation of the Hand and Fingers, vol. 1, p. 713. AMPUTATIONS IN THE UPPER EXTREMITY. 793 Amputation through the metacarpus is done much in thesame way, except that both flaps are first dissected up, and then,a five-tailed muslin retractor being applied to protect the softparts, the saw is carried evenly across the bones so as to dividethem all at the same time. Amputation of the little finger is much like that of thethumb,
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