Unknown, English

Leg Amputation

Reference Type:
mid-18th century
In 1745, surgeons in Great Britain separated from barbers. Prior to that date they were members of the Company of Barber-Surgeons (hence the red and white barber pole). There was a status differential between physicians (Doctor)—who studied at university and used their minds—and surgeons (Mister), who were apprenticed and used their hands and thus considered a variant of tradesman. In 1800 the Royal College of Surgeons was formed. This painting represents surgical education in the interim, which consisted of apprenticeships and lecture demonstrations such as this mid-thigh amputation. The patient was sedated with liquor or opium, but still had to be restrained. A tourniquet was applied to reduce bleeding and pain by compressing major nerves, and a circumferential knife strike was used to separate muscles. The bone was sawed, major blood vessels ligated, and the stump was either cauterized with a hot iron or covered with a muscle or skin flap that was then sutured. Sawdust can be seen on floor to make it less slippery and to aid in sweeping up the gore. Many died of hemorrhage or infection. A recipient of an ankle amputation wrote this description: “The horror of great darkness, and the sense of desertion by God and man, bordering close on despair, which swept through my mind and overwhelmed my heart, I can never forget…During the operation, in spite of the pain it occasioned, my senses were preternaturally acute…I still recall with unwelcome vividness…the twisting of the tourniquet, the first incision, the fingering of the sawed bone …the bloody dismembered limb lying on the floor.” (Quoted by Atul Gawande, M.D. in “Two Hundred Years of Surgery,” New England Journal of Medicine, May 3, 2012) Notes by Dr. Linda Pessar and Mariann Smith
Art of Medicine
History of Medicine
Royal College of Surgeons of England, London