No. III.

QUESTIONS SUBMITTED TO MR. W. HEATHER BIGG AND MR. GROSSMITH.

1. In adapting an artificial limb to a stump formed by the circular or double-flap transfixion modes of amputating, do you allow any pressure to be borne on the end of the stump?

2. If such pressure is not allowed, what is the reason for its avoidance?

3. In what proportion of stumps, formed by these methods, do you find a moveable mass of soft tissues over the sawn

end of the bones?

4. After these modes of amputating, do you find generally that the cicatrix is adherent to the sawn end of the bone?

DEAR SIR,

Mr. BIGG's Letter to Mr. TEALE.

LEICESTER SQUARE, LONDON, W. C.
July 13th, 1858.

It affords me very great pleasure to place at your disposal whatever experience I possess on the subject of stumps after amputation, and the relation they bear to the adaptation of artificial limbs.

In reply to the first question;-it is contrary to my practice to allow of any pressure being taken against the end of

the stump by the bottom of the bucket, and for the following

reasons:

1st. In almost every case of amputation above the knee, a certain amount of tenderness remains at the inferior extremity of the limb; hence, if pressure, even of the slightest character, were allowed to be exercised against it, the patient, in shrinking, as he necessarily would, from the inconvenience occasioned to his stump, would lose that confidence so highly requisite for enabling him to walk with ease, and would be continually exposed to the risk of falling.

2d. As artificial legs are at present constructed, the attachment to the patient's body is principally obtained by the bucket, which receives the stump, being so conformed that the weight of the patient tends to gently press the stump in a downward direction within it. Perfect apposition is thus secured between the integumentary surface and the internal surface of the bucket. This principle is, however, limited by a rule which I, in common with many other scientific mechanicians, have long maintained, namely, that after a certain allowance is made for the stump sinking into the receptacle prepared for it, the weight of the body should be received by the posterior margin of the bucket; or, in other words, that the tuberosity of the ischium should be the point against which the weight of the body ought to be borne by the artificial leg. The advantage of this arrangement becomes apparent, when the tenderness and pain occasioned in almost every instance where the integuments pertaining to the stump are forcibly drawn upwards is borne in mind. But there is also an important mechanical reason for the point I have just stated being selected, viz., that as in the skeleton the line of gravity common to the body and the leg passes through the tuberosity of the ischium, so is it highly essential that in the substitute the same law should be maintained.

3d. The end of the stump is easily inflamed and abraded by friction.