Art, craft and science of limb amputation Part 1. Art and craft of amputation: from Hippocrates to Ambroise Pare (V century B.C. – XVI century)

Abstract

Limb amputation is one of the oldest and most famous operation in surgery. Over the millennia, the tools for its implementation and the technique for its perfomance have been constantly improved. In part 1 of the article, using historical, chronological and dialectical methods, as well as the method of comparative content analysis a number of printed (Hippocrates, V-IV centuries B.C.; Celsus, I century; Abu-alQasim, XI century; A. Paré, XVI century, etc.), material (prostheses, surgical instruments) and visual (engraving, painting, etc.) sources, the circumstances and features of the emergence and development of instruments and techniques for limbs amputation from antiquity to the era were studied and recreated Renaissance. The main indication for amputation was the limb death (gangrene), as well as significant tissue trauma caused by cold or firearms (since the XIV century). The limb was truncated (or isolated) with a circular section along the demarcation line (in ancient times) or within healthy tissues (in the Middle Ages). The operation was carried out under a tourniquet applied above the level of amputation; healthy tissues were shifted proximally; sometimes a second tourniquet was applied - below the cut-off level. Anesthesia was achieved by operating in a state of painful shock, after bloodletting, or by applying a tight ligature (tourniquet). Bleeding was stopped with the surgeon's finger, cauterization or vessel cutting of, ligature of one vessel or the entire bleeding tissue (en masse), suturing of the bleeding vessel (A. Paré), as well as astringents and a bandage. The wound of the stump was left open or brought together with sutures. A major stage in the development of amputation was the work of A. Paré (XVI century), who improved instruments (in particular, clamps for stopping bleeding), the technique of the operation, and pain relief during its performance. If in the Ancient World and in the early Middle Ages amputation was life-threatening, available only to a few of the most skilled doctors, was performed relatively rarely and was akin to art, then after its development in the XIII–XIV centuries. barbers began to perform it everywhere, routinely and gradually turned into a craft. Further development of indications for amputation, techniques for its implementation and the transformation of this operation from a craft into a science from the XVII century. until the middle of the twentieth century will be reflected in part 2 of this article.