[From the American Practitioner and News, December 16, 1893.] 
ON AMPUTATION AT THE HIP-JOINT. 
BY G. P. HACHKNBERG,UrTD. 
Since the late war a radical change has taken place in the operation 
of amputation at the hip-joint under certain conditions. In the wars 
of Napoleon I, Baron Larrey performed the operation six times, with a 
mortality of five cases. For many years many of his distinguished 
surgical successors met with no better success. From such unhappy 
results it was considered by many a criminal practice to perform this 
operation. 
Under this state of discouragement I was called upon to perform the 
operation in 1861 on a lad, seventeen years of age, who had an extensive 
strumous necrosis of the femur. I had hesitated to operate for a year 
or more, but the patient’s suffering was so great that it was about his 
daily cry that I should “ cut his leg off.’’ Finally I submitted the case 
to able medical counsel, and under their approval, more than my own, 
I performed the operation. Having but little confidence in any of the 
usual flap operations, and as life is jeopardized in the ratio of their near- 
ness to the abdomen, I thought of a plan that seemed to me would act 
more favorably. The authorities on hand made the amputation at the 
upper thigh, i in 7 prove fatal; in the excision of the hip-joint, 1 in 15 
proved fatal. Taking the three operations into consideration, that is, 
including amputation at the hip-joint, what can be more conclusive than 
that the flap tends greatly to a fatal shock and septicemia. With these 
facts before me, I submitted my patient to the double operation of 
(circular) amputation of the upper thigh, followed immediately by 
excision of the remaining femur out of the joint. To effect this expe- 
ditiously I had instruments constructed expressly for the case: as the 
“ flexible knife,” made out of a watch-spring, to cut the upper femur 
out of the periosteum, and a holder to transfix the bone while this part 
of the operation was performed, etc. The operation was enforced with 
facility, and the following are the advantages we thought in favor of 
this method of amputating at the hip-joint over the usual methods: 
1. It removes the wound from the body, and thereby lessens a priori 
the tendency to mortality. 
2. It is performed with less loss of blood. 
3. The shock is not likely to be so great. 
4. The surface of the wound is less. 2 
5. The flaps (if such they can be considered) are shorter and more 
massive, and therefore tend less to sloughing. 
6. A sufficient stump may be secured for the adjustment of an arti- 
ficial leg. 
7. Owing to the remarkably close dissection that takes place by 
using the flexible knife in cutting the bone out of a hypertrophic peri- 
osteum, may we not retain the physiological function of that mem- 
brane so as, in course of time, even to give osseous or cartilaginous 
consistency to the stump? 
Unfortunately we finally lost our patient through secondary hem- 
orrhage. 
The operation was performed in the presence of an able corps ot 
surgeons and physicians, and reported in the Boston Medical and Sur- 
gical Journal, vol. lxvi, and referred to by the Surgeon-General in his 
Special Circular No. 7, O11 Amputation at the Hip-joint. 
The object I have in referring to this case at this late day is to estab- 
lish my priority in causing an important change in performing this 
formidable operation; and why in my “ Medical Consultation Book,” 
in the list of “Proper Names in Medicine,” I affixed my name to the 
operation. The report of the case drew special attention in the sur- 
gical centers of Europe, and was performed with modifications in sev- 
eral hospitals, but from the reports usually given as original opera- 
tions. After the operation was accepted in this country, credit of it 
was dealt out in details to every operator, particularly when the opera- 
tion was performed with success. In the late war, in the U. S. Army, 
the operation was performed seven times with success, cases reported 
as “ Re-amputation at the Hip-joint.” Since the war, in civil practice, 
the operation in this and European countries has been repeatedly per- 
formed with success. 
While iu winter quarters, 1862-3, at Buckhannon, W.Va., I was sum- 
moned to the home of Sergeant Phillips of the Ffirst Virginia Infantry, 
about twenty miles through a guerilla-infested country. Amputation 
at the liip-joint was the operation indicated. He was suffering from a 
gunshot wound; the ball passed through Scarpa’s triangle, fracturing 
the left femur close below the trochanters. He had been wounded nine 
months before I saw him, and in the military hospital was considered 
a hopeless case. I found him very much reduced, with a thigh enor- 
mously distended and fistulated at several places. I concluded not to 
amputate, but made a bold and extensive dissection in hunt for the ball, 3 
which was the source of all the mischief. I found it partly imbedded 
in an ossified formation between the fractured ends of the bone. I 
broke two bullet forceps in the attempt to dislodge it, and was now left 
helpless without the necessary instruments to prosecute further the 
operation. At the same time the patient was alarmingly affected by 
the chloroform. At this critical moment I quickly placed my knee 
under his thigh, and with a quick, heavy blow on his knee caused a sur- 
gical fracture of the thigh at the weak point where the ball was lodged. 
I was now able to pick out the ball, which was in two parts, with all 
the necrosed spiculse, with my fingers. Under the care of a local phy- 
sician, who assisted me in the operation, the patient finally recovered, 
with a leg about four inches too short. He was for many years a pen- 
sioner, and I am not aware but he is still living. 
This was the most formidable surgical operation in my experience. 
But when the Surgeon-General called for reports of surgical operations 
of the war for the Medical and Surgical History of the Rebellion, while 
accepting others that I reported, this one he would not accept, or it was 
overlooked. 
Austin, Texas.