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Image of the Week: Amputation

21 Feb, 2014

L0009863 A medicinal dictionary, detail: amputation of big toe

This looks like a horrifying suggestion for DIY surgery – using a hammer and a chisel-like object to amputate a big toe – but it’s actually an illustration from an 18th century medical dictionary. Thankfully amputation techniques have moved on a bit since this was published in 1743.

Amputations usually come about for one of three reasons: gangrene, a limb posing a threat to life through being cancerous or infected, or serious trauma such as being crushed.

Diabetes is the most common cause of lower limb amputation, and people with diabetes are 15 times more likely to require a leg amputation than people without. Keeping your diabetes well controlled can help to reduce this risk.

If you do happen to accidentally slice off a finger or toe try not to panic. The NHS advise you wrap it in sterile gauze, pop it in a resealable bag or plastic container and then surround it with ice. (NB – don’t put the severed limb in direct contact with the ice as this can damage it.) Digits can survive up to eight hours if properly packed and cooled, though limbs such as a hand or foot will only manage up to six hours.

That said, we highly recommend that you try to avoid such accidents, and definitely don’t try to recreate the scene depicted in the image above.

Wellcome Images is one of the world’s richest and most unusual collections, with themes ranging from medical and social history to contemporary healthcare and biomedical science. Over 100,000 high resolution images from our historical collections are now free to use under the Creative Commons-Attribution only (CC-BY) licence.

4 Comments leave one →
  1. 25 Feb, 2014 10:41 am

    great image!

  2. 14 Mar, 2014 3:39 pm

    Kate is absolutely right that this looks like a horrifying suggestion for DIY surgery, and it would be perfectly reasonable to conclude from this image that 18th-century surgery was crude and reckless stuff. Neither of these things are necessarily true, however, and part of the problem is that this particular image has been digitally cropped in such a way as to remove crucial context. It is of course true that amputation techniques have moved on since 1743, but the mallet and chisel were to be avoided if possible, as is made explicit in the very book in which this image appears!

    This image is fig. 17 of Table XXXIII of Volume 1 of Robert James’s three-volume Medicinal Dictionary; Including Physic, Surgery, Anatomy, Chymistry, and Botany, in All Their Branches Relative to Medicine (1743-1745), and it’s one of many hundreds of images in the work. The work contains a very detailed 11-page entry on the history and practice of amputation, which discusses a variety of techniques, their provenance, and case histories. References within the text alert the reader to specific figs., including the mallet and chisel one.

    There are another 16 engraved images in Table XXXIII, but you wouldn’t know it from the image on the Wellcome Images site. Even the engraved text “Fig.17”, indicating that this is one of at least 17 images, has been digitally removed. Table XXXIII also contains images of a knife used for removing tumours, a syringe “proper for injecting liquors into the urethra of males, and the vagina of females, for the cure of wounds and ulcers”, a cauterising device, with a wooden case “to conceal the red-hot iron from terrifying the patient” and, interestingly, “the needle used by the inhabitants of China and Japan, for making their acupuncture”. Viewed in this context, the image starts to appear less DIY, and more part of a sober and encyclopaedic survey of a full and varied range of available and historic surgical and therapeutic techniques.

    In the entry on amputation, James claims that he has several times removed fingers with mallet and chisel, as has another medical practitioner named Roonhuyse, “with success, whatever some people may think to the contrary”. It seems to me that here James is quite aware of his contemporary audience being just as sceptical as we would be when presented with the idea of it being a good idea to remove a digit with a mallet and chisel. James furthermore makes it very clear that of three possible techniques, amputation of a digit with a mallet and chisel is not his preferred choice. Better is with a pair of “sheers”, and better still to cut with a knife at the joint, leaving a flap of skin to cover the end of the bone, and avoiding the danger of splintering the bone. Indeed on the following page, when he moves on from amputating digits to amputating hands, he notes that “the hand may be amputated at one blow, as was formerly practised, by placing a strong and sharp sharp chisel near the wrist, and with a heavy mallet driving it through… but this way of amputating is not only very hazardous, but also very pernicious… The modern surgeons therefore act very reasonably in substituting the knife and saw in place of the mallet and chisel.” So, the mallet and chisel is an available technique, but one to be avoided if at all possible, and one avoided by “modern surgeons”.

    I know all this because I followed the links and read a digitised copy of the book at Eighteenth Century Collections Online:

    http://gale.cengage.co.uk/product-highlights/history/eighteenth-century-collections-online.aspx

    If you look up the work here, Table XXXIII is image 1090 of 1091: easy to find if you’re familiar with this sort of source material, tricky otherwise. And, in any case, you need an institutional login to access electronic resources like Eighteenth Century Collections Online, only available to those of us lucky enough to be employed by major research universities. You could also look at the copy held in the Wellcome Library on Euston Road. But most people obviously aren’t going to do that, so the issue of the decontextualised foot, mallet and chisel remains.

    There’s a lot of worrying online right now that digital images are being copied, distributed, tweeted and re-tweeted in such a way that the original source material is not attributed, and verification is impossible. This is not the case with the Wellcome Images site: clear and detailed credits are given for each image, which is after all how I was able to look up a copy of the original work. The problem here is not a problem of lack of attribution, but a problem of lack of context. It’s quite hard to express how different the image looks within the much larger Table, let alone how much pertinent context is given by the above-quoted text.

    It’s also of course the case that worrying about the instability of images, their meaning and interpretation as a consequence of new publishing and copying technologies is hardly a novel issue. Mid 18th century books were often pirated, corrupted, copied, misattributed. Copperplate engravings from one book found themselves reproduced in another, recycled, reappropriated, pirated, all of which entailed alteration of meaning, all of which people tried and failed to police. This is not a problem that began with blogging and Twitter!

    It’s also possible that this is one particularly unfortunate image. Indeed there are several images depicting 18th-century surgical instruments on the Wellcome Images site where entire engraved plates and tables containing multiple images are presented as a whole, not cropped. I should also add that I don’t want to be the context police: the trouble with demanding more context is that there is always someone who demands even more context. Someone might say that not only is it impossible to understand the image without reading the book, but it’s impossible to understand the image without having read all the other midcentury medical treatises, or without knowing Latin, or without having examined historical instruments in museums… The question is of balance: how can we share medical history images as widely as possible without distorting them too much? It’s a hard question, and I don’t have all the answers.

  3. 18 Mar, 2014 12:04 pm

    I thought it might be useful to respond to the very helpful and informative comments from Nicky Reeves above. The photograph we used in the blog here was actually taken many years ago, on black and white 5×4 negative film, by photographers fulfilling an order for photography from a Wellcome Library user – photocopying would not have been allowed of such a valuable book. The 5×4 negative was then scanned, probably in around 1999, by our digitisation team. There was no digital cropping nor alteration, the negative was simply scanned in its entirety in order to make its content available online. If we had photographed this page more recently, we would have also taken an image of the whole plate too. I hope this contextual information helps explain why this detail was published on the Wellcome Images website.

  4. 19 Mar, 2014 9:30 pm

    Thanks to Catherine for taking the time to write this helpful response. I have to say I hadn’t considered the image itself having such a interesting material as well as digital history. All very interesting. Obviously I was also wrong about how the image came to be isolated. I hope my (somewhat long) comments were of some constructive use. Cheers, Nicky.

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