Page:The American Cyclopædia (1879) Volume I.djvu/474

442 AMPUTATION of the tourniquet by Morel and its per- fection by Petit, in the 17th and 18th cen- turies, still further diminished the dangers. When it is done for a disease, it is spoken of as a pathological amputation ; when for an injury, it is named "primary" or "secondary," accord- ing as it is performed before or after the occur- rence of the inflammation which is induced by the violence done to the part. During the in- flammatory period the operation is contra-indi- cated except for some very urgent reason. The deaths following primary amputations are some- what fewer in number than those after second- ary, except in the case of the thigh. Where done for disease, the mortality is very much less. No rule in surgery is better established than that the death rate increases as we ap- proach the trunk. An amputation of the leg is less dangerous than of the thigh, and that through the lower part of the thigh less than through its upper part. Moreover, an amputa- tion through the upper extremity is less grave than one through a corresponding part of the lower extremity. In performing amputation, the patient is placed under the influence of an anaesthetic, which by its abolition of pain and much of the terror diminishes the shock to his system, and enables the surgeon to operate more carefully and on a part deprived of mo- tion. The circulation through the main artery is arrested by pressure with the finger or the tourniquet. The skin and muscles are then cut by a series of sweeps of the knife round the circumference of the limb, the parts being drawn toward the trunk by an assistant as each one is completed. In this way, as the bone is approached, the parts are divided at a higher and higher level. The bono is then sawed, the sharp edges or corners being rounded off so as not to press upon the part. The chief arteries are treated in such a way as to close their open extremities. This may be done by grasping the end with the forceps and twisting it several times, which is called torsion ; or by pressure with a needle passed through the muscles and over or through the vessel, called acupressure ; or, most usually, by tying it with a ligature, which consists of a well waxed string of silk or other material. The tourniquet is then removed, and the small vessels which bleed are treated in the same way, provided the contact with the air does not cause them to contract. The soft parts are then drawn over the end of the bone and stitched together. The method of cutting the soft parts described above is known as the circular. What is called the flap operation may be performed by trans- fixion, cutting from within outward, or by cut- ting from without inward. In either case a single or a double flap may be made. This lat- ter process may be rendered intelligible by taking a circular piece of paper and folding it along one of its diameters. The centre of the circle would represent the situation of the end of the bone, and the circumference the mar- gins of the skin which are stitched together. AMRU'L-KAIS If the cut surfaces grow together at once, there is said to be primary union. This result is but seldom attained, at least throughout, and as a rule the union is secondary, in which case sup- puration takes place, and granulations spring up which grow together and fill up the wound. For the accidents which may occur after am- putation, see GANGKENE, HEMORRHAGE, NECRO- SIS, OSTEO-MYELITIS, and TETANUS. AMRITSIR, or I mrifsir, a town of the Punjaub, Hindostan, between the Ravee and the Beas, an affluent of the Sutlej, 36 m. E. of Lahore ; pop. about 130,000. There is in the town an extensive *tank, built, or rather restored, in 1581, by Ram Das, the 4th Guru or holy man of the Sikhs, the name of which Amritsir, the pool of immortality was in the course of time transferred to the whole town. In the centre of the pool is a temple sacred to Govind Singh, the last of the Gurus. Amritsir is a place of considerable trade, one of the commer- cial depots of N. W. India. It is an open town, but Runjeet Singh built a fort there in 1809. AMRl) IBN EL-AAS, one of Mohammed's early proselytes, died in 663. He belonged to the Koreishites, and in early life was furiously op- posed to Mohammed, ridiculing him in epigrams and satirical verses, and even attacking those of the new faith who had settled in Abyssinia. At last, however, he was converted, and his zeal in behalf of his new faith was as uncompromising as his opposition had been. The first two succes- sors of the prophet, Abu Bekr and Omar, were chiefly indebted to his valor for the conquest of Syria. He carried his conquering arms into Egypt, and, at the head of only 4,000 men, took Pelusium and founded Old Cairo. He soon laid siege to Alexandria, and distinguished himself as much by his personal bravery as by his skill and conduct as a general. He was present in the assault, and in an attack on the citadel was taken prisoner with a faithful slave. Brought before the commander of the fortress, his slave, striking him in the face, ordered him to be silent in the presence of his betters; and this device saved his life by leading his con- querors to suppose him a person of no rank. He was sent back to the Mohammedan camp, with a proposition for a truce. This was re- fused, and the city was taken with a loss to the Arabs of 23,000 men. Amru spared the city, but the orders of Omar subsequently caused the conflagration of the library. Amru became emir of Egypt, and his firm govern- ment conciliated the inhabitants. He pro- jected a canal for uniting the waters of the Nile with the head of the Red sea. Having been recalled by Caliph Othnian, the Alexan- drians in his absence revolted, and surrendered the city to the Greeks. Amru returned, and once more reduced the city and spared the inhabitants. The caliph Moawiyah owed his accession to Amru, who declared for him in preference to his rival Ali. MKri.-kls. or Amrnleais, an Arabian poet, author of one of the seven Afoallacahs, poems