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ARE CONSERVATIVE AMPUTATIONS ALWAYS IN THE BEST INTERESTS OF THE PATIENT?Read before the Mississippi Valley Medical Association, St. Louis, Mo., October 16, 1891.

JAMA. 1891;XVII(22):842-846. doi:10.1001/jama.1891.02411000020001d.
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In pre aseptic days, amputations were properly governed by an inflexible rule which taught that the first duty of the surgeon was to save every possible ounce of tissue, because, first, experience had demonstrated that the nearer the point of amputation approached the trunk and the broader the stump, the greater the risk of life; second, it was generally believed that in all cases the usefulness of a stump increased with its length.

These principles, still taught in all of our standard text-books (save one) and having been practiced by every eminent operator from the first records of surgery down to the days of asepsis, are in general use to day—although the conditions forming the basis for their advocacy no longer exist, at least in their former weight and importance.

The first of these principles was formulated at a time when pyæmia, septicæmia, or like complication endangered the life of


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