I determined that by great rapidity he might be got off the table alive, so operated in the following manner:--Fixing the tourniquet firmly near both groins, I first amputated the right leg by Carden's method, and tied the femoral only, wrapped up the stump in a towel wrung out of carbolic solution 1-20, then took off the other limb by Mr. Spence's method,--it had been injured higher than the right, so that I could not save the condyles of the femur,--then tied the femoral there, and fixed it up with another towel; then returning to the first, I tied one or two large branches which spouted, and rolled it up again, then back to the left one, doing the same, and getting the tourniquet off both limbs. On going back to the right the surface was nearly dry and glazed, so, asking Dr. Maclaren, who assisted me, to stitch it up and insert a drainage-tube, I did the same for the left, so rapidly that the patient was in his bed with his limbs dressed and bandaged in 24-1/2 minutes from the time he entered the hospital gate. The strictest antiseptic precautions were observed, two engines being used to furnish spray. Of course this great rapidity was due to the fact that everything was ready, the assistants all in hospital, admirably disciplined, and steam had been up in the spray engines. Shock was comparatively trivial; his temperature once, and only once, reached 100°. His stumps healed by first intention, and he was in the garden on the seventh day after the operation. I have now in three cases found the benefit of this mode of dealing with double primary amputation in avoiding shock, lessening the time needed, and greatly diminishing the number of vessels requiring to be tied. In a previous case of double amputation for railway smash at the knees, the patient was almost pulseless, and had he been kept many minutes more on the table would not have left it alive. He also rapidly recovered. The case is interesting also as showing that, when the assistants know their work, the strictest adherence to antiseptic precautions need not in itself make either the operation or the dressing tedious, though it can easily be made an excuse for much fussing and many delays.[51] FOOTNOTES: [24] For details see article "Amputation" in Cooper's _Surgical Dictionary_, and the short sketch of the history in Mr. Lister's paper in the third volume of Holmes's _System of Surgery_. [25] See a most interesting foot-note to Professor Lister's paper on "Amputation," in Holmes's _System of Surgery_, vol. iii. pp. 52, 53. [26] _Manuel d'Opérations chirurgicales._ [27] FIG. IV. shows dorsal view of incision. FIG. III. shows face of completed stump; R, radial; U, ulnar.