Medicine: Too Many Miracles

Of all the daring operations devised by modern surgeons, few have seemed more exciting than "replantation"—the reattachment of a completely severed arm or leg to the body. But, worries the current Journal of the American Medical Association, such operations have become all too popular: too many doctors try them without recognizing the disadvantages for some patients.

Surgeons at Massachusetts General Hospital started the trend in 1962 when they successfully reattached the severed right arm of Little League Pitcher Everett Knowles Jr. "There was something for everyone in the tale of the red-haired teen-ager," says a Journal editorial. "The public could indulge their curiosity about medical 'miracles.' " Unfortunately, the Journal continues, doctors also reacted with too much enthusiasm. Over-zealous surgeons "tried to reunite every limb, or part of it, regardless of the patient's condition or the merits of the occasion."

In the four years since the remarkable surgery on Ev Knowles—who now uses his right hand and arm as if he were naturally left-handed—there have been dozens of similar operations performed. In at least half the cases the surgery failed. Most should never have been tried, argues the A.M.A. "If the patient has one good leg, the other should not be replanted. The chances of neurologic recovery are poor, the handicap of a shortened extremity severe, and the value of a prosthesis great enough that the patient is served best with a good stump and an artificial limb. An entire arm should not usually be restored to a patient over 40 if he has one good arm. Recovery of protective sensation in the fingers will seldom be worth the prolonged disability and the rehabilitative operations."

The ideal patient for replantation, concludes the Journal, is someone under 30 who has suffered no other major injury at the same time, whose severed limb is in good shape, and who is in a hospital where medical facilities are equal to the intricate job. In all other cases, doctors will be serving their patients best by prescribing artificial limbs.