Medicine: Sewing Back an Arm

"When I saw this kid coming down the street, sobbing, I thought he'd been in a fight," said Norman Woodside, a paper-company foreman of Somerville, Mass. "But then I looked at his right hand—he was holding it awkwardly with his left—and I saw it was reversed." Foreman Woodside could not see what was inside the bloody right sleeve of Everett Knowles Jr., a twelve-year-old Little League pitcher. Woodside ran to phone the police, he called to Alice Chmielewski. a shipping-room clerk: "There's a boy here with a broken arm." Mrs. Chmielewski tried to put on a tourniquet above the break. She was puzzled to find an empty space. She stuffed this with rags to stop the bleeding. Then the police ambulance sirened up and rushed the boy to the emergency room of Massachusetts General Hospital in Boston. There, when his long-sleeved shirt was removed, the full extent of Ev Knowles's injury became clear: his right arm was completely severed from the shoulder.

It almost seemed as if the many surgical specialists of Mass General had been waiting for him for ten years. For all that time, they had been sure of their ability to put a severed human limb back in place, with bones, blood vessels, nerves, muscles and skin all reconnected—but they had never had a suitable case. In most accidental amputations, the limb is too badly mangled, and the patient's general condition too poor. Ev Knowles was different.

He had been in perfect health until that afternoon when he was slammed against a bridge abutment while riding a freight train. The arm was not mangled, although its upper part was torn. Duty surgeon Dr. L. Henry Edmunds promptly spotted a chance for a historic operation. He started giving the boy two pints of blood, to combat shock, and antibiotics and tetanus shots to guard against infection. Then Dr. Ronald A. Malt, chief resident surgeon, gave the go-ahead order that called in all the specialists who would make the operation a major team effort.

Flush the Arteries. Even before the boy, already under anesthesia, was hustled to the operating theater, his arm was put in a tub of chipped ice. The doctors dared lose no time in this effort to cut down the tissues' need for oxygen and thus delay the onset of rigor mortis in the muscles. Ev Knowles's shoulder joint was intact. The break in the humerus (the only bone in the upper arm) was between two and three inches below the joint. Says M.G.H. Spokesman Dr. Robert Shaw: "It was as though the arm had been laid on a bar and whacked with a sledge into multiple fragments." About an inch of the bone had been destroyed, mainly on the outer side.

Dr. John Herrmann took the arm to the operating room. To guard against clots, he flushed out the whole artery-vein system with a special saline solution combined with antibiotics, an anticoagulant and a radiopaque dye. X rays promptly showed that the arterial tree was open all the way to the fingertips. Relieved, Dr. Herrmann picked up the arm, carried it carefully to the operating table on which Ev Knowles had just been wheeled in, all draped except for his torn and bloody shoulder.