Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.

Date:
MDCCCXLIX [1849]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.

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    little effusion into the abdomen. His urine was of a smoky colour, and very albumi¬ nous. He was cupped on the loins, and ordered a drachm of compound jalap pow¬ der iwice a-day, and a warm bath twice a-week. The treatment was continued, though less vigorously, for about six weeks, when he was discharged quite well.—Me¬ dical Times, xix. p. 144. [There is nothing new in this observa¬ tion, Schonlein and others having noticed years ago that copaiva has a tendency to produce Bright’s disease. The above case, if neglected, would probably have termi¬ nated in this disease.—See Remak’s Diag- nostische und Pathologische Unlersuchun- gen, pp. 168-9. Berlin; 1845.] III.—PRACTICE OF SURGERY. 11.—On the Means of insuring Success in Cases of Amputation. By Professor C. Sedillot.—The object of M. Sedillot’s re¬ marks is to show, that making allowance for other causes, much of the fatality fol¬ lowing amputations maybe accounted for by the method of operation, and the sub¬ sequent plans of dressing the stump. After speaking of the circular operation generally adopted in France, and showing that to obviate the constant tendency of the hone to protrude, or the formation of a conical stump, the surgeon is obliged to compress the limbs above by a circular bandage, to prevent the muscular retrac¬ tion, to support the soft parts, and main¬ tain the integuments of the proper length; and that, besides these bandages, the parts are united by means of plasters and stitches, and covered with pledgets of lint and compresses, the whole being retained by more bandaging ; he points out the bad effects of these dressings, and then pro¬ poses his method of procedure to do away with all these evils. This method is, simply to abandon the circular amputa¬ tion, and to operate by a single anterior flap, the flap being so cut as to embrace two-tbirds of the circumference of the limb, the remaining third being cut per¬ pendicularly, on a level with the angles of the flap; so that, after the hone is sawn through, the flap may, by its own weight, fall upon and cover the surface of the wound, without requiring any complicated dressings. A piece of lint folded, about two finger-breadths in size, moistened with some digestive, is placed over the bone, so as to form a central canal to per¬ mit the escape of the discharge. The angles of the flap are held in apposition by means of two hare-lip pins : tbe lint is re¬ moved at the end of three or four days, leaving a vertical drain, in which neither blood, serum, nor pus, can accumulate. M. Sedillot states in favour of this plan, that out of twelve amputations during the preceding fifteen months, including one of the thigh, six of the leg, one at the ankle- joint, one of the great toe, one of the fore-arm, and one of the finger, he had YOU. II.—NO. I. only lost one case, that of the great toe. The Parisian editor however remarks, that M. Baudens at Val de Grace, who adopts M. Sedillot’s method, has not bad a greater proportion of success than the surgeons of the civil hospitals of Paris.—Annales de Thera2yeutique Medico-Chirurgicale, Sep¬ tember and October, 1848. [M. Sedillot explains, that by anterior flap, he does not use the term in its exact anatomical sense; that, for example, by the anterior aspect of the fore-arm, he means its posterior (?) and external region, and by anterior, as applied to the upper arm, he means external. He does not ex¬ plain, however, what we wish especially to know, where he gets a sufficient anterior flap in the leg, which will, by its own weight, cover in the wound; perhaps go¬ ing a little further round the limb than in the fore-arm, he gets it from its posterior region. Whilst we admit that much of the suc¬ cess of amputation depends on the plan of operating, the after dressing and treat¬ ment, we must look to other causes less under the control of the surgeon than these, to explain the mortality of the great er amputations; but even as regard.® the plan of operating and treatment which M. Sc'dillot seems to propose as new, to say nothing of the principles involved in the method of antero-posterior flaps, re¬ commended by Mr Liston, and the simple plan of dressing, which he advocated so strongly; had M. Se'dillot taken the trouble to acquaint himself with the his¬ tory of amputation in other countries, he would have found that the identical plan of operation by single flap, which he pro¬ poses, even to the position whence the flap is obtained, and the placing the pled¬ get of lint between the bone and flap, w'as recommended and practised con¬ stantly by Mr O’Halloran of Limerick, in amputating the thigh, arm, and fore-arm, as far back as 1765.] 12_Amputation of the Ankle-Joint. By M. Robert, (Hopital Beaujon).—5T. Robert performed this operation on a girl B