The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton.

  • John Eric Erichsen
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    lowed, more particularly in cases of primary amputation, and in all wounds where union by adhesion may be hoped for. But in amputation for disease^ when patients are in a low and irritable condition, I think it is better to apply the dressings immediately after the performance of the amputation, before the effects of the chloroform are recovered from. Before doing this, it is desirable that all oozing should have ceased, and with this view, after the ligatures have all been applied, I commonly pour a jug or two full of cold water over the face of the stump, and then proceed with the dressings, which must be conducted in accordance with the general principles to be laid down when we come to speak of wounds. The stump should not be bandaged until the third or fourth day, unless it is very fleshy and heavy; and at first the roller should not be brought over its face, but merely by circular turns, as far as the line of incision. When suppuration is subsiding, and cicatrization going on, the bandage may ad- vantageously be brought over the face of the stump. As a general rule, it will be found that a narrow roller will adapt itself better than a broader one. After cicatrization is completed, the patient should be allowed to go about on crutches, but must not wear an artificial limb for several months, until the parts have become firmly consolidated; during the whole of this time the stump should be kept carefully bandaged, and not be exposed to injury. On examining the structure of a stump, after a year or two have elapsed from the time of its formation, it will be found to be composed of a mass of fibro-cel- lular tissue, the muscular and tendinous structures that enter into the formation having become transformed into this. The ends of the bones will be found to be rounded, and the medullary canal filled up, the vessels being obliterated up to the nearest collateral branch (Fig. 12). The ends of the nerves are thickened, and commonly assume a bulbous appearance (Fig. 13). On examining these rounded or oval tumors, they will be found to Fis-i2- be fibro-cellular masses having nervous fibrillar thinly scattered throughout. The proper adaptation of artificial limbs is a matter of considerable consequence, and the in- genious mechanical contrivances that are at the present day adapted to stumps, amongst which those introduced by Mr. Gray, of Cork Street, deserve especial mention, leave little to be de- sired. The surgeon had better leave the details of these mechanical contrivances to the instru- ment-maker ; but he should see that they are made light consistently with sufficient strength and support, and that the end of the stump is never pressed upon by them.* Thus, after am- putation of the thigh, the artificial limb should take its bearing-point from the lower part of the pelvis and hip. In amputation immediately be- low the knee, this joint should be bent and re- ceived into the socket of the instrument, and if the amputation be at a lower point ihan this, and the stump be extended in the artificial limb, its end must be pro- jected from injurious pressure. It is only in the case of disarticulation at the ankle-joint, when the soft tissues of the heel are left, that pressure can be advan- tageously borne upon the end of the stump. Morbid condition of stumps.—It not unfrecmently happens that the end of the bone in a stump necroses. This occurs either in consecpience of the injury inflicted by the jarring of the saw, or happens in those stumps that unite by the a [The most perfect of all the artificial limbs we now possess, is the one invented by Mr B F P-ilmer No. 376 Chestnut Street, Philadelphia. This invention received the prize-medal at the World's Fvliihi! uion of 1851. It merits the entire confidence of the surgeon.—Ed.] U s txmDl
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