Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

    61/1282 (page 49)
    AMP Mr. Justamond recommends the following application to milk-abscesses: Ammonize Muriatez Zj. Spiritus Roris marini bj. Misce. Linen rags ate to be wet with the remedy, and kept continually applied to the part affected. There can be little doubt of the utility of this lotion in dispersing the induration, left after mammary abscesses; but, while these cases are accompanied with much pain, tension, and in- flammation, emollient fomentations and poultices are to be preferred. AMPUTATION. The operation of cutting off a limb, or other part of the body, as the breast, penis, &c. Such an operation frequently becomes indis- pensably proper, on the principle of sacrificing a branch, as it were, for the sake of taking the only rational chance of saving the trunk itself. In- deed, the suggestion of this measure, in cases of mortification, where there is no chance of the parts recovering, may be said to be derived from nature herself, who by a process, to which I shall advert in speaking of mortification, detaches the dead from the living parts ; this separation is fol- lowed by cicatrization, and the patient recovers. The necessity for amputation has always ex- isted, and ever will continue, as long as the de- structive effects of injuries and diseases of the limbs cannot be obviated in any other manner. As Graefe observes, there was once a period, {I should say, about forty years ago) when the operation was more frequently practised, than at present, and this fact is to be imputed less to the caprice of surgeons, than to the imperfection of the means which used to be employed for the relief of local diseases. For then aneurisms of the limbs, and some other cases, at present treated with success, were always deemed incurable without amputation. Boucher, Gervaise, Faure, and Bilguer inveighed against the frequent per- formance of amputation on the field of battle; yet their arguments must prove of little value, unless a path were at the same time traced, which would conduct us to the method of remedying the circumstances which form the necessity for the operation. When this condition is fulfilled, and more effectual modes of treatment are de- vised, as for instance, with respect to the gun- shot wounds, specified by Bilguer, then the neces- sity for amputation in such cases would cease of itself. (Normen fur die Ablisung griésserer Gliedmassen, p. 13, 4to. Berlin, 1812.) As the author of another valuable modern work has said, it is an excellent observation, founded on the purest humanity, and justified by the soundest professional principles, that to save one limb is infinitely more honourable to the surgeon, than to have performed numerous amputations, however successful; but, it is a remark, notwithstanding its quaintness, fully as true, that it is much better for a man to “to live with three limbs, than to die with four.” (Hennen on M: ilitary Surgery, p. 251, Ed. 2.) To this saying should be added the reflection, that some unfortunate beings, influenced by a relish for life, have been known to submit to the Joss of all their legs and arms, and yet recover, In the Hétel des Invalides at Paris, mutilated objects. are in recollection, who had lost their thighs and arms, so that, unless assisted, they could not stir, and it was necessary to feed and AMP 49 wait upon them, like new-born infants. (Morand Opuse. de Chir. p. 183, and Graefe Op. cit. p. 23.) The amputation of the large limbs was an- ciently practised under many disadvantages. The best way of making the incisions was unknown; the ignorance of the old surgeons about the right method of stopping hemorrhage was the death of a large proportion of the patients, who had cou- rage to submit to the operation; the mode of healing the wound by the first intention was not understood, or not duly appreciated; and the in- struments were as awkward and clumsy, as the dressings were irritating and improper. Modern practitioners have materially simplified all the chief operations in surgery; an object, whiclt has been accomplished not merely by let~ ting anatomical science be the main guide of their proceedings; not simply by devising more judicious, and less painful methods’ not only by diminishing the number, and improving the con- struction of instruments; but, also, in a very essential degree, by abandoning the use of a mul- titude of external applications, most of which were useless or hurtful. The Greek, Roman, and Arabian practitioners amputated limbs with feelings of alarm, and, in general, with the most melancholy results; while modern surgeons proceed to the operation com- pletely fearless, well knowing that it mostly proves successful: hence, as Graefe justly remarks, no- thing can be more evident, than that the patient’s safety must depend very much upon the kind of practice. (See Normen fur die Ablisung gris- serer Gliedmassen, p. 1.) By practice, is here implied the mode in which the operation is per- formed, the way in which the wound is dressed, and the whole of the after-treatment. But, much improved as amputation has been, it cannot be dissembled, that it is an operation at once terrible to bear, dreadful to behold, and sometimes severe and fatal in the consequences which it itself produces, while the patient, if saved, is left for ever afterwards in a crippled, mutilated state. Hence it is the surgeon’s duty never to have recourse to so serious a proceed- ing, without a perfect and well-grounded con- viction of its necessity. Amputation should be generally regarded as the last expedient to which a surgeon ought to resort; an expedient justi- fiable, as a late writer says, only when the part is either already gangrenous, or the seat of so much injury, or disease, that the attempt to preserve it any longer, would expose the patient’s life to the greatest danger. . (Dict. des Sciences Med. T. 1, p. 472.) ; Although, says a distinguished modern sur- geon, this amounts to a confession, that the cure of some local disorders is not within the limits of our art, yet, on the other hand, it furnishes a proof, that surgery may be the means of saving life under circumstances, which, without its assist- ance, would infallibly have a fatal termination. The operation is adopted as the safest measure : the cause is removed for the prevention of con- sequences. (Gracfe, Op. cit. p. 14.) Nothing can be more absurd, or more misap- plied, than the censures sometimes passed upon amputation, because the body is mutilated by it, &e. Although, as a modern writer remarks, the objection proves the limitation of human knows K