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.

    68/1282 (page 56)
    ‘The very late period, at which an extensive necrosis may follow the injury of a bone, and make amputation necessary, is sometimes almost incredible. Schmucker details the case of a cap- tain, who received a musket-ball through the left arm, four or five inches above the elbow. The bone was violently struck, but not broken ; se- veral exfoliations followed, and after more than a year’s treatment, the patient appeared perfectly cured. For nine years this officer remained well; but, at the end of this time, being on a journey, he was attacked with pain and inflam- mation in the wounded part, and febrile sym- ptoms. He hastened to Berlin, and put himself under the care of Theden and Schmucker, who found an abscess in the situation of the former wound, and, as an opening had been already made, the bone could be felt stripped of its periosteum. At length, a piece of bone exfoliated, and became loose, precisely under the brachial artery, which interfered with its removal. Not- withstanding the discharge, the elbow-joint conti- nued swelled, and there were red points observ- able, not only above that. joint, but also over the heads of the ulna and radius, indicating dis- ease of those bones. Amputation was therefore performed by Theden, and the patient got quite well. On examining the os brachii, a splinter breadth, its edges being thin and sharp, while its centre was more than three lines thick, The bone, every where about the place, where it had been struck by the ball, seemed to consist of cal- lus without any medullary cavity, and the whole of it down to the elbow had no periosteum. The cartilage appeared also disposed to separate, and the periosteum was detached from the radius and ulna, which were likewise affected with necrosis. (See Schmucker’s Vermischte Chir. Schriften, B. 1, p, 23. Ed. 2,) 8. Cancerous and other inveterate diseases, such as fungus hematodes. Cancerous, inveterate diseases, and malignant incurable ulcers on the limbs, sometimes render amputation a matter of necessity. In treating of cancer, we shall remark, that little or no con- fidence can be placed either in internal or any kind of topical remedies, and that there is nothing, except the total separation of the part affected, upon which any rational hopes of cure can be built. Cancer is not frequently seen on the ex- tremities. Every man of experience, however, must occasionally have seen, in this situation, if not actually cancer, diseases quite as intractable, and which cannot be cured, except by removing the affected part. This may often be accom- plished, without cutting off the whole limb. But, when the disease has spread beyond certain bounds, amputation, above the part affected, is the only thing to which recourse can be had with any hope of success. Sometimes when the ope- ration has been delayed too long, even amputa- tion itself will not effect a cure. In a few cases of fungus heematodes, the operation has succeed~ ed, however, ‘after the disease had reappeared, excision of the diseased parts. Yet, from what I have seen of fungus heematodes, I should much doubt, whether the benefit obtained by amputa- tion would be lasting, as when this disease shows itself only externally, internal organs are mostly at the same time similarly affected. (See Fungus Hematodes.) Besides cancerous, there are other ulcers which may render amputation indispensable. Thus, when an extensive ulcer, of any sort whatsoever, is evidently impairing the health; when, instead of yielding to remedies, it becomes larger and more inveterate; when, in short, it puts life in imminent danger; amputation should be ad- vised. 9. Various tumors. That there are numerous swellings, which de- stroy the texture of the limbs, rendering them useless; causing dreadful sufferings, and bring- ing the patients into the most debilitated state, no man of observation can fail to have seen. When such tumors can neither be dispersed, nor cut out with safety, amputation of the limb is the only resource. Mr. Pott has particularly described a tumor affecting the leg, for which the operation is some- times requisite. It has its seat in the middle of the calf of the leg, or rather more towards its upper part, under the gastrocnemius and soleus muscles. It begins by a small, hard, deep-seated swelling, sometimes very painful, sometimes but little so, and only hindering the.patient’s exer- cises. It does not alter the natural colour of the skin, at least until it has attained a considerable size. It enlarges gradually, does not soften as it enlarges, but continues through the greatest part of it incompressibly hard, and, when it is got to a large size, it seems to contain a fluid, which may be felt towards the bottom, or resting, as it were, on the back part of the bones. If an open- ing be made for the discharge of this fluid, it must be made very deep, and through a strangely distempered mass. This fluid is generally small in quantity, and consists of a sanies mixed with grumous blood: the discharge of it pro- duces very little diminution of the tumor, and very high symptoms of irritation and inflamma- tion come on, and advancing with great rapidity, and most exquisite pain, very soon destroy the patient, either by the fever, which is high, and unremitting, or by a mortification of the whole leg. If amputation has not been performed, and the patient dies, after the tumor has been freely prevents all satisfactory examination; but, if the limb was removed, without any previous opera- tion (and which Mr. Pott, in his experience, found to be the only way of preserving the pa- tient’s life), the posterior tibial artery will be found to be enlarged, distempered, and burst; the muscles of the calf to have been converted into a strangely morbid mass; and the posterior part of both the tibia and fibula more or less ca- rious. (Pott on Amputation.) It seems only necessary to adduce another species of tumor to illustrate the necessity of amputation. The following case is related by Mr. Abernethy. A woman was admitted into St. and three in breadth. lesser size and hardness. ham, by its pressure on the nerves and vessels,