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.

    69/1282 (page 57)
    had greatly lessened the sensibility, and ob- structed the circulation of the leg, so that the limb was very edematous. As it appeared im- possible to remove this tumor, and its origin and connexions were unknown, amputation was performed. On examining the amputated limb, the tumor in the ham could only. be divided with a saw. Several slices were taken out of it by this means, and appeared to consist of a coagu- Jable and vascular substance, in the interstices of which, a great deal of bony matter was deposited. The remainder of the tumor was macerated, and dried, and it appeared to be formed of an ir- regular and compact deposition of the earth of bone. The tumor on the front of the thigh was of the same nature as that of the ham, but contained so little lime, that it could be cut with a knife. The thigh bone was not at all diseased, which is mentioned, because when bony matter is deposited in a limb, it generally arises from the disease of a bone. (Surgical Observations, 1804.) Before the late facts and improvements, re- lative to the treatment of aneurisms, these cases, on the extremities, were generally set down as requiring amputation. Even Mr. Pott, and J. L. Petit, wrote in recommendation of such prac- tice, and their observations on this subject are among the few parts of their writings, which the enlargement of surgical knowledge, since their time, has rendered objectionable. The surgeon, to whom the honour of first correcting this erro- neous doctrine belongs, is A. N. Guenault, who opposed the advice delivered on this subject by Petit. (Haller, Disp. Chir. vol. 5, p. 155.) I shall conclude these remarks on the cases requiring amputation, with advising surgeons never to undertake this serious operation, with- out consulting the opinions of other professional men, whenever their advice can be obtained. The best operators are often deficient in that invalua- ble kind of judgment, by which the cases, abso- lutely demanding amputation, are discriminated from others, in which the operation may be wisely postponed, and a chance taken of preserving the limb. Historical Remarks on Amputation. The history of amputation evinces, that the steps of surgery to perfection are slow, and that they even sometimes deviate from the straight path, though, upon all essential points, no retro- gradation has ever taken place. Here nature has acted as the guide, and the surgeon’s chief merit has consisted in obeying the hints which she her- self has thrown out. As already mentioned, the following natural occurrence, no doubt, was one of the circumstances, which first led to the bold practice of amputation; in consequence of dis- ease, and grievous local injuries, whole limbs were sometimes seized with mortification. In the majority of cases, this was attended with so much constitutional disturbance, that the patients died; but, in other less numerous instances, the mortification was confined to the part ; suppura- tion was established between the dead and living parts; the whole of the mortified limb fell off; the suppurating surfaces healed up; and thus, by the powers of nature, the patients were restored to health. Here was clearly proved the possibi- lity of recovery, notwithstanding the loss of a Jimb. The surgeon, as Briinninghausen remarks, 57 viewed with surprise this course of nature, and hardly ventured to promote it by the feeble means formerly employed, which, however, were not really needed. But, as the mortified parts, pre- viously to their detachment, caused great annoy- ance by their fetor, a surgical attempt was at length made to get rid of them; in doing which, the knife was always kept from touching the liv- ing flesh, on account of a well-grounded fear of bleeding, for the suppression of which no effec- tual methods were known. Such was the prac- tice that prevailed from Hippocrates down to Celsus. (Erfahr., &c. tiber die Amp. p. 14.) ‘¢ Partes autem corporis, que infra terminos de- nigrationis fuerint, ubi jam prorsus emortuze fuerint et dolorem. non senserint, ad articulos auferendz ea cautione ut ne vulnus inferatur,” &c. (De Articulis, sect. 6.) Here we find, that the earliest mode of amputation was that done at the joints. A. C. Celsus, who lived in the reign of Tibe- rius, and whose book, de. Re Medica, should be scription of the mode of amputating gangrenous limbs. (Lid. 7. c. 33.) It has been often re- marked, that Celsus has left no instructions for securing the divided blood-vessels; but it has not been commonly noticed, that, in his chapter on wounds, he directs us to stop hemorrhage by taking hold of the vessels, then tying them in two places, and dividing the intermediate por- tion. Ifthis measure cannot be adopted, he ad- vises the use of a cauterizing iron. Several hints are to be met with in the writings of Celsus, from which it may be inferred, that the ligature of bleeding vessels was sometimes practised at the early age in which he lived; and this suppo- sition is strengthened, by a fragment of Archi- genes, preserved by Cocchius, on the subject of amputation, where he speaks of tying, or sowing, the blood-vessels. We are not, however, in pos- session of all the writings of medical authors, prior to the time of Galen, and must therefore remain in doubt upon this point. (Rees’s Cyclo- pedia, Art. Amputation.) This anonymous writer argues, therefore, with some appearance of reason, that if amputa- tion often proved fatal in the days of Celsus, ‘* seepe in ipso opere,”’ as the expression is, it was owing to the want of some efficacious me- thod of compressing the blood-vessels, during the operation itself; for, whether the use of the liga- ture were known to the ancients or not, no doubt exists about their ignorance of the tourni- quet. But, adinitting that the ancients were not al- together uninformed of the plan of tying arte- ries, it cannot be credited, that they adopted the practice to any extent; for, if they had, they would not have continued so partial to the cautery, boiling oils, and a farrago of astringent applications. ‘They would also never have had recourse to the barbarous method of cutting the flesh with a red-hot knife, with the view of stop- ping the hemorrhage by converting the whole surface of the stump into an eschar. Painful in its execution, and horrid in its consequence, as this burning operation was, it seldom proved a lasting antidote to the bleeding, which generally came on in a fatal manner, as soon as the sloughs were loose. On this part of the subject, my own