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.

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    ideas fully agree with those of a distinguished foreign surgeon, who says, that although the docu- ment left us may prove, that the ligature was known to the ancients, and employed in cases of aneu- risms and wounded blood-vessels, nay, that the arteries were secured with a needle and ligature; yet, the practice could not have been extended custom of making the incisions in the dead parts, the method scarcely admitted of being put in exe- cution. (Brunninghausen, Erfahr.iiber die, Am- put. p. 29.) Ambrose Paré, therefore, seems to me to deserve as much praise for the introduction of the ligature into common use, as if no allusion to this method whatsoever had existed in the writ- ings of Celsus and other ancients. The different parts of the operation, meriting particular attention, are, the choice of the part of the limb where the incisions are to begin; the measures for guarding against bleeding during the operation; the division of the integu- ments, muscles, and-bones, which is to be ac- complished in such a manner, that the whole sur- face of the stump will afterwards be covered with skin; tying the arteries, which should be done without including the nerves, or any other adja- cent part; placing the integuments in a proper position after the operation; and, finally, the subsequent treatment of the wound. At the period of making the incision, the an- cients contented themselves with having the skin forcibly drawn upward by an assistant; they next divided, with one sweep of the knife, the integu- ments and flesh down to the bone, and, after- wards, sawed the bone on a level with the soft parts, which were drawn upward. Celsus consi- dered it better to let the incision encroach upon the living flesh, than leave any of the diseased parts behind. ‘“ Et potiusex sana parte aliquid excidatur, quam ex egra relinquatur.” (De Me- dicina, Lib. 7, c. 33.) It appears, however, that his views extended further than those of most of his contemporaries, and even his followers, almost down to modern times. After cutting the muscles down to the bone, he says, that the flesh should be reflected, and de- tached underneath with a scalpel, in order to de- nude a portion of the bone, which is then to be sawn as near as possible to the healthy fiesh, He states that, when this plan is pursued, the skin around the wound will be so loose, that it can almost be made to cover the extremiiy of the bone. It is to be lamented, that this advice, inculcated by Celsus, should not have been comprehended, or that it should have been so neglected, as to stand in need, as it were, of a new discoverer, and that a suggestion of such importance should have re- mained so long useless. But, the fact is, he- morrhage formerly rendered amputation so dan- gerous, that the ancient surgeons could not de- vote much attention to any thing else in the operation, and practitioners amputated so seldom, that we read in Albucasis, that he positively re- fused to cut off a person’s hand, lest a fatal he- morrhage should ensue, and the patient did it himself and recovered. Over that part of the stump which the small quantity of preserved skin would not cover, Celsus recommended com- presses, and a sponge dipped in vinegar to be laid. (De Re Medica, Lib. 7. ¢. 33.) Archigenes, who was born at Apamia, in Syria, was the disciple of Agathinus, and physician to Philip, king of that country. He repaired to Rome, where he practised physic and surgery, in the reign of the emperor. Trajan, about 108 years after the birth of Christ. (Portal, Hist. de V Anatomie et de la Chirurgie, Vol. 1, p. 61.) In the history of amputation, the name of Archi- genes is conspicuous, not only because he is supposed to have been acquainted with the use of the needle and ligature for the stoppage of bleed- ing, but because his description of the operation is in some respects more minute than that of Celsus. For the hinderance of loss of blood in the cperation, says Sprengel, (Geschichte der Chir. B. 1. p. 404, Hall, 1805,) he first of all tied up the vessels, and often the whole limb, over which he also sprinkled cold water. The integuments were then drawn upwards from the wound, and confined there with a band; and, after the limb was off, he cauterized the stump, and applied folded compresses. The band was now loosened, and a mixture of leeks and salt laid on the stump, to which were also applied oil and cerate. (WVicet. Coll. Chir. p. 155.) Such was likewise the practice of Heliodorus, who thus early made objections to the plan of cutting off a limb by a single stroke, @ proposal that was re- newed in far later days. ‘The same author has also spoken of amputating at the joints; a method, of which he disapproves. (Nicci. Coll. Chir. p. 155.) However, Galen entertained a favourable opinion of it, on account of its safety and expe- dition. (Comm. 4, in lib. de artic, p- 650.) Galen’s precepts concerning amputation are, upon the whole, very like those given by Hip- pocrates; for he directs only dead parts to be cut, and the stump to be cauterized. (De Arie Curativa ad Glouconem, lib. 2.) By all the old writers, amputation was entirely restricted to cases of mortification ; further they were afraid to go; and this precept, and all the other doctrines of Galen, may be said to have been the guide of the whole surgical profession for full fourteen centuries. The timid Arabians were not partial to ampu- tation, and even in cases of mortification, gene- _ rally preferred a farrago of useless applications, like Armenian bole, &c.- Paulus AXgineta, like Galen, deviated from Celsus’s good rule of making the incisions in the healthy parts, and | only approved of making the requisite division near them. (Lib. 4, c. 19, p- 140.) Avicenna, however, repeated the directions left by the Greek writers, (Can. lib. 4. Fen. 3, tr. 1, p. 454.) and Abu’l Kasem proposed doing the operation with a red-hot knife. (Chirurg. lib. 1. Sect. 52, p.99.) In the middle ages, little was done for the improvement of amputation. Inthe 14th century, gunpowder was invented, and soon applied to the purposes of war, so that an abun- dance of cases must have presented themselves, in which the wise maxim of not deferring ampu- tation, until mortification had come on, but of preventing the mischief by the operation, ought to have struck an intelligent surgeon. One might also expect that practitioners would now have been led to make the incisions in the sound flesh. Unfortunately, the invention of gun- powder, and its immediate consequences in sur- | gery, happened at a period when practitioners |