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.

    74/1282 (page 62)
    the bone, they detached the flesh further from it upwards, previously to taking the saw; but, on the contrary, if Sprengel wishes us to believe, that there were practitioners, who previously to Lowdham, in the operation of amputation, formed what in England is usually understood by a flap, that is a portion of flesh, generally of a semilu- nar shape, and saved particularly from one side of the member for covering the bone, I cannot see any reason for coinciding with Sprengel’s ob- servation. Upon the merit of Lowdham’s sug- gestions, and the practice and principles incul- cated by J. Yonge, some reflections lately sent me by Mr. Carwardine; I insert with great plea- sure, as perhaps he is right in thinking, that the third edition of this work did not do justice to the memory of the latter writer. *¢ At the time Yonge wrote (1679) says Mr. Carwardine, it was supposed impossible to heal a stump tefore the bone had exfoliated, and there- fore, no surgeon would venture upon an attempt at uniting the surface by the first intention. Now this union by the first intention, was the chief object of Mr. Yonge in proposing the flap son, who wrote precisely 100 years after him, that we must attribute the honor of this improve- ment. It is related in a letter addressed to his friend Thomas Hobs, chirurgeon in London, dated Plymouth, August 3, 1678, and published 1679, at the end of his Currus Triumphalis e Terebintho. It begins thus: — ‘Sir, I find by yours that you are surprised with the intimation I gave you, of a way of amputating large members, so as to be able to cure them per symphysin in three weeks ; and without fouling or scaling the bone. It is a paradox which I will now evince to you to be a truth, after I have first taken notice of what you affirm, that there is a necessity of scaling the ends of those bones left bare after the usual manner of dismembering be- fore the stump can be soundly cured; that you never yet found it otherwise, but that where it hath been attempted, the stumps have apostu- mated, and the caries come off thereby. *« Yonge then acknowledges, that it was from an ingenious brother, Mr. C. Lowdham of Exe- ter, that he had the first hint thereof. He then describes the operation—the laying down the flap over the face of the stump, and sewing it by four or five stitches, &c. After this Yonge pro- ceeds with a methodical enumeration of the ad- vantages of this mode of operating over all others then in use, viz. that it is more speedy—the cure not occupying uw fourth of the usual time—no suppuration—no exfoliation—less danger of he- morrhage—not liable to break open again from the pressure from an artificial leg, &c. «The foregoing abstract will show (says Mr. presently to be described, in which he dresses the flap and the stump as distinct surfaces, can be re- garded as a revival of Lowdham’s operation, or whether it has been superseded or improved upon by the mechanical ingenuity of the Dutch and Faye and Verduin, appear to have been merely clumsy and unscientific contrivances for the sup- pression of hemorrhage. Garengeot's operation had also for its object, to supersede the use of the ligature, which, however, after twelve years practice, he was obliged to give up, and tie the lars of all these methods the reader will presently meet with.) Opinions therefore founded upon the practice of these gentlemen, I conceive cannot fairly be admitted as evidence against the flap operation of Lowdham, which nevertheless ap- pears sinking in the estimation of the best mo- dern surgeons: pevhaps no material advantage is gained by it over the common mede of operating in the lower extremitics, as now practised—but even here, cases may occur where we are glad to resort to it: a few years since, I attended a patient in consultation with a friend at Dunmow, in Es- sex, where we thought it necessary to remove a man’s leg for a caries of the tibia. An ulceration in front extended so high, that no integument could be saved, and the limb would have been removed above the knee, if I had not suggested the propriety of making a flap from the calf of the leg. The tibia was obliged to be sawn as high as possible, but the flap was left sufficiently long to cover the surface, and that most important ob- ject, the bend of the knee, was preserved to bear the pressure of a wooden leg. Inthe removal of the arm at the shoulder joint, doubtless the advantages of making a flap from the deltoid, &c. are suf- ficiently established ; but, in the mode of dressing, I presume, that no English surgeon will admit, that the practice of M. Larrey (perhaps the most eminent surgeon that has been formed by the wars of Bonaparte, and whose practice will be here- after noticed) can supersede the method of Yonge (or Lowdham) who wrote 140 years before him ! Larrey introduces charpie beneath the flap to prevent union by the first intention! Lowdham’s object is simply to lay the flap over the wound to prevent exfoliation, and to heal the surface ‘ per symphysin’ in three weeks.” —To the cor- rectness of these sentiments of Mr. Carwardine, I believe, that every impartial surgeon will bear witness ; and it merely remains for me to thank him for his obliging communication, and say, that I have recently looked over the copy of the Currus Triumphalis e Terebintho, preserved in the valuable library of the ‘Medical and Chi- rurgical Society, and find, that what he has stated is fully confirmed. by the contents of that an- cient work. At the same time, I retain the belief, that the example set by Mr. Alanson, with respect to the proper method of dressing stumps, and obtaining a speedy union of the wound, is entitled to the praise of posterity, because his ad- vice was so well enforced that it soon produced a revolution in practice, while the correct sugges- tions of Lowdham and Yonge, like the hint in Celsus, of the double incision, had sunk into ob- livion, or were only known to a few admirers of surgical antiquities. As Sprengel remarks, Purmann, Dionis, (Cours a’ Oper. de Chir. p. 611.) De la Vaue the integuments, and then applying a band round the member. expresses a strong aversion to the actual cautery.