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.

    75/1282 (page 63)
    which must be left behind, would impede the healing of the stump, and he was apprehensive of the articular surface of the femur becoming diseased. De la Vauguyon relied upon the styptic properties of vitriol, and he praised draw- ing back the muscles by means of the kind of bag invented by Fabricius Hildanus. Taking off the limbs at the joints was first commended again in modern times by J. Mun- nicks, who was more partial to styptics, than the ligature; and for dressing the wound employed compresses and sticking plaster. (Chirurgia, p» 101.) Mauquest de la Mothe adopted the plan of operating recommended by Dionis; he was also one of the first who made common use of the tourniquet in amputations, afterwards drawing out the vessels with the forceps and tying them. (Traité Compl. de Chir. Vol. 3.9.171.) Lowd- ham’s original suggestion of amputating with a flap has been briefly noticed. About eighteen years after Yonge’s publication, Peter Verduin, an eminent surgeon at Amsterdam, submitted to the judgment of the profession a new kind of flap amputation, which he had put in practice. (See Dis, Epistolica de Nova Ariuum decur- tandorum ratione, Svo. Amst. 1696.) The following are the chief particulars of Verduin’s flap operation. ‘wo compresses were applied, one under the ham, and the other on the course of the large vessels. ‘The thigh was wrapped in a fine linen cloth, which was sustained by some turns of a roller. This apparatus was covered with a piece of leather, six inches broad, furnished with three straps with buckles, to secure it round the part. The tourniquet was placed in the usual manner. The part, above the place intended to be ampu- tated, was surrounded with a leather strap. The point of a crooked knife, which was made to pass as near to the back part of the bones as possible, was thrust in on one side of the leg, and made to come out on the other. The knife was then car- vied down nearly to the tendo achillis, and thus it separated almost the whole calf of the leg. The flap being formed, the operation was finished in the ordinary manner. The wound was then washed with a wet sponge, in order to clear it from the fragments of sawn bone. The leather strap, which served to secure the flesh, was next loosened, and the flap laid over the stump. The wound was dressed with lycoperdon, lint, and tow, over which was put a bladder, sustained by strips of sticking-plaster. Upon this bladder was placed an instrument, called a retinaculum, con- sisting of a compress, and a concave plate, which were made to press upon the stump, by means of two straps, which crossed each other, and were attached to the broad leather strap surrounding the thigh. In 1702, Sabourin ,an able surgeon at Geneva, gave an account of Verduin’s practice io the Royal Academy of Sciences, which, however, declined to pronounce any judgment about it, without further experience, Though this method of amputation was ob- jected to by Kénerding, in a tract published at Am- sterdam in 1705, it was afterwards highly ex. tolled by P. Massuet, on account of the quick. ness with which the stump healed, the safety with which the flap served for the stoppage of the 63 hemorrhage, and the avoidance of exfoliation by . the non-exposure of the bone. He also dwelt upon the excellency of the stump for the applica- tion of an artificial foot. (De ? Amputation @ lambeau, 8v0. Paris, 1756.) Heister disapproved of the flap amputation, because it appeared to him, that the irritation of the flesh by the projecting bones was apt to cause pain and inflammation: he operated himself after the manner of Dionis, and was strongly in favour of the use of ligatures. Some excellent precepts were delivered by J. L. Petit concerning amputation. He improved the tourniquet ; and, instead of the large crooked am- putating knife, formerly employed, first brought into use the straight more moderate-sized knives with sharp backs, now seen in the hands of the best surgeons, because much better calculated than crooked knives, for dividing the flesh by a sawing movement, which is the only right and surgical way of attempting to cut any part of the human body. He proved that making the di- vision in the mortified parts was frequently fol- lowed by hemorrhage ; and for the suppression of bleeding he thought it the best principle to pro- mote the formation of a coagulum. (Mém. de V’ Acad. des Sciences, an 1732, p. 285. See Hemorrhage.) Yor compressing the vessels, he employed an instrument, which covered the stump, like Verduin’s retinaculum, and made pressure by means of a screw. His only objec- tion to Verduin’s method was, that the exten- sion of gangrene up the limb frequently hindered the formation of so large a flap. He laid down the valuable general maxim of always removing as much bone, and as little flesh, as possible ; for which purpose, he invented what is termed the double incision, or dividing the business of cutting through the soft parts into two stages. About an inch higher than the place where he meant to saw through the bones, he first made the circular cut through the integuments down to the muscles ; the skin was then pulled up so as to leave the flesh uncovered to the extent of an inch, and the muscles were now divided at the highest point of their exposure. Lastly, the flesh was held out of the way with a retractor, and the bone was sawn through high enough up to allow of its extremity being well covered with flesh and integuments. The greatest defect in the doc- trines of Petit, relative to amputation, was the confidence he put in pressure, instead of the liga- ture. (Traité des Malad. Chir. vol. 3. p. 126.) The first performance of amputation at the ments and alterations of that operation sug- gested by Garengeot, De la Faye, Desault, xc. I shall notice in a future section. In chronological order, the next event, claim- ing notice, in the history of amputation, was the promulgation of an opinion by T. R. Gagnier, that Verduin’s flap-amputation might be traced back to times of great antiquity, the method de- scribed by Celsus being very similar. ( Haller, Diss. Chir. vol. 5. p. 161.) On this point, with reference to Lowdham, the true inventor of the flap-operation, I have already delivered my own sentiments. The flap-amputation of the leg, after Verduin’s manner, was tried by De la Faye, who found, that the pressure of the flap was not enough to check bleeding from all the vessels, as it only