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.

    77/1282 (page 65)
    ‘the parts insensible. (Haller, Diss. Chir. Vol. 5, p. 155.) A similar occurrence was related by Acrel (Chir. hiindels. p. 557 ;). and Lalouette professed himself a believer in the security from hemorrhage, on account of the vessels being filled with coagula, and therefore he also approved of letting dead parts be removed, or rather fall off, without bloodshed. (Haller, Diss. Chir. Vol. 5, p. 273.) In cases where the projecting bone of the stump was affected with necrosis, Bagieu, an ex- perienced military surgeon, ventured to amputate a second time, and urged a variety of arguments im defence of the practice. (Mém. del’ Acad. de Chir. T. 2, p. 274.) He coincided with Le Dran and Bromfield, however, about the pro- priety of restricting amputation to few cases, and has related numerous examples of Jimbs being saved, which, according to the doctrines then in vogue, ought to have been cut off. (Deux Lettres @un Chir. de VArmée, 12mo. Paris, 1750.) ' M. Louis, a French surgeon of extraordinary talents, introduced the plan of dividing the loose muscles first, and lastly those, which are closely connected with the bone. He noticed, that the muscles of the thigh, after being divided, were retracted in an unequal degree. He observed, that the superficial ones extending along the limb, more or less obliquely, without being attached to the bone, were drawn up with greater force, and in a greater degree, than others, which are deeply situated, in some measure, parallel to the axis of the femur, and fixed to this bone throughout their whole length. The retraction begins the very instant when the muscles are cut, and is not completed till a short time has elapsed. Hence, the effect should be promoted, and be as perfect as possible, before the bone is sawn. In the amputation of the thigh, M. Louis was always desirous of letting the muscles contract as far as they could, and, for this reason, he was rather averse to using the tourniquet, as the circular pressure of this instrument in some measure counteracted what he wished to take place, and hence, at onetime he preferred letting an assistant make pressure on the artery, though he sub- ‘sequently expressed his approbation of the tourni- quet proposed by M. Pipelet for compressing the femoral artery. (Mém. de 0 Acad. de Chir. Vol. 4, p. 60. 4to.) _ Actuated by such principles, Louis practised a kind of double incision different from that of Cheselden and Petit, and different also from Alanson’s method, which I shall hereafter notice. By the first stroke, he cut, at the same time, both the integuments and the loose superficial muscles ; by the second, he divided those muscles, which are deep, and closely adherent to the femur. On the first, deep, circular, cut being completed, Louis used to remove a band, which was placed round the limb, above the track of the knife. This was taken off, in order to allow the divided muscles to become retracted without any impediment. He next cut the deep adherent muscles, on a level with the surfaces of those oose ones, which had been divided in the first neision, and which had now attained their utmost tate of retraction. In this way, he could evi- lently saw the bone very high up, and the painful lissection of the skin from the muscles was 65 avoided. Louis was conscious, that there was more necessity for saving muscle than skin; and he knew, that when an incision was made at once down to the bone, the retraction of the divided muscles always left the edge of the skin project- ing a considerable way beyond them. Hence he deemed the plan of first saving a portion of skin, by dissecting it from the muscles, and turning it up, quite unnecessary. As the bone should always be sawn rather higher than the division of the soft parts, Louis, like J. L. Petit, and most other judicious surgeons, highly approved of the employment ofa retractor. He was likewise the author of some valuable instructions for preventing the protrusion of the bone after the operation. (See Mém. de? Acad. de Chir. T. 2, p. 268-410, &c. 4to.) The impartial reader, who takes the trouble to read the remarks on amputation, pub- lished by this greatest of all the French surgeons of the last century, with the exception: perhaps of J. L. Petit, and Desault, will be impressed at once with the force and perspicuity of his matter, and with the evident propriety of a good deal of the practice inculcated, In England, Cheselden, and not-J. L. Petit, is regarded as the surgeon, who revived Celsus’s method, by proposing to divide the soft parts by @ double incision, that is, by cutting the skin and cellular substance first, and then, by dividing the muscles, down to the bone, on a level with the edge of the skin, so that the bone might be sawn higher up, and its end be more completely covered with skin. Whether Cheselden had the pri- ority in this improvement, I cannot’ presume to say ; but, he gave an account of it in Gataker’s translation of Le Dran’s treatise on the opera tions, as early as 1749, which was long prior to the appearance of Petit’s posthumous writings ; and Mr. Cheselden further mentions, that, during his apprenticeship to Mr. Fern, he had com- municated to that gentleman his sentiments about the double incision. In order to hinder the stump from assuming a pyramidal, or sugar-loaf shape, which some- times happened notwithstanding every improve-~ ment hitherto mentioned, a circular bandage was employed, which acted by supporting the skin and muscles, and preventing their retraction: This bandage, when properly applied, from the upper part of the limb downward; fulfilled ina - certain measure the end proposed, though many stumps yet turned out very badly. Mr. Sharp was induced, therefore, to revive the ancient plan of bringing the edges of the skin together with sutures; but, the pain and other inconveniences of this method were such, that it was never ex- tensively adopted, and Mr. Sharp himself ul- timately abandoned it. The cross-bandage, how- ever, which he used to put over the end of the stump, remains in fashion even at the present day. (Treatise on the Oper. p. 2165 Critical Inquiry, p. 262.) It is to be regretted, that an excellent modern surgeon, the late Mr. Hey, should have commended, so much as he has done, the use of sutures, in bringing together the edges of the wound after amputation. (Pracs tical Observations in Surgery, p.534, Edit. i25) . In opposition to Louis, the inefficiency of his method for hindering the protrusion of the bone was asserted by Valentin, who thought the object might be-better attained by dividing ae parts;