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.

    78/1282 (page 66)
    while they were in a state of tensiori, for which purpose, he recommended changing the posture wasabout tocut. (Récherches Critiques sur la Chirurgie moderne, 8vo. Amst. 1772). Valen- tin’s proposal seems never to have made much impression on the profession; whether on ac- count of its inconvenience, or inefficacy, I know not: certain it is, many cases present them- cannot be changed during the operation, owing to the nature of the disease, or cannot be altered without extreme agony. At this period arose the celebrated contro- versy about the propriety of amputation in ge- neral. As Sprengel remarks, several French surgeons now began to be convinced, with Le Dran and Bagieu, that the operation was un- dertaken on too light grounds, and, in particular, that many bad complicated fractures might be cured without amputation. Such was the doctrine of Boucher (Mém. de ? Acad. de Chir. T. 2, p. 304), Gervaise (Anfungsgr. der Wundarzn. 8vo. Strasb. 1755), and Faure (Mém. qui ont concouru pour le prix de V Ac. de Chir. Vol. 1, p- 100). The latter especially urged the pru- dence of delay, in gunshot wounds, and com- minuted injuries of the bones. But, the writer, who at this time made most noise in the world, by his general condemnation of amputation, was Bilguer, (Diss. de Membrorum Amputatione, gvo. Hal. 1761), whose sentiments received a complete a refutation from his own contempo- raries, Pott, (Chir. Works, Vol. 2), Morand, (Opuse. de Chir. T. 1, p. 232), and De La Mar- tiniére (Mém. de ? Acad.de Chir. Vol. 4, p. 1), and also from later writers, to whom reference ‘willde made in speaking of Gunshot Wounds. Even Bilguer himself was compelled to admit the necessity of amputation in cases of gangrene. (Anweis fiir die Feldwundirzie, 8. 170.) Bilguer’s colleague, the celebrated Schmucker, inclined to the same doctrines, and has detailed several cases, where limbs were not only shattered, but actually carried away by balls, yet where a cure followed without amputation. One of his maxims was, that it was better for the member to be taken off by gunshot, than by the surgeon’s knife, as the ball operated on a healthy subject, the knife on a person debilitated by an hospital. (Chir. Wahrn. Th. 2. S. 493.) In a later valuable essay on this subject, he restricts am- putation to shattered limbs, affected with gan- grene. His mode of operating was that of M. Louis. He sanctioned joint-operations at the hip and shoulder; but condemned those of the knee and elbow, as never answering. (Verm. Soon after the middle of the last century, the practice of amputating at the joints began to excite increased attention ; but, as this is a topic, to which [I must presently return, it is unneces- sary now to dwell upon it. The writings of Puthod, Wohler, Brasdor, Barbet, Sabatier, Park, Moreau, and Vermandois, in relation to this subject deserve particular notice. I now come to Mr. Alanson, whose name is as eonspicuous in the history of amputation as that of any surgeon yet mentioned. His chief objects were to hinder a protrusion of the bone, and promote union by the first intention. He res jected the band, which was formerly put round the limb for the guidance of the knife, as alto- gether useless, and an impediment to the quick performance of the circular incision through the skin. When the tourniquet had been applied, an assistant grasped the integuments with both hands, and drew them and the muscles firmly upwards. The operator then fixed his eye upon the proper part where he was to begin the incision, which was made with considerable facility and despatch, the knife passing with greater quickness in consequence of the tense state of the integu- ments. : After the incision through the skin had been made, the assistant ‘still continued a steady support of the parts, while Mr. Alanson separated the cellular and ligamentous, attach- ments with the point of his knife till as much skin had been drawn up as would, with the muscles, divided in the particular way hereafter recommended, fully cover the whole surface of the wound. Then, instead of applying the knife close to the edge of the integuments, and dividing the muscles in a circular perpendicular manner down to the bone, Mr. Alanson proceeded as follows: when operating upon the thigh, and standing on the outside of the’ limb, he applied the edge of his knife under the edge of the sup- ported integuments, upon the inner margin of the vastus internus muscle, and cut obliquely through that and the adjacent muscles, upwards as to the limb, and down to the bone, so as to lay it bare about three or four finger-breadths higher than is usually done, by the common per- pendicular circular incision. He now drew the knife towards himself; then keeping its point upon the bone, and the edge in the same oblique line already pointed out for the former incision, he divided the rest of the muscles in that direction all round the limb; the point of the knife being in contact with, and revolving round the bone through the whole of the division. According to Mr. Alanson, the speedy execu- tion of the above-directed incision, will be much expedited by one assistant continuing a firm and steady elevation of the parts, and another taking care to keep the skin from being wounded, as the knife goes through the muscles, at the under part of the limb. Mr. Alanson censures the old method of depriving the bone of its periosteum to a considerable extent, above and below the part, where the saw was to pass, not only as creating un- necessary delay, but, since the periosteum serves to support the vessels in their passage to the bone, as apt to produce exfoliations. above the part where the bone is to be divided with the saw. Instead of this practice, he recommends first the application of the retractor, as advised by Gooch and Brom- field; and then denuding the bone at the part, where the saw is to pass, whereby the bone may be sawn off higher than is usually practised; a material object for hindering a projection of the bone, and forming a small cicatrix. ) If the flesh of a stump, formed in the thigh, agreeably to the foregoing plan, be gently brought forward after the operation, and the surface of the wound be then viewed, it may be said to resemble in some degree, a conical cavity, the apex of which is the extremity of the bone; and. the parts, thus divided, Mr. Alanson thought the best calculated to prevent.a sugar-loaf stump.