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.

    79/1282 (page 67)
    whether two, three, ov four finger-breadths higher, than the edge of the retracted integuments ; or, in other words, the quantity of muscular sub- stance to be taken out, in making the double in- cision, must be regulated by considering the Jength of the limb, and the quantity of skin that has been previously saved by dividing the membranous attachments. The quantity of skin be in such exact proportion to each other, that the whole surface of the wound will afterwards be easily covered, and the limb not more shortened, than is necessary to obtain this end. After the removal of the limb, Mr. Alanson drew each bleeding artery gently out with the te- naculum, and tied it as nakedly as possible, with a common slender ligature. When the large ves. sels had been tied, the tourniquet was immediate. ly slackened, and the wound well cleaned, in or- der to detect any vessel, that might otherwise have remained concealed with its orifice blocked up with coagulated blood; and before the wound was dressed, its whole surface was examined with the greatest accuracy, by which means Mr. Alan- son frequently observed a pulsation, where no hemorrhage previously appeared, and turned out a small clot of blood from within the orifice of a considerable artery. He is very particular in recommending every vessel to be secured that is likely to bleed on the attack of the symptomatic fever; for besides the fatigue and pain, to which such an accident immediately exposes the patient, it seriously interrupts the desired union of the wound. He used always to clean the whole sur. face of the wound well with a sponge and warm water, as he thought, that the lodgment of any coagulated blood would be a considerable obstruce tion to the quick union of the parts. . The skin and muscles were now gently brought forwards ; a flannel roller was put round the body, and carried two or three times rather tightly round the upper part of the thigh, as at this point, it was intended to form what Mr. Alanson called a sufficient basis, which materially added to the support of the skin and muscles, The roller was then carried down in a circular direction to the extremity of the stump, not so tight as to press rudely or forcibly, but so as to give an easy Support to the parts. ' The skin and muscles were now placed over the bone, in such a direction, that the wound ap- peared only as a line across the face of the stump, with the angles at each side, from which points, the ligatures were left out, as their vicinity to either angle might direct. The skin was easily secured in this posture by long slips of linen, or lint of the breadth of about two fingers, spread with cerate, or any cooling ointment. Ifthe skin did not easily meet, strips of sticking plaster were preferred. These were applied from below up- wards, across the face of the stump, and over them a soft tow-pledget and compress of linen; the whole being retained with the many-tailed bandage, and two tails placed perpendicularly, in order to retain the dressings upon the face of the stump. Aa Mr. Alanson censured the plan of raising the end of the stump far from the surface of the bed with pillows, as the posterior muscles were re- ‘tracted by it; and he considered it best to raise 67 the stump only about half a hand’s breadth from the surface of the bed, by which means the muscles were put in an easy relaxed position. The many-tailed bandage Mr. Alanson found much more convenient than the woollen cap, frequently used in former times to support the dressings; and he observes, that, though this seems well calculated to answer that purpose, yet if itbe not put on with particular care, the skin is liable to be drawn backwards from the face of the stump; nor can the wound be dressed, without first lifting up the stump to remove the cap. (See dlanson’s Practical Obs. on Amputation, 8vo. Lond. 1779.) The chief peculiarity of Alanson’s method of operating, namely the mode, in which he recom- mends the oblique division of the muscles to be performed, did not, however, meet with universal approbation, and his extensive dissection of the skin from the muscles was complained of as ex- cessively painful. The formation of a conical wound, by following Alanson’s directions, was regarded by several as impracticable. (See Mar- ten’s Paradowieen, B. 1. S. 88; Loeffler, Bey- trage 1. No.7 3 Wardenburg. Briefe Eines Arz- tes 2 B. p. 203; Richter, Anfangsgr. vol. 7; Gracfe, Normen, &c. p.8 3 H. ey. Pract. Obs.) In my opinion, there can be no doubt of the truth of some of the criticisms made by these, and some other writers, on the impossibility of making a wound, with a regular conical cavity, by ob- serving the directions given by Alanson; for, if the knife be carried round the member with its edge turned obliquely upwards towards the bone, it will pass spirally, and, of course, the end of the incision will be considerably higher, than the be- ginning. But, though Alanson probably never did himself exactly what he has stated, I am sure, that his proposition of making an oblique division of the muscles all round the member, has been the source of great improvement in amputations in general, and is what is usually aimed at by all the best modern surgeons. It is true, they do not actually perform the oblique incision all round the limb, by one stroke, or revolution of the knife round the bone, as Alanson says that he did; but, they accomplish their purpose by repeated, distinct, and suitable applications of the edge of the instrument, turned obliquely up- wards towards the bone, or bones. Amongst others, Mynors found fault with some of Alanson’s instructions, and thought every desideratum might be more certainly at. tained by saving skin enough, and then cutting through the muscles. The first incision, how- ever, he directed obliquely upwards through the integuments, while they were drawn up by an assistant, and he then cut down to the bone. 1783.) Sprengel considers Mynors’s plan merely as a revival of Celsus’s method, as it had in view only the preservation of skin, and not the forma- tion of a fleshy cushion. (Geschichte der Chir. B. 1. p. 426.) Kirkland endeavoured to improve Mynors’s plan, by cutting off a piece of skin at each angle of the stump, so as to keep the integuments from being thrown into folds; and, in Opposition to Pott, he defended the sentiments of Bilguer, concerning the successful management of despe- rate cases, without amputation. (On the present Fg