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.

    90/1282 (page 78)
    If. possible, the dressings should never be re- moved before the fourth day, not reckoning the one on which the amputation is performed; and Sir Astley Cooper even prefers the sixth, or eighth day, merely removing on the fourth one strip of plaster, in order to let out any confined matter. (See Lancet, vol. 1, p. 150.) Monro also set down the fifth, sixth, or seventh day, as generally soon enough for the change of the dressings. He allows, however, that, if the smell of the wound should become offensive, the outer dressings may be removed sooner. Even when the dressings are to be taken away, it will fre- quently be found useful not to remove one strip of plaster; but, the stump must be made clean, and any discharge washed away. ‘These, and other valuable precepts, derived from the eminent Dr. A. Monro senior, are worthy their great source, and the correctness of them promises to be acknowledged for ever. The manner of renewing the dressings of stumps, is indeed a very important business, which should never be entrusted to mere novices ; for, in taking off the straps of sticking plaster, if great care be not taken, the slight and newly formed adhesions may be torn asunder. ‘Thus, as Mr. A.C. Hutchison has remarked, if the strap be pulled off by holding one end of it at nearly a right angle with the adhering part, the flap will be raised up with it, and thus a separa- tion of the newly united parts will be produced. <¢ My plan (says he) is to reflect the raised end of the strap close down upon the adhering part, and to bring it gently forward with one hand, while the removing part of the strap is followed by two fingers of the other placed upon the skin, &c. and when one end is detached from its ad- hesion, as far as the line of incision on the face of the stump, in like manner the other end is brought down and wholly removed.” (Pract. Obs. p. 46.) In order to facilitate the removal of the plasters, and save the patient a great deal of pain, I have always followed the plan of letting warmish water drop over them from a sponge for a few minutes previously to the attempt to remove them. In the early part of the treatment, it is also a valua- ble rule never to let every strap of plaster be off. at once, so as to leave the flesh quite unsup- ported. Some skill and care are also invariably necessary, to avoid pulling away the ligatures with the dressings. At the end of five or six days, the surgeon may begin to try, ina very gentle manner, whe- ther any of the ligatures are loose; observing rather to twist, than suddenly pull them directly outward. However, he should not use the smallest force, nor persist if the trial create pain. One would hardly try, whether the ligature on the main artery were loose, before the eighth or ninth day. If minute ligatures made of dentist’s silk be employed, and both their ends cut off close to the knot, of course, this delicate business of trying to get rid of the irritation of these foreign bodies is entirely superseded. Though, in the above account, I have directed the edges of the wound, after the amputation of the thigh, to be brought together in such a way, that the wound shall appear as a line across the face of the stump, yet there are instances, in which the bone seems most easily and conveniently perpendicular direction. Mr. B. Bell, indeed, generally approved of it, as affording a ready outlet for matter ; it is like- On the other hand, Mr. C. Hutchison objects to it, because it seems to him, that when a stump, thus put up, is laid on a pillow, the pressure tends to separate and open the lower part of the wound, | (Pract. Obs. on Surgery, p. 37.) é It is curious to remark, however, that the thing, which leads this gentleman to disapprove of the plan, is one which would be urged in its — actually take the precaution of never closing the cit. p. 14.) that the cicatrix afterwards became situated imme- diately over the end of the bone, the pressure of — which was very likely to make the part ulcerate. | However, in St. Bartholomew’s Hospital I have | seen the edges of the wound occasionally brought | I assisted Mr. Ramsden at Christ’s Hospital, | when an attempt was made to put up the wound in the common manner, the bone seemed to make considerable pressure against the skin, which did not happen, when the line of the wound was — made in the other direction, which of course was | immediately adopted. Mr. Hey has noticed this — subject as follows: the integuments and muscles | may be brought into contact by pressing either the anterior and posterior parts, or the sides of — the thigh, together.. The former method, by the — gradual retraction of the posterior muscles, causes / the integuments of the anterior part of the stump { to cover more completely the extremity of the bone. | The latter method causes the integuments and - muscles to meet each other the more readily, and therefore, is to be preferred, when the quantity stumps made inthis manner. In a case, in which ! of soft parts preserved is somewhat deficient. | (Pract. Obs. on Surgery, p» 533, Edit. 2.) [ From the observations of another modern’ writer, who disapproves of making the line of the stump perpendicular, the difficulty of covering | the end of the bone sometimes arises from not) duly relaxing the posterior muscles of the thigh, and therefore he condemns laying the stump on too high a pillow. (A. C. Hutchison, Pract. together, after amputation, so that they may. unite by the first intention, has received, for mariy years past, the’ universal approbation of British surgeons. It is their general practice in the treatment of all incised wounds. It may be said to be the pride of English surgery ; for, in nothing does she display more convincingly, her superiority. Baron Larrey, however, in cases of amputation, disapproves of the attempt to unite the wound by the first intention, and merely) brings forward its edges somewhat towards eact) other with a piece of linen, that covers | | | Obs. p. 41.) The plan of bringing the edges of the wound)