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.

    93/1282 (page 81)
    ‘way through, or is thrown off, and the hemorrhage returns; or, some other branch is opened, and ‘another ligature is required, which is equally » uncertain; and under this succession of ligatures -and hemorrhages, the patient dies...’ Here, cut- _. ting down to the principal artery, in preference ‘to another amputation, has. often succeeded’; ‘but, under certain circumstances, it fails, and amputation becomes ‘ultimately necessary. At the- same time, it is allowed, ‘that this operation “may also fail.- On the whole,Mr. Guthrie pro- _fesses himself:to be an advocate in most’cases for ‘proceeding should not: answer, he would then ‘the artery in these cases, he thinks, should’not be ‘adopted indiscriminately, the doctrines’ of aneu- ‘rism not being here applicable, because there isa “wounded vessel, with an external opening. © “In the thigh, -the operation is less certain, than in --the arm, and especially, if it is not the main ar- tery: that bleeds; for, the branch, from which the hemorrhage proceeds may. come from the profunda, and tying the artery in'the groin on ‘such opinion would be doing a serious operation, and one; which probably would not succeed ; for, ‘the anastomosing branches would restore the cir- culation in the stump in’a‘short time, and again estabiish the bleeding. If it is the femoral artery that bleeds, and the ligature is applied high, it is very liable to a return of hemorrhage. To obviate these: difficulties, “the part from which the bleeding comes should be well studied, amd the shortest distance from the stump care- fully noted, at which compression on the artery commands the bleeding; and, at this spot, the ligature’ should be applied, provided it is not within the sphere of the inflammation of the stump.” (On Gunshot Wounds, ‘p. 105-106.) Thus far the advice: seems to me correct and valuable; but, where the hemorrhage could be restrained by taking up tli artery in the groin, though not lower down, I doubt the propriety of preferring amputation to this other far less severe operation, admitting that the efficiency of a liga- ture above the protunda, has been proved ‘in the manner judiciously recommended by Mr. Guthrie, viz. by means of pressure, - ta The following is the counsel offered by Mr. Hey in a case of this nature. _ “When we are under the necessity of ampu- tating a limb, that has suffered great contusion, though the operation is performed upon a part apparently sound, the wound sometimes becomes sloughy and ill conditioned. No good granula.- tions arise to cover the extremities of the ‘ar- teries ; but the ligatures cut through ‘these vessels, or becoming loose, cease’ to make a Sufficient pressure upom them, and hence re- peated hemorrhages ensue. This is a dane. gerous state for a patient; for, if the vessels are taken up afresh with the needle, the hemorr- hage will now and then return in the course of tion of dry sponge, cut’ transversely, as directed by Mr. White, (Cases ‘in Surgery), has been found singularly useful, and has saved the life of the patient, But, a constant) pressure must be kept upon the “pieces of sponge, by the fingers of a succession pf assistants, till granulations 8i begin. to arise upon ‘the sturhp, and the prospect of future hemorrhage disappears. This method on the thigh, or leg, where the great vessels are deeply seated. In the arm, above’ the elbow, artery may be taken up, with a portion ef mus- cular flesh, above the surface of the stump, by making first an incision through the intecuments. within the last’ year, with’ complete success, had failed. “In the morbid sloughy state of the stump, in a liquid, composed of equal quantities of lemon- ‘Juice and rectitied spirit of wine, has been found very advantageous, and has caused it to put ‘on soon a healthy aspect.’ (P. 536, 537, edit. 2.) 7 ON PROTRUSION OF THE BONE. | It is clearly proved by the observations of M. Louis, that this disagreeable consequence may be generally prevented’ by taking care to ‘divide the loose muscles first; and (after their complete retraction, which will be favoured by no band, nor tourniquet, being applied round the limb), by observing to divide with a bistoury the muscles which adhere to the bone ;' for instance, the crural muscle, and the point of adhesion of femur. By this method, the bone‘may be sawn three finger-breadths higher than it can be, if no attention be paid to beginning with the division ‘of ‘the loose muscles, and concluding with that of such as'are more attached to the bone.’ * The protrusion of the bones will never take place, so long as they are immediately encom— passed, with the fleshy substance of the musc¢les ; this proposition is incontestable. The staté of the skin, whether longer or shorter, conduces nothing to this protrusion; nor will the incon- venience be prevented by drawing the skin up- ward, and preserving as much of it as possible, (See Mém. sur la Saille de VOs apres Vampita- tion in Mém. de V Acad. de Chirurgie, tom. 5, p» 273, edit. in 12mo.)> ~ F - As Mr. Guthrie has correctly observed, a protrusion of the bone, after sloughing of the stump, or other accidental circumstances, will sometimes happen, without'any fault’on the part of the operator; but, he thinks, it may almost always be prevented by attention to the following rules: 1. To leave: the integuments attached to the muscles, instead of turning them back. 2. When the muscles are cut through in a slant- ing’ direction, upwards and inwards, or even directly’ downwards, to separate’ them from the bone, so that it may appear at the bottom of the cone as a depressed point ;' 3. To cut the bone short, and to keep the thigh constantly bandaged from the trunk during the cure, so as to prevent the retraction of the muscles. If, sdys’ Mr. Guthrie, a surgeon find directly after the opera- tion, that the bone cannot be well covered, he as will reduce it to its, proper length. The error may be remedied. at this moment’ with very little inconvenience in comparison with what