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.

    94/1282 (page 82)
    ® 82 must afterwards be encountered, if the opportu- nity be neglected. (On Gunshot Wounds p. 109.) For some very useful directions how to bandage and support the soft parts with adhesive plasters, with the view of counteracting the tendency of the bone to protrude, I refer to some observations by Mr. Wright. (See Brom- jield’s Chir. Cases, &c. Vol. 1, p. 177.) Having explained, that the surest way of preventing the evil is to save a sufficiency of muscle, especially of that muscular substance which is naturally most near and adherent to the bone, we shall next speak of the mode of relief. When the end of the thigh-bone protrudes, it of course hinders cicatrization, and becomes itself affected with necrosis. By the process of exfoliation, the dead portion of bone is some- times thrown off, and a cure follows. But, in general, this desirable change is extremely tedious, and the result uncertain, because it frequently happens, that, after the piece of bene has sepa- rated, the rest yet projects too much, and the stump still continues too conical to heal firmly enough to be capable of bearing the pressure of a wooden leg. When, however, the end of the bone forms only a slight projection, and ‘the stump is not too conical, it is always best to leave nature to throw off the redundant exfoliating portion. In the opposite circumstances, the removal of all such part of it as cannot be covered by the integuments, is the best practice, and, if well executed, will effect a cure. This second operation is exceedingly un- pleasant to the surgeon, because patients are apt to suspect, and not without reason, that the first was not properly managed. Let ime there- fore repeat, that the surest way of avoiding the evil, is to cut the deep muscles, rather higher than the superficial ones, as inculcated by M. Louis, by which means, the bone will certainly lie within the level of the surface of the divided flesh. The advice delivered by my friend, Mr. Guthrie, I also consider valuable. The second performance of amputation is a still more severe and unpleasant operation; yet, as Dr. Hennen has explained, it sometimes be- comes necessary from osteosarcoma, extensive necrosis, abscesses of the medulla, unsuspected fissure, phagedena, or great protrusion of bone, with an extensively diseased periosteum, witere the powers of nature are inadequate to the cure. ‘‘ If the general health is not impaired, and the flesh does not peel off from the bone, as if it were boiled, the efforts of nature may be trusted to, aided by proper bandaging, and, in some eases, by the employment of the saw ; but, when restless nights, intense pain, flushings, and irre- gular bowels, with great tumefaction and hard- ness of the stump, take place, indicating ap- proaching hectic, and there is evidence of an irregular action of the parts, osseous matter becoming deposited, and forming .a distinct tu- mour around the stump, our best plan will be to operate again near the trunk.’ (Principles of Military Surgery, p. 266, Ed. 2.) Sometimes amputation has been considered necessary a se- cond time, in consequence of a morbid protuber- ance, or ganglion of the nerves of the stump, always attended with excruciating pain and great irritability of the part, and sometimes with retrac- tion of the skin, and protrusion of the bone. Sir Astley Cooper, in his leettires, relates one in stance of such a stump high up the arm, where, upon examination of the part near the axilla, a tumour was felt, which, when touched, made the patient jump, as if he had been electrified. In this case, as the bone protruded, amputation at the shoulder was performed. In another example, where a leg-stump was in a painful irritable state from a similar cause, Sir Astley Cooper effec- tually relieved the patient by removing the dis- eased end of the posterior tibial nerve. In a third instance, amputation was repeated at the patient’s desire, and the nerves were found en- larged, forming a ganglion which partly rested upon the extremity of the bone. Such a degree’ of irritation had been produced by it, that no part of the stump could be touched without exciting a kind of electric shock. In a case that occurred in the Middlesex Hospital, amputation of the thigh was performed a second time, in consequence’ of the first stump being thus diseased. A com- plete ganglion, or plexus of nerves was found closely adhering to the removed portion of bone, having almost the appearance of cartilage. The os femoris was of an unusually small size, but. the linea aspera larger than natural. (See Lancet, Vol. 1, p. 315; Vol. 2, p.192.) The following works are particularly recom- mended by Dr. Hennen, for information on dis- eases of the bones of stumps: Bonn, Thesaurus Osstum Morborum, Amst. 1788; Weidmann de Necrosi Ossium, Francof. 1798 ; Macdonald, de Necrosi ac Callo, Edinb. 1799; the above- mentioned Essays of M. Louis; Levéillé sur les Mal. des Os aprés ? Amputation, Mém. de la So-' cieté, d’ Emulation, T. 1, p. 1483 Von Hoorn De tis, que in partibus membri, presertim osseis amputatione vulneratis, notanda sunt, Lugd. 1803. Roux, de la resection des Os Malades, Paris, 1812; and Mém de Physiologie, &c. pat Scarpa, et Lévéilié, Paris, 1804. ) | SPASMS OF THE 8TUM?. Spasmodie contractions of the muscles of the stump is another very afflicting occurrence. Such spasms put the patient to the greatest agony, tend to cause a protrusion of the bone, or sugar-loaf stump, and, in some cases, increase, affect the whole body, and ultimately prove fatal. But, this unfortunate affection, which was rather frequent after amputations performed in the an- cient manner, is infinitely less so, after the mo- dern improved plans of operating, tying the vessels, and dressing the wound. When, how-' ever, it does occur, the stump must be kept-from starting, by fastening it to the pillow and bedding, on which it lies, the flesh is to be properly sup- ported with a bandage applied from the pelvic downwards, and opium, and the-camphor mixture should be liberally exhibited. (Hncyclopédic Méthodique, Partie Chir. T. 1, p. 93. Latta’ Surgery, Vol. ILI. &c.) | FLAF-AMPUTATION OF THE THIGH, | Although I concur with the majority of sur- geons in regarding the operation by a circulal incision the most eligible under ordinary circum: stances, no doubt can exist about the preference: which should be given to amputating with a flap in particular examples. This method, I believe has the important advantage of being least ex: ‘ *