The principles and practice of surgery / by John Ashhurst ; illustrated with five hundred and thirty-three engravings on wood.
- John Ashhurst
- Date:
- 1871
Licence: Public Domain Mark
Credit: The principles and practice of surgery / by John Ashhurst ; illustrated with five hundred and thirty-three engravings on wood. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![Fiff. 46. sometimes even necessary to resort to tenotomy when milder measures will not suffice. 8. Periostitis^ Osteitis^ and Osteo-myelitis, one or all, may occur in a stump, and may defeat the surgeon's anticipations of a successful issue. If acute and extensive, these affections endanger life, and, especially in the femnr, are apt to terminate fatally. The diffuse suppurative form of osteo-myelitis is especiallj^ apt to occur when the division of the bone has exposed the medullary cavity, and is almost sure to end in pyaemia and death; the onl}^ mode of treatment is reamputation at the nearest joint, and this is of course an almost desperate remedy. Less violent forms of bone inflammation result in the oc- currence of— 9. Necrosis, which may likewise be produced by injury from the saw, at the time of operation. The treatment of this condition consists pretty much in waiting for the nat- ural separation o*£ the necrosed part, which will then be exfoliated as a ring of dead bone, or as a long conical sequestrum. I do not believe that anything is to be gained, under these circumstances, by interference with the slow but safe processes of nature; in the case, however, of the occurrence of acute necrosis, as it is sometimes called, or more properl}^ diffuse subperiosteal suppuration, it may be necessary to reamputate to save life, just as it would be under the same circumstances occurring elsewhere than in a stump. 10. Caries may occur in the bone of a stump. I have seen benefit result in such cases from the injection of the preparation introduced by M. Notta, under the name of Liqueur de Villate. [E. Zinci sulphatis, Cupri sulphatis, aa gr. xv; Liq. plumbi subacetatis fSss; Acid. acet. dilut. vel. Aceti alb. f 5iijss. M.] 11. Finally, an adventitious bursa may be formed over the bone of a stump, as in any other part subjected to much pressure. If this bursa become painful, the artificial limb should be altered so as to relieve it from pressure; if this be not sufficient, an effort may be made to obliter- ate the burs by the introduction of the tincture of iodine or by estab- lishing a small seton, or the bursa itself may be excised. Mortality after Amputation.—The results of amputation depend on a variety of conditions. Some of these are common to this as to other serious operations, and have mostly been sufficiently referred to in the chapter on operations in general; the most important circumstances coming into this categor}^ are the age and the constitutional state of the patient, and the hygienic conditions to which he is subjected before, at the time of, and after the amputation. The relation between the baro- metric condition of the atmosphere and the mortality after amputation has been particularly investigated by Dr. Addinell Hewson. He finds that, at the Pennsylvania Hospital, the mortalitj^ varied from 11 per cent, with an ascending, to 20 per cent, with a stationary, and 2S per cent, with a falling barometer. While the column of mercury was rising, the average duration of life, in fatal cases, was only seven daj-s, but was thirteen while the column was falling; and of all the cases that died within three daj^s, over 15 per cent, proved fatal while the barometer was rising. Surel}^, he adds, these figures need no commentary as to how well they sustain the idea that the results of operations are Necroisis of the bone after ampu- tation.](https://iiif.wellcomecollection.org/image/b21039094_0109.jp2/full/800%2C/0/default.jpg)
