Case of traumatic spreading gangrene, after severe compound fracture of the leg, for which amputation beneath the trochanter was performed, and the arteries secured by four acupressure needles : the femoral artery, at its giving off the profunda branch, was relieved from pressure at the forty-ninth hour after the operation, with recovery, and remarks / by P.D. Handyside.

Handyside, P. D. (Peter David), 1808-1881

Date:: [1860]

Credit: Case of traumatic spreading gangrene, after severe compound fracture of the leg, for which amputation beneath the trochanter was performed, and the arteries secured by four acupressure needles : the femoral artery, at its giving off the profunda branch, was relieved from pressure at the forty-ninth hour after the operation, with recovery, and remarks / by P.D. Handyside. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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a lacerated and contused state of the muscles of the calf, inter- spersed with thick coagula that extended as high nearly as the hough, and the obstructed state of the arteries,—renders it exceed- ingly doubtful whether primary amputation, had it been performed beioio the knee, would have been followed by recovery, or, at best, by a recovery unaccompanied by prolonged and exhausting sup- purations, and probable sloughings ; though it must at the same time be admitted, that in that case the ultimate danger to life would certainly, upon the whole, have proved less than under the spread- ing gangrene that eventually occurred, and that rendered a more severe operation necessary. Secondly, We cannot but regard this case, in its ultimate result, as an important addition to Surgical Statistics. Mr Bryant's recent tables of the results of 300 cases of Amputation, collected from the records of Guy's Hospital,1 exhibit a difference of 15 per cent, be- tween primary and secondary Traumatic Amputations through the thigh, these severally being as 60 to 75 per cent, of a fatality,—and of + 4 percent, through the leg, these severally being as 62'5 to 66*66 per cent, of a fatality. These tables show, moreover, that Traumatic Amputations of the Leg are at least as fatal as those of the Thigh; and, as a whole, that secondary amputations are more fatal than primary. Thirdly, The limb was so involved in the gangrenous inflamma- tion, that amputation lower down the thigh could not, with any hope of success, have been performed. Fourthly, The rapid improvement in the condition of the patient immediately on the removal of the source of constitutional irritation by the operation, and by the exhibition of full doses of opium, was immediately seen in the restored sleep, appetite, and mental powers, and more slowly in the state of the pulse. Fifthly, On the withdrawal of the acupressure needles, no sup- purating points, Dr Todd states, presented;2 and the punctures healed kindly. Sixthly, Although the profession generally seems, as yet, scarcely prepared to admit the advantages which Dr Simpson seeks to attach to his discovery of Acupressure, yet, in due time, such additional experience will be acquired, that none, I believe, will hesitate in admitting the accuracy of his inductions. From the use that I have made of it in M' 's case,.without having seen the process pre- viously employed on the dead or living body, the performance of Acupressure seems to me to be free from all difficulty. I may add, that the haamorrhage from the divided vessels was arrested with greater expedition in this way than by ligature ; for, in closing the bleeding orifices by needles, I wholly dispensed with an assistant: 1 Transactions of the Royal Medico-CMrurgical Society, vol. xlii., p. 67 _ 2 On Acupuncturations of the body, and the absence of all inflammation and its effects, see the Edinburgh Med. and Surg. Journal, vol. xxvii., p. ]!)?, as quoted by Dr Simpson in the January number of the Edin. Medical Journal, p. 650

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