A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese.

  • Cooper, Samuel, 1780-1848.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese. Source: Wellcome Collection.

Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.

    69/1188
    pletely covered with skin. Whether Cheselden had the priority in this improvement, I cannot presume to say; but he, gave an account of it in Gataker's transla- tion of Le Dran's treatise on the operations, as early as 1749, which was long prior to the appearance of Petit's posthumous writings: and Mr. Cheselden farther men- tions, that during his apprenticeship to Mr. Fern he had communicated to that gentleman his sentiments about the double incision. In order to hinder the stump from assuming a pyra- midal or sugar-loaf shape, which sometimes happened notwithstanding every improvement hitherto men- tioned, a circular bandage was employed, which acted by supporting the skin and muscles, and preventing their retraction. This bandage, when properly applied, from the upper part of the limb downward, fulfilled in a certain measure the end proposed, though many stumps yet turned out very badly. Mr. Sharp was in- duced, therefore, to revive the ancient plan of bringing the edges of the skin together with sutures; but the pain and other inconveniences of this method were such that it was never extensively adopted, and Mr. Sharp himself ultimately abandoned it. The cross-1 bandage, however, which he used to put over the end of the stump, remains in fashion even at the present day.—(Treatise on the Oper. p. 216; Critical Inquiry, p. 268.) It is to be regretted that an excellent modern surgeon, the late Mr. Hey, should have commended so much as he has done the use of sutures, in bringing to- gether the edges of the wound after amputation.—(Prac- tical Observations in Surgery, p. 534, edit. 2.) In opposition to Louis, (he inefficiency of his method for hindering the protrusion of the bone was asserted by Valentin, who thought the object might be better at- tained by dividing the parts while they were in a state of tension; for which purpose he recommended chang- ing the posture of the limb, according to the parts which he was about to cut.—(Recherehes Critiques sur la Chirurgie Moderne, 8vo. Amst. 1772.) Valentin's proposal seems never to have made much impression on the profession ; whether on account of its incon- venience or inefficacy, I know not; certain it is, many cases present themselves, in which the posture of a limb absolutely cannot be changed during the operation, owing to the nature of the disease, or cannot be altered without extreme agony. At this period arose the celebrated controversy about the propriety of amputation in general. As Sprengel remarks, several French surgeons now began to be convinced, with Le Dran and Bagieu, that the operation was undertaken on too slight grounds, and in parti- cular that many bad complicated fractures might be cured without amputation. Such was the doctrine of Boucher (Mem. de l'Acad. de Chir. t. 2, p. 304), Ger- vaise (Anfangsgr. der Wundarzn. 8vo. Strasb. 1755), and Faure (Mem. qui ont concourn pour le Prix de l'Ac. de Chir. vol. 1, p. 100) The latter especially urged the prudence of delay in gun-shot wounds, and comminuted injuries of the bones. But the writer who at this time made the most noise in the world by his general condemnation of amputation, was BilgUer \Diss. de Membrorum Amputatione, 8vo. Hal. 1761), whose sentiments received a complete refutation from his own contemporaries, Pott (Chir. Works, vol. 2j, Morarfd (Opusc. de Chir. t. 1, p. 232), and de La Mar- tiniere (Mem. de l'Acad. de Chir. vol. 4, p. 1), and also from later writers, to whom reference will be made in speaking of Gun-shot Wounds. Even Bilguer himself was compelled to admit the necessity of amputation in cases of gangrene.—(Anweis. fur die Feldwundarzie, s. 170.) Bilguer's colleague, the celebrated Schmucker, in- clined to the same doctrines, and has detailed several cases where limbs were not only shattered, but actu- ally carried away by balls, yet where a cure followed without amputation. One of his maxims was, that it was better for the member to be taken off by gun-shot than by the surgeon's knife, as the ball operated on a healthy subject, and the knife on a person debilitated by an hospital.— Chir. Wahrn. th. 2, s. 493.) In a later valuable essay on this subject, he restricts amputation to shattered limbs affected with gangrene. His mode of operating was that of M. Louis. He sanctioned joint-operations on the hip and shoulder: but con- demned those of the knee and elbow as never answer- ing —^Verm. Schrift. th. 1, s. 3.) Soon after the middle of the last century, the prac- tice or amputating at the joints began to excite increased attention ; but as this is a topic to which I must pre sently return, it is unnecessary now to dwell upon it The writings of Puthod, Wohler, Brasdor, Barbet, fea- batier, Park, Moreau, and Vermandois, in relation to this subject, deserve particular notice. I now come to Mr. Alanson, whose name is as con- spicuous in the history of amputation as that of any surgeon yet mentioned. His chief objects were to hin- der a protrusion of the bone, and to promote union by the first intention. He rejected the band which was formerly put round the limb for the guidance of the knife, as altogether useless, and an impediment to the quick performance of the circular incision through the skin. When the tourniquet had been applied, an as- sistant grasped the integuments with both hands, and drew them and the muscles firmly upwards. The ope- rator then fixed his eye upon the proper part where he was to begin the incision, which was made with consi- derable facility and despatch, the knife passing with, greater quickness in consequence of the tense state of the integuments. After the incision through the skin had been made, the . assistant still continued a steady support of the parts, while Mr. Alanson separated the cellular and ligamentous attachments with the point of his knife till as much skin had been drawn up as would, with the muscles divided in the particular way hereafter recom- mended, fully cover the whole surface of the wound. Then, instead of applying the knife close to the edge of the integuments, and dividing the muscles in a circular perpendicular manner down to the bone, Mr. Alanson proceeded as follows : when operating upon the thigh, and standing on the outside of the limb, he applied the edge of his knife under the edge of the supported inte- guments, upon the inner margin of the vastus internus muscle, and cut obliquely through that and the adja- cent muscles upwards as to the limb, and down to the bone, so as to lay it bare about three or four finger- breadths higher than is usually done by the common perpendicular circular incision. He now drew the knife towards himself; then keeping its point upon the bone, and the edge in the same oblique line already pointed out for the former incision, he divided the rest of the muscles in that direction all round the limb ; the point of the knife being in contact with and revolving round the bone through the whole of the division. According to Mr. Alanson, the speedy execution of the above-directed Incision will be much expedited by one assistant continuing a firm and steady elevation of the parts, and another taking care to keep the skin from being wounded as the knife goes through the muscles, at the under part of the limb. Mr. Alanson censures the old method of depriving the bone of its periosteum to a considerable extent above and below the part where the saw was to pass, not only as creating unnecessary delay, but, since the periosteum serves to support the vessels in their passage to the bone, as apt to produce exfoliations above the part where the bone is to be di- vided with the saw. Instead of this practice he re- commends first the application of the retractor, as ad- vised by Gooch and Bromfield; and then denuding the bone at the part where the saw is to pass, whereby the bone may be sawed off higher than is usually practised; a material object for hindering a projection of the bone and forming a small cicatrix. If the flesh of a stump formed in the thigh agreeably to the foregoing plan, be gently brought forwards after the operation, and the surface of the wound be then viewed, it may be said to resemble in some degree a conical cavity, the apex of which is the extremity of the bone; and the parts thus divided Mr. Alanson thought the best calculated to prevent a sugar-loaf stump. The part where the bone is to be laid bare, whether two, three, or four finger breadths higher than the edgr of the retracted integuments ; or, in other words, the quantity of muscular substance to betaken out in mak ing the double incision, must be regulated by consider- ing the length of the limb, and the quantity of skin that has been previously saved by dividing the membranous attachments. The quantity of skin saved, and muscu- lar substance taken out, must be in such exact propor- I tion to each other, that the whole surface of the wound will afterward be easily covered, and the limb not more shortened than is necessary to obtain this end. i Alter the removal of the limb, Mr. Alanson drew each