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.
- Samuel Cooper
- Date:
- 1844
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.
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![bleeding ertery gently out with the tenaculum, and tied it as nakedly as possible with a common slender liga- ture. When the large vessels had been tied, the tour- niquet was immediately slackened, and the wound well cleaned, in order to detect any vessel that might other- wise-have remaineu^concealed with its orifice blocked up with coagulated blood; and before the wound was dressed, its whole surface was examined with the great- est accuracy; by which means Mr. Alanson frequently observed a pulsation where no hemorrhage previously appeared, and turned out a small clot of blood from within the orifice of a considerable artery. He is very particular in recommending every vessel to be secured that is likely to bleed on the attack of the symptomatic fever; for, besides the fatigue and pain to which such an accident immediately exposes the patient, it seriously interrupts the desired union of the wound. He used always to clean the whole surface of the wound well with a sponge and warm water, as be thought that the lodgement of any coagulated blood would be a consider- able obstruction to the quick union of the parts. The skin and muscles were now gently brought for- wards ; a flannel roller was put around the body, and carried two or three times rather tightly round the upper part of the thigh, as at this point it was intended to form what Mr. Alanson called a sufficient basis, which materially added to the support of the skin and muscles. The roller was then carried.down in a cir- cular direction to the extremity of the stump, not so tight as to press rudely or forcibly, but so as to give an easy support to the parts. The skin and muscles were now placed over the bone in such a direction that the wound appeared only as a line across the face of the stump, with the angles at each side, from which points the ligatures were left out, as their vicinity to either angle might direct. The skin was easily secured in this posture by long slips of linen or lint of the breadth of about two fingers, spread with cerate or any cooling ointment. If the skin did not easily meet, strips of sticking-plasteT were preferred. These were applied from below upwards, I across the face of the stump, and over them a soft' tow-pledget and compress of linen; the whole being retained with the many-tailed bandage, and two tails placed perpendicularly, in order to retain the dressings upon the face of the stump. Mr. Alanson censured the plan of raising the end of I the stump far from the surface of the bed with pillows, as the posterior muscles were retracted by it; and he considered it best to raise the stump only about half a I hand's breadth from the surface of the bed, by which I means the muscles were put in an easy relaxed posi-1 tion. The many-tailed bandage Mr. Alanson found ] much more convenient than the woollen cap, frequently used in former times to support the dressings ; and he observes, that though this seems well calculated to an- swer that purpose, yet if it be not put on with particu- lar care, the skin is liable to be drawn backwards from the face of the stump; nor can the wound be dressed without first lifting up the stump to remove the cap.—(See Alanson's Pract. Obs. on Amputation, 8vo. Lond. 1779.) The chief peculiarity of Alanson's method of ope- rating, namely, the mode in which he recommended the oblique division of the muscles to be performed, did not, however, meet with universal approbation, and his extensive dissection of the skin from the muscles was complained of as excessively painful. The forma- tion of a conical wound by following Alanson's direc- tions, was regarded by several is impracticable.—(See Marten's Paradoxieen, b. 1, s. 88; LoefHer, Beytrage 1, No. 7 ; Wardenburg, Briefe eines Arztes, b. 2, p. 20; Richt.jr, Anfangsgr. vol. 7; Graefe, Normen, &c. p. 8; Hey, Pract. Obs.) In my opinion there can be no doubt of the truth of some of the criticisms made by these and some other writers on the impossibility of making a wound with a regular conical cavity, by ob- serving the directions given by Alanson; for if the knife be carried round the member with its edge turned obliquely upwards towards the bone, it will pass spi- rally, and of course the end of the incision will be consi- derably higher than the beginning. But though Alanson probably never did himself exactly what he has stated, I am sure that his proposition of making an oblique division of the muscles all round the member has been the source of great improvement in amputations in general, and is what is usually aimed at by all the best modern surgeons. It is true they do not actually per- form the oblique incision all round the limb by one stroke or revolution of the knife round the bone, as Alanson says that he did; but they accomplish their purpose by repeated, distinct, and suitable applications of the edge of the instrument turned obliquely upwards towards the bone or bones. Among others, Mynors found fault with some of Alan- son's instructions, and thought every desideratum- might be more certainly attained by saving skin enough, and then cutting through the muscles. The first inci- sion, however, he directed obliquely upwards through the integuments, wliile they were drawn up by an as sistant, and he then cut down to the bone.—(Pract Thoughts on Amputation, 8vo. Birming. 1783.) Spren gel considers Mynors's plan merely as a revival of Cel- sus's method, as it had in view only the preservation of skin, and not the formation of a fleshy cushion.— (Geschichte der Cbir. b. 1, p. 426.) Kirkland endeavoured to improve Mynors's plan by cutting off a piece of skin at each angle of the stump,, so as to keep the integuments from being thrown into folds ; and in opposition to Pott, he defended the senti- ments of Bilguer concerning the successful manage- ment of desperate cases without amputation.—(On the present State of Surgery, p. 273, and Thoughts on Am- putation, 8vo. Lond. 1780.) B. Bell used to operate very much in the same way as Mynors; and when it seemed advantageous to make a flap, he did not disapprove of the plans suggested by Ravaton, Verduin, and Alanson.—(Syst. of Surgery.) An interesting paper on amputation was some years, ago published by Loder ; its chief purport was to de- fend Alanson's method with some slight modifications.. —(Chir. und Medic. Beobacht. b. 1, p. 20, 8vo. 1794.) However, the alterations suggested by Loder do not seem to Graefe at all adequate to the removal of the difficulties with which the mode of cutting the flesh ex- actly after Alanson's directions is complicated.—(Not- men fiir die Abl. griisserer Gliedmassen, p. 8, 4to. Ber- lin, 1812.) The removal of limbs, without bloodshed, proposed by Guido di Cauliaco in the 14th century, has met with modern defenders in J. Wrabetz and W. G. Plouquet. J. Wrabetz, with a ligature, which was daily made tighter, took off an arm above the elbow. In the fissure he sprinkled a styptic powder. On the fourth day, the flesh was severed down to the bone, which was sawed through.—(Geschichte eines ohne Messer abgesetzten Oberarms, 8vo. Freyb. 1782.) Plouquet thought the plan suited to emaciated timid subjects, but not well adapted to the leg or forearm.—(Von der Unblutigen Abnehmung der Glieder, 8vo. Tub. 1786.) Some other modes of doing flap-amputations, and in particular the suggestions and improvements made by Hey, Chopart, Dupuytren, Larrey, Lisfranc, and other- modern practitioners, will be noticed in the description of the amputation of particular members. . In the mean, time, I shall conclude this section with mentioning the- laudable attempts made at different periods to render the patient less sensible of the agony produced by the- removal of a limb. Theodoricus, as we have said, ad ministered for this purpose opium and hemlock, and though he was imitated by many of the ancient sur- geons, few moderns have deemed the practice worthy of being continued. Guido made the experiment of benumbing the parts with a tight ligature ; but a ma- chine devised a few years ago in England expressly for the object of stupifying the nerves of a limb pre- viously to amputation, is perhaps not undeserving of farther consideration.—(See J. Moore's Method of pre- venting or diminishing Pain in several Operations of ■Surgery, 8vo. Lond. 1784.) The great reason of the- latter plan being given up is, that some patients have- made more complaint of the sufferings occasioned by the process of dulling the sensibility of the nerves than of the agony of amputation itself without any such ex- pedient. Yet daily experience proves that the pressure- caused on the sciatic nerve by sitting with the pelvis in a certain position, will completely benumb the foot and leg, and this with such an absence of pain, that the person so affected is actually unaware of his foot being asleep, as it is termed, until he tries to walk. On the littie good done by warming and oiling the cut- ting instruments, a method once much commended (Faust und Hunold uber die Anwendungdes Oehls uni der Warme. p. 3—23, Leipsic, 1806), I am sure it is uo necessary for me to comment.](https://iiif.wellcomecollection.org/image/b2103719x_0070.jp2/full/800%2C/0/default.jpg)
