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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![rially promotes the comfort of the patient, and the conve- nience of the surgeon, while it has not produced ill con- sequences or any unpleasant effect, in the cases which have come under his own observation. According to Mr. Lawrence, the small knots of silk generally sepa- rate early, and come away with the discharge; that where the integuments have united by the first inten- tion, the ligatures often come out rather later, with very trifling suppuration, and that, in some instances, they remain quietly in tbe part.—l.Op. cit. vol. 8, p. 490.) After the battle of Waterloo, it was fried in many cases by Mr. Collier and by my self, though our ligatures were certainly not so minute and eligiule as those employed by my friend Mr. Lawrence, whose plan essentially re- quires the use of minute ligatures made of dentisYs silk. As I joined the army in the field after nine days, and was therefore obliged to leave my patients at Brus- sels to the care of others, I lost the opportunity of wit- nessing the effects of this method. But from Mr. Collier I afterward learned, that the new plan and the common one appeared in Ins judgment to answer about equally well; which report, considering hat we did not use the smallest ligatures, must be regarded as favourable. When the plan is tried, single strong threads and silks, or rather the kind of ligature which will be described in another place (see Ligature), should be employed ; for otherwise, the knots would be large, and likely to create suppuration and future trouble. The practice has likewise been tried by Delpech at Montpellier; but it is not explained whether he used single threads or silks, or whether any inconveniences resulted from the method.— See Relation d'un Voyage fait a Londres en 1814, ou Parallele-de la Chirurgie An- glaise avec la Chirurgie Francaise par P. J. Roux, 8vo. 1815.) Yet candour requires me to state, that the me- thod is not generally adopted, and that one well-in- formed writer, as I shall hereafter notice see Hemor- rhage) j has recited a case and some experiments, which are unfavourable to the practice.— Cross, in Lond. Med. Repository, vol. 7, p. 355.) By Sir Astley Cooper, the practice has been found to occasion suppuration, and he has therefore given it up.— Lancet, vol. 1, p. J49.) Mr. Guthrie, in two or three instances, has also seen some ill-looking abscesses arise from the presence of the bits of ligature, though he approves of the plan where the wound will not unite by the first intention, which, however, can rarely be known beforehand.— ;On Gun-shot Wounds, p. 941.i On this subject, it merits particular attention, that no cases can be re- garded as fair trials of Mr. Lawrence's method, unless Drecisely such ligatures as he himself employs be nsed. [Dr. Koch, Professor of Chemical Surgery at the Hospital of Munich, Bavaria, after performing the flap- peration on the thigh, contents himself with approxi- mating the flaps without securing any vessel: thus dis- pensing with ligatures altogether, as he finds that keeping the cut surfaces in perfect co aptation is suffi- cient to prevent hemorrhage; and his success has been truly surprising. Dr. Wagner has long since proved in this country, that ligatures may be dispensed with in cases of surgical wounds, in which they are not only ap- plied by most surgeons, b ut t hought ind ispensabl e. See the report of his operation for removing the lower jaw, in which he used no ligatures. Many surgeons in this country are satisfied with securing the larger arteries only, and incur the risk of unimportant hemorrhages from the smaller vessels rattier than multiply their ligatures. Professor Davidge, of Maryland, fell into the opposite extreme ; from having encountered terri- ble secondary hemorrhages in the early part of his prac- tice, he would never leave a single artery without a ligature, if he could distinguish it, and would often wait half an hour after amputation before closing the stump. He operated with singular success ; but if he had used animal ligatures, his cases would not have been retarded for the sloughing of their pendent ex- tremities. He used to say in his lectures, that arteries were like felons and murderers; there is no safety for us without we rope them.— Hits .] Sometimes the sawed surface of the bone itself bleeds rather profusely. When this happens, it is an excellent plan, which T have often seen my late master Mr. Ramsden and others adopt with the greatest suc- cess, to hold a compress of lint over the end of the bone during th < time requisite for securing the rest of the vessels. At the end of this period, the compress may generally be taken away, the bleeding from the hone having entirely ceased. As Monro remarks, the sur- geon ought not to content himself with tying only such vessels as he observes throwing out blood, white me patient is Taint with pain ; he should endeavour to rouse him from that fainlish state by a cordial, and then wiping off the coagulated blood with a spongOTjM in warm water, he should examine narrowly all the surface of the stump, for otherwise he may expect to be obliged by a fresh hemorrhage to undo all the dressings.—lOn Amputation of the larger Extremities, p. 475, Monro's Works.) When there is merely an oozing from small vessels, Bromfield's advice to loosen the tourniquet completely is highly proper, ascitis measure, and washing the stump with a little cold water, will put an entire stop to such bleeding, without any occasion for more ligatures'. A good deal of blood is sometimes lost from the mouths of the larger veins, and where they bleed much in de- bilitated subjects, I think Dr. Hennen is right in re- commending them to be tied.— On Military Surgery, p. 261.) There is no necessity for doing so, however, in ordinary cases, nor should I be disposed to imitate Mr. Hey, who, in consequence of having seen a few in- stances of bleeding from the femoral vein, generally enclosed that vessel in the ligature along with the ar- tery.— Practical Obs. in Surgery, p. 530, ed. 2.) This method was sanctioned by the eminent Desault, who says, that if the vein he left open,'and the bandage at the upper part of the limb be too tight, the flood regur- gitates downwards, and hemorrhage takes place, as this surgeon assures us he has often seen. When the vein and artery lie close together, as often happens, one branch of the forceps is to be introduced into the ar- tery, and the'other into the vein, which being done, the two vessels are to be drawn out together, and included in' one ligature, but if they are not so near together, they must be tied separately.—(Euvres Chir. de Desault par Bichat, t. 2, p. 550, 8vo. Paris, 1601.) At St. Bartholomew's, it is not the usual practice to tie the femoral vein ; and except in particular cases, I consider the custom wrong, because a ligature on a large vein sometimes excites a dangerous and fatal inflammation within the vessel, while the intervention of the vein between the one side of the circle of the ligature and the artery, must rather tend to hinder the thread from operating in the most desirable manner upon the lat- ter vessel. The wound is now to be ^venly closed with strips of sticking plaster, so that the edges of the skin may form a straight line across the face of the stump. This was the mode commended by Alanson, and is what is pre- ferred by the generality of sitrgeons in this country. It is also advised by Graefe.—(Normen fur die Abl. griissererGliedm. p. 106. Guthrie on Gun-shot Wounds, p. 208.) Over these plasters and the ends of the liga- tures it is best to place some pieces of lint, spread with the unguentum cetaceum, in order to keep such lint from sticking, which becomes an exceedingly trouble- some circumstance when the dressings are to be re- moved. I am decidedly averse to trie general plan of loading the stump with a large mass of plasters, pledgets, compresses, flannels, &c.; and I sec no rea- son why the strips of adhesive plaster and a pledget of simple ointment should not suffice, when supported by two cross bandages and a common linen roller, applied spirally round the limb from above downwards. The first turn of the roller, indeed, should be fixed round the pelvis, while the lower circles secure the cross ban- dages, often called the Malta cross, over the end of the stump. It is also an excellent method to leave some little interspaces between the plasters, and in summefr to keep the linen bandages constantly wet with cold water. In this way any discharge will readily escape, and the parts, being kept cool, will be less disposed to hemorrhage and inflammation. Sir Astley Cooper states, that he has seldom suc- ceeded with his stumps above the elbow or knee wher. a roller was not employed, which, he says, prevents retraction of the muscles and extensive suppuration After applying the roller, and bringing the integuments togsther, he merely puts three strips of adhesive plas- ter over the wound, and one round the stump to keep the ends of the plaster in their place: in hot weiither he applies a lotion of spirit of wine and water.— Lan cet, vol. 1, p. 150 )](https://iiif.wellcomecollection.org/image/b2103719x_0077.jp2/full/800%2C/0/default.jpg)
