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.

    80/1188
    ■ eistance to the blood in the ar,„y* \hich anastomose with them, occasion the coutractmg'power of the heart and arteries to dilate, and force more blood into their Other branches, but these being cut in the amputation will pour out their blood, and so hemorrhage is brought on. Making much pressure round the stump is highly deserving of reprobation; and whenever there is an universal oozing of blood I would recommend the ope- rator to be sure that the circulation in the superficial veins is not impeded by the tightness of any bandage or tourniquet. If the bleeding should not be from an artery of conse- quence, the application of linen dipped in cold water will sometimes check it, and the disagreeable necessity for removing the dressings and opening the wound may thus be avoided. But it often happens that the wound must be opened, and the bleeding vessel tied. This is a very painful proceeding, and when the dressings have been applied some hours, sp that the stump has had time to inflame, nothing can exceed the suffering to which the patient is now subjected. Here we see the prudence of being particularly careful at first to tie every suspicious vessel. The second sort of hemorrhage after amputation arises from ulceration of the large arteries, and may- occur a month after the operation, when the ligatures are all away, and the patient seems nearly well. Two such cases are related b/ Mr. Bromfield.—(Vol. i, p. 307.) Now that the plan of covering the stump With sound skin is adopted, this kind of bleeding is less -common than formerly. When the bleeding vessel is large there is no chance of putting the patient out of danger, except by cutting down to the vessel and tying it. The trunk of the vessel, however, may sometimes be more conveniently tied than the bleeding branch itself. Mr. Key makes mention of a particular sort of he- morrhage after the operation: I have seen, says he, a few instances,of the integuments becoming so contracted after the operation as to compress the veins just above the extremity of the stump, and bring on after some hours a copious hemorrhage. When it has appeared clear to me that the hemorrhage was venous, I have made a division of the integuments on one side of the thigh, sufficient to remove the stricture, and this method has immediately suppressed the hemorrhage. >—(P. 530, edit. 2.) I have never yet met with a case in which a hemor- rhage was unequivocally produced by a contraction of the integuments. Dr. Hennen says that he has seen only one example, and it was successfully treated by loosening the bandage and moistening the dressings with cold water.—(On Military Surgery, p. 264, ed. 2.) Doubts may therefore be entertained, whether the cause was the pressure of the integuments or of the roller on the veins. In Mr. Guthrie's truly practical work there are some excellent remarks on the hemorrhages which, in an irritable and sloughing state of a stump, frequently take place from the small branches, or from the main trunks of the arteries, in consequence of ulceration. It is 'says he not always easy to discover the bleeding vessel, or, when discovered, to secure it on the face of the stump; for, as the ulcerative process has not ceased, and the end of the artery, which is to be se- cured, is not sound, no healthy action takes place. The ligature very soon cuts its way through, or is thrown oft, and the hemorrhage returns; or some other branch is opened, and another ligature is required which is equally uncertain; and under this succession of liga- tures and hemorrhages the patient dies, Here cutting down to the principal artery in preference to another amputation has often succeeded; but under certain cir- cumstances it fails, and amputation becomes ultimately necessary. At the same time it is allowed that this operation may also fail. On the whole, Mr. Guthrie professes himself to be an advocate in most cases for tying the artery in the first instance ; and if this pro- ceeding should not answer, he would then amputate. However, the practice of taking up the artery, he thinks, should not be adopted indiscriminately, the doc- trines of aneurism not being here applicable, because there is a wounded vessel with an external opening. In he thigh the operation is less certain than in the arm, ami especially if it is not the main artery that bleeds ; for I lie bra . h from which the hemorrhage proceeds may i E 2 come from the profunda, and tying the artery in the groin on such opinion would be doing a serious ope- ration, and one which probably would not succeed ; for the anastomosing branches would restore the circula tion- in the stump in a short time, and again establish the bleeding. If it is the femoral artery (that bleeds, and the ligature is applied high, it is very liable to a return of hemorrhage. To obviate these difficulties, the part from which the bleeding comes should be well studied, and the shortest distance from the stump care- fully noted, at which compression on the artery com- mands the bleeding; and at this spot the ligature should be applied, provided k is not within the sphere Of the inflammation of the stump.—(On Gun-shot Wounds, p. i05, 100.J Thus far the advice seems to me correct and valuable; but where the hemorrhage could be re- strained by taking up the artery in the groin, though not lower down, I doubt the propriety of preferring ampu- tation to, this other less severe operation, provided the efficiency of a ligature above the profunda he proved in the manner judiciously recommended by Mr. Guth- rie, viz. by means of pressure. The following is the counsel offered by Mr. Hey: When we are under the necessity of amputating a limb that has suffered great contusion, though the ope- ration is performed upon a part apparently sound, the wound sometimes becomes sloughy and ill-conditioned No good granulations arise to cover the extremities of the arteries; but the ligatures cut through these ves- sels, or becoming loose, cease to make a sufficient pres- sure upon them, and hence repeated hemorrhages ensue. This is a dangerous state for a patient; for if the vessels are taken up afresh with the needle, the he- morrhage will now and then return in the course of two or three days. In such cases, the application of dry sponge cut transversely, as directed by Mr. White (Cases in Surgery), has been found singularly useful, and has saved the life of the patient. But a constant pressure must be kept upon the pieces of sponge by the fingers of a succession of assistants, till, granulations begin to arise upon the stump, and the prospect of fu- ture hemorrhage disappears. This method is of the greatest importance after amputation on the thigh or leg, where the great vessels are deeply seated. In the arm, above the elbow, where the vessels are more su- perficial, the great artery may be taken up with a por tion of muscular flesh above the surface of the stump, by making first an incision through the integuments. My colleague, Mr. Logan, has done this twice within the last year with complete success, when repeated ligatures, applied in the usual way, had failed. •' In the morbid sloughy state of the stump, above-mentioned, the application of lint, soaked in^a liquid composed of equal quantities of lemon- jufce and rectified spirit of wine, has been found very advantageous, and has caused it to put on soon a healthy aspect.—(P. 536, 537, edit. 2.) [When this operation is necessary in crowded hos- pitals, where hospital gangrene is prevailing, Delpecb. recommends the practice of cutting off the ligatures close to the knots on the vessels, so that the lips of the wound may be more completely and ai curately brought together. By this means, as his experience 1 as taught him,, the risk of the wound being affected is materially les- sened. The small particles of the ligatures enclosed^ in the stump, he says, are discharged at a period when; the patient has regained strength enough to be moved! into a heaJfiiy atmosphere, little openings being pro- duced for their escape, and healing up again within, twenty-four hours. He assures us that he has never seen the practice give rise to an abscess. Delpech is led by the view he takes of the consequences of suppu ration, and the contraction of cicatrices, to prefer bringing the sides of the wound together after ampu- tation of the thigh, so that the line of the cicatrix may be transverse and not perpendicular. His reason is that most of the ligatures which unavoidably produce suppuration are placed on branches of the profunda in the posterior part of the limb, consequently here the greatest contraction follows cicatrization, and the ante- rior flap is thereby drawn over the extremity of the bone in the most advantageous manner.—(Chirurg Clinique, t. 2, p. 395.) The same author gives an in- stance of the failure of a seton to unite a broken thigh- bone, where no union had followed a long trial of com mon means; and he was in the end compelled to