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
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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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    amputate the limb at the hip joint; the second example of his performing this severe operation.—i,P. 406.) Under certain circumstances he is an advocate for the excision of diseased joints in preference to amputa- tion ; and refers the union of the bones in this case, not 'o the same process by which fractures are united, but i the production of a fibrous substance analo- gous 11 that of a cicatrix. Several successful ex- amples 'if the practice are recorded.—;?. 472.) With respect u 'incured fractures, I have now one under my care in the King's Bench. The accideul happened two vears and a half ago, and I have recommended the trial of a setoo.—P'ff. | ON PROTRUSION OF THE BONE. It is clearly proved by the observations of M. Louis, that this disagreeable-consequence maybe generally prevented by taking care to divide the loose muscles first and after their complete retraction, which will be favoured by no band or tourniquet being applied round the limb,) by observing to divide with a bistoury the muscles which adhere to the bone ; for instance, the crural muscle, and the adhesion of the vasti and triceps to the spine of the femur. By this method the bone may be sawn three finger-breadths higher than ' it could be if no attention were paid to beginning with the division of the loose muscles, and concluding with that of others attached to the bone. The protrusion of the bones will never take place so long as they are immediately encompassed with the fleshy substance of the muscles : this proposition is incontestable. The state of the skin, whether longer or shorter, conduces nothing to this protrusion ; nor will the inconvenience be prevented by drawing the skin upwards and preserving as much of it as possible. — See M m. sur la Saille de I'Os apres ramputation, in M m. de l'A ;ad. de Chirurgie, torn. 5, p. 273, edit, in 12mo. I As Mr. Outhrie has observed, a protrusion ol the bone, after sloughing of the stump, or other accidental circumstances, will sometimes happen without any fault on the part of the operator; but he thinks it may almost al vavs be prevented by attention to the following rules :—l.To leave the integuments attached to the muscles, instead of turning them hack. 2. When the muscles are cut through in a slanting direction, upwards and inwards, or oven directly downwards, to separate them from the bone, so that it may appear at the bottom of the cone as a depressed point. 3. To cut the bone short, and to keep the (thigh constantly bandaged from the trunk during the cure, so as to prevent the retraction of the muscles. If, says Mr. Guthrie, a surgeon find, directly after the operation, that the bone cannot be well covered, he should imme- diately saw off as much more of it as will reduce it to its proper length The error may be remedied at this moment with very little inconvenience in com- parison with what, must afterward be encountered if the opportunity be neglected.— On Gun-shot Wounds, p. 109. For some very useful directions how to ban- dage and support the soft parts with adhesive plasters, with the view of counteracting the tendency of the bone to protrude, 1 refer to some observations by Mr. Wright.—(See Bromfield'sChir. Cases,&c. vol.1, p.177.) Having explained, that the surest way of preventing the evil is to save a sufficiency of muscle, especially of that muscular substance which is naturally most near and adherent to the bone, we shall next speak of ;u„ „,n*» 0r .-e!:sf. Wlien the end of the thigh-bone protrudes, it of Course hinders cicatrization and becomes itself affected with necrosis. Bv the process of exfoliation, the dead nortion of bone is sometimes thrown off, and a cure follows But, in general, this desirable change is ex- -melv tedious, and the result uncertain because it tr<- , \,minis that- after the piece of bone has frequently haPP*'* ^ * jecrs too much, and the separated »be «aj conical to heal firmly enough stump SUM fon™J?ri lhe pressure of a wooden leg. U> be capable of bearin UUP a Wtnn, however, the CTdom comcal?it „ illway8 projection, and the stump si redundant exfo- kst to leave »^*5S&Ve4l the re- liating portion. In the [> P°>' b ercd by tne moval of all suchi part of il «canno execuled, integuments is the best practice, ^ will effect a cure. -vreedufiv unpleasant to This second operation is exceeuuisiy p the surgeon, because patients are apt t°™fP«£j£g not without reason, that the first was not |»P«y managed. Let me therefore repeat tba-the surest way of avoiding the evil is to cut the deep' musttes rather higher than the superficial ones, as by M. Louis, by which means the bone will Cftrtauiiy fie within the level of the surface of the divided flesh The advice delivered by my friend, Mr. Guthrie, I also consider valuable. » . ... The second performance of amputation is a still more severe and unpleasant operation; yet, as ur. Henneu has explained, it sometimes becomes neces- sary for osteosarcoma, extensive necrosis, abscesses ot the medulla, unsuspected fissure, phagedena, or great protrusion of bone, with an extensively diseased peri- osteum, where the powers of nature are inadequate to the cure If the general health is not impaired, and the flesh does not peel off from the bone, as if it were boiled, the efforts of nature may be trusted to, aided by proper bandaging, and, in some cases, by the employ- ment of the saw; but wjien restless nights, intense pain, flushings, and irregular bowels, with great tume- faction and hardness of the stump take place, indi- cating approaching hectic, and there is evidence of an irregular action of the parts, osseous matter becoming deposited, and forming a distinct tumour around the stump, our best plan will be to operate again near the trunk.—(Principles of Military Surgery, p. 266, ed. 2.) Sometimes amputation has been considered necessary a second time, in consequence of a morbid protube- rance of the nerves of the stump, a change noticed by Molinelli, Morgagni, Lower, Arnemann, and Prochaska, and always attended with excruciating pain and great irritability of the part, and sometimes with retraction of the skin, and protrusion of the bone. Sir Astley Cooper, in his Lectures, relates one instance of such a stump high up the arm, where, upon examination of the part near the axilla, a tumour was felt,which,when touched, made the patient jump as if he had been elec- trified. In this case, as the bone protruded, amputa- tion at the shoulder was performed. In another ex- ample, where a leg-stump was in a painful irritable state from a similar cause, Sir Astley Coopar effectu- ally relieved the patient by removing the diseased end of the posterior tibial nerve. In a third instance, am- putation was repeated at the patient's desire, and the nerves were found enlarged, forming a ganglion which partly rested upon the extremity of the hone. Such a degree of irritation had been produced by it, that no part of the stump could be touched without exciting a kind of electric snock. In a case that occurred in the Middlesex Hospital, amputation of the thigh was per- formed a second time, in consequence of the first stump being thus diseased. A complete ganglion, or plexus of nerves, was found closely adhering to the removed portion of bone, having almost the appearance of cartilage. The os femoris was of an unusually small size, but the linea aspera larger than natural — See Lancet, vol. 1, p. 115 ; vol. 2, p. 192.) _ The following works may be consulted for informa- tion on diseases of the bones of stumps: Bonn, The- saurus Ossium Morborum, Amst. 1788; Weidmann de Necrosi Ossium, Francof. 1798 ; Macdonald, de Necrosi ac Callo, Edinb. 1799- the above-mentioned Essays of M. Louis; Levtille sur les Mai. des Os apres 1'Amputation, Mi m. de la Soci«te d'Emulation, t. 1, p. 148; Von Hoom De iis, qua; in partibus membri, prae- sertim osseis amputatione vulneratis, notanda sunt: Lugd. 1803. Roux, de la resection des Os Malades, Paris, 1812; M-m. de Physiologie, &c. par Scarpa, et Leveille, Paris, 1804.) SPASMS OF THE STUMP. Spasmodic contractions of the muscles of the stump is another very afflicting occurrence. Such spasms put the patient to the greatest agony, tend to cause a protrusion of the bone or s«gar-loaf stump, and .n some cases increase, affect the whole body, and ulti- mately prove fatal. But this unfortunate affection, which was rather frequent after amputations per- formed in the ancient manner, is infinitely less so after the modern improved plans of operating, tying the vessels, and dressing the wound. When, bow- ever, it does occur, the stump must be kept from start- ing, by fastening it to the pillow and bedding'on which it lies, the flesh is to be properly supported with a bandage applied from the pelvis downwards, and