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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![During two weeks succeed;ng his arrival in the city, medicines were administered with a view of allaying irritation, and imparting tone to the system, but hectic and night sweats, notwithstanding, supervened. As ulcerations began to occur by the side of the tibia, and all the symptoms became worse, it was resolved to amputate at the hip-joint as the only chance of saving t.ie life of the patient. On the 7th of October, 1824, the patient, after having passed a comfortable niglnywas placed upon the table in order to be operated on. An incision was made over the femoral artery as it emerges from under the femoral arch, and the vessel secured by ligature. While feeling on the outside of the artery for the lesser trochanter, the pulsation of a vessel apparently but ', little smaller than the femoral artery immediately be- > low the ligature, convinced us that in this case the f profunda femoris was given off above the femoral arch, as we occasionally find it. Thisvessel was taken up. Lisfranc's knife was then introduced between the artery and bone, and carried through close by the neck of the femur towards the tuber ischii, thus forming the inner flap. The external flap was formed by cutting from without inwards. The hemorrhage from the veins and small arteries was considerable when the incisions were made, and numerous vessels were taken up: but comparatively little blood was lost during the opera- tion, and the patient was put to bed shortly after it was completed. After the inner flap was cut, some of the surgical attendants, examining the lesser trochanter, pronounced that the head of the bone was not diseased. In order to satisfy the doubts expressed, the bone was sawed through the lesser trochanter, when it was found to be of the consistence of cheese, being denuded of periosteum on the outer side up towards the joint, and requiring to be removed, which was afterward done, as originally contemplated. It is scarcely necessary for us to enter into the detail of symptoms and treatment subsequent to the opera- tion, as nothing occurred worthy of note, except various degrees of irritation of the stomach and whole system, previous to the coming away of the ligatures. The treatment consisted in regulating the diet, and admi- nistering anodyne and tonic medicines according to circumstances. On the 15th of October, eight days from the opera- tion, two-thirds of the stump was healed by the first intention. Between the 17th and 31st of October, all the ligatures, seventeen in number, were removed ; and by the 20th of November the whole stump was effectually healed, and the boy had become fat and lusty. There can be no doubt but that this limb might have been saved without difficulty, had the proper treatment been instituted when the accident occurred. When it came under our charge, nothing short of the operation above related could have saved this boy's life.—ftcp.sv.] Another successful amputation at the hip was per- formed by Mr. Orten : the disease commenced in the knee; but terminated in extensive disease of the thigh- bone, large abscesses, and dislocation of the knee the leg being fixed in the bent position, and drawn under the thigh.— See Med. Chir. Trans, vol. 13, p. 605.) On the other hand, the failures of this operation are numerous, though undertaken by surgeons of reputa- tion and ability. Mr. Guthrie, Dr. Emery, Mr. Brown- ngg, Baron Larrey, Walther, Graefe, Mr. Brodie, Mr Carmichael (Trans, of the Assoc. Physicians, vol. 3,, Drs. Blick and Cole, and many other military practi- tioners, have had opportunities of amputating at the hip without success. A calculation has been made, that out of twenty ex- amples of hip-joint amputation, six have had a favour- able termination.—(Chelius, Handb. der Chir. b. 2, p. 763.) According to my computations, this account is rather too favourable. No one can expect, however, this operation not to fail in a large proportion of the cases in which it is at- tempted ; this must always happen, let it be done in the most skilful manner possible. Yet, as there are unquestionably some descriptions of injury, where life must be inevitably lost, if this proceeding he re- jected, and experience proves that it sometimes an- swers, an important consideration is. what cases are most proper for it ? Here I am decidedly of opinion with Professor Thomson, that the examples, in which it is particularly called for, and where no 'delay should be suffered, are those in which the head or neck ofthe thigh-bone lias been fractured by a musket-ball, grapb- shot, or small piece of shell. Eight or ten such cases, where amputation ought to have been done in the first instance, were brought in wagons several days alter the assault on Bergen-op-Zooin, into the hospital su- perintended by myself at Oudenbosch. and not one of these patients lived ten days alter their removal. In the whole course of my professional life, I have never elsewhere witnessed so much suffering, or suppuration in such profusibn. From each limb, I should guess, that at least three or four pints, of matter were dis- charged daily. Had amputation at the hip been per- formed at first, some of these patients might possibly have been saved; at all events, I am certain that it was their only chance Larrey, as I have slated, thinks the operation pro- per, where the thigh has been shot off high up, or where the femur and soft parts near the hip have been broken, and extensively lacerated by a cannon-ball or pieces of shell. Here the operation though perhaps the only chance) must almost always fail, because, as Professor Thomson observes, these injuries occasion a shock to the constitution, of which the patient mostly sinks either immediately, or in a few hours.— Obs. made in the Mil. Hosp. in Belgium, p. 274.) The truth of this observation I saw exemplified at Merx- ham, near Antwerp, at the bombardment of the French fleet in that port; a shell burst between the thighs of one of the guards ; tore and lacerated two-thirds of i he thickness of the upper part ofthe right thigh; broke the ascending ramus of the ischium ; lacerated the perineum and scrotum; and fractured the higher part of the femur. There was no hemorrhage of con- sequence ; but the exposed lacerated surface of the soft parts was immense, and the unfortunate soldier, who lay with his hairs standing erect, and bereft of his intellectual faculties, sunk in the course of a quarter of an hour into a state of insensibility, and was quite dead in twenty minutes. However, there are nume- rous cases in which the patients, after dreadful injuries of the upper part of the thigh, are less depressed and overcome, and live several weeks; facts clearly prov- ing that the operation ought to be attempted. Many instances of this kind are relaled by Mr. Guthrie.— (On Gun-shot Wounds, p. 134, &c.) Bad and incura- ble disease of the upper part of the femur (not the scrofulous hip, nor any other example m which the pelvis is affected; may also require the performance of ampulation at the hip-joint, as was recently illustrated in the practice of Mr. Syme, of Edinburgh, and in that of Sir Astley Cooper. The case in which Mr. Car- michael amputated at the hip, was what is termed an osteosarcoma; the patient, a girl 19 years of age, died on the fifth day —(See Trans, of the King's and Queen's College of Physicians, Ireland, vol. 2, p. 357, &c, and vol. 3, p. 158.) Dr. Mott's case, already referred to, was one of fracture of the upper part of the femur, ending in disease of the bone and extensive abscesses. The disease, for which Delpech operated, was necrosis of the thigh-bone. The propriety of the operation in desperate cases is now perfectly established. AMPUTATION AT THE SHOULDER-JOINT. H. F. Le Dran performed the first operation of this kind, of which the particulars are recorded. It was m a case of caries and exostosis, reaching from the middle to the neck of the humerus. Le Dran bean with rendering himself master of the bleeding, for which purpose he introduced a straight needle and a strong ligature under the artery. This was passed from the front to the back part of the arm as closely to the axilla and bone as possible. The ligature then in- cluding the vessels, ihe flesh surrounding them and the skin covering them, was tightened over a compress Le Dran, with a straight narrow knife, then made a transverse incision through the skin and deltoid muscle down lo the joint, and ihrough the ligament surround- ing the head of the humerus. An assistant now rais-d the arm and dislocated the head of the bone from the cavity- of the scapula. This allowed the knife to be passed with ease between Ihe hone and the flesh Le Dran hefl carried the knife downwards, keeping ts edge always somewhat inclined towards he bine fa SF-KmSE he gradjially cut through all .he parts, as far as a little below ihe ligature. As there was a large 1 flap, Le Dran made a second ligature with a curved](https://iiif.wellcomecollection.org/image/b2103719x_0091.jp2/full/800%2C/0/default.jpg)
