A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    45/878 (page 21)
    ^emma, when the surgeon, who had trusted to his assistant to have all the requisite instruments at hand, had to wait till a saw was pro- cured : fortunately, in this instance, the saw was in a contiguous apart- ment , but Sir Anthony Carlisle used to refer to a similar oversight when the instrument was many miles off. If the surgeon does trust to an assistant to have all things properly prepared, as may be the case on certain occasions, he ought still to satisfy himself before com- mencing an important operation, that nothing is wanting which may be of service. Undoubtedly the responsibility rests with him ; and in practising on the dead body, these preliminaries, for the sake ot rendering the lesson more complete, should all be as carefully at- tended to, as if the proceedings were about to be done on the living. 1 he positions of both patient and surgeon are of much moment also; occasionally it may be necessary to change both; but there should be no excuse for a surgeon, who, after forming the first flap in amputation ot the thigh, only then discovers that he is on the wrong side of the patient, and, in order to complete the operation, has to walk round to the place where he ought to have been at the commence- ment. I have also seen an occurrence of this kind, and, as a teacher, 1 must say, that although such untoward events may not be of serious consequence to the patient, assuredly they reflect little credit on the surgeon, or on the art which he professes. On the dead subject it is not necessary to provide all that may be required on the living; but, for the sake of illustration, I shall sup- pose a case occurring in practice;—in which event, then, to make sure at all the requisite apparatus for an operation is provided, the best p an is to lay everything in order on a small table or tray, which can be placed near the surgeon; as, for example, in a capital amputation, ey may be placed thus: a tourniquet, if one is deemed necessary, o command the circulation; a knife, to cut the soft parts; saw to divide the bones; cutting forceps to remove spiculae of bone; forceps and tenaculum to lay hold of the arteries requiring to be tied; liga- tures to apply to these vessels; needles with thread to stitch the wound straps of adhesive plaster, lint, and bandages, to dress it; sponges with water, cold and hot, to wipe away the blood ; and such other apparatus as, from the circumstances of the case, the surgeon may deem requisite: moreover, no capital operation should ever be commenced without some cordial being ready, in case the patient should grow faint. Wine is generally provided on such occasions; but it may be well in some instances to have stronger stimulants at hand, as brandy,, whiskey, or a pungent preparation of ammonia. 1 he quantity of wine which a patient will take during the perform- ance ot a severe and protracted operation is often remarkable; and this should be kept in view when a formidable proceeding is contem- plated. During amputation in the thigh, an accident occurred with the tourniquet, and the patient, already much exhausted by disease, grew faint from the sudden loss of blood, as well as from the shock of the operation: his pulse was gone at the wrists, and scarcely to be felt