History of a successful case of amputation at the hip-joint : (the limb 48 inches in circumference, 99 pounds weight) / by J. Sampson Gamgee.

  • Gamgee, Sampson, 1828-1886.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: History of a successful case of amputation at the hip-joint : (the limb 48 inches in circumference, 99 pounds weight) / by J. Sampson Gamgee. Source: Wellcome Collection.

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    other as a ferrule, of variable size, round the outside of the osseous structure; hence the general rule of practice, in cancerous disease of bone, to amputate at, or beyond, the joint above; in presumably non-malignant cases, to operate at a good distance from the seat of mischief. In the ease of Joseph Bramwell, the diagnosis was in favour of benignancy; but there was so little room for the knife, that in the uncertainty concerning the condition of the medullary canal, I resolved to give the patient the benefit of the anatomical doubt, to ensure the removal of the disease in its entirety, in the event of operation being finally determined upon. The question was thus narrowed to examining the statistical evidence for and against amputation at the hip-joint, in relation to the particular case. For sufiiciently obvious reasons it may safely be admitted that, with rare exceptions, successful coxo-femoTal disarticulations are on record, but that it is otherwise with the deaths, of which, for instance, I am acquainted with three speedy ones, in the practice of ditferent surgeons, nowhere published; a number doubtless very inadequately representing the faults of omission in the desired statistics. It was sufficient for my purpose to know that the contemplated operation had repeatedly proved successful; generally, it is true, in cases which could not compare with the present one for mechanical and clinical difficulties, but these were, I thought, more than counterbalanced by the means which it was proposed to employ to surmount them. I must confess to a very great distrust of almost all the surgical statistics extant, a feeling cherished with satisfaction, because with its growth I have become more and more convinced that the mortality, which the text-books teach is attendant upon the performance of great surgical operations, is in no way a necessary result, but in great measui'e due to a number of avoidable accidents and conditions. Whatever be the statistical result, now on record, in any of the so-called capital operations of surgery, I think it is quite safe to predict that the mortality will be much smaller, provided a few cardinal points be held steadily in view. Istly, to adapt the operative procedure to each particular case, regardless of systems and methods; 2ndly, to make no sacrifice to brilliancy of execution; 3rdly, to be most accurate and watchful in the minutest details; 4thly, to ensure constant and perfect cleanliness and ventilation; 5th]y, to give no medicine unless absolutely required; when it is so, to steer a judicious course between the stuffing and incongruous pharmacy, inherited from