A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery / collected from the most authentic and oiginal sources of information ; comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymoloy and signification of the principal terms. The whole illustrated by numerous interesting cases ... / By Samuel Cooper.

  • Cooper, Samuel, 1780-1848.
Date:
1813
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery / collected from the most authentic and oiginal sources of information ; comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymoloy and signification of the principal terms. The whole illustrated by numerous interesting cases ... / By Samuel Cooper. Source: Wellcome Collection.

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    suffers, lie is amply compensated by all the benefits resulting from the operation. (En- cyclopedia Methodique; Partie Chirurgicale, Turn. 1, p. 81.) See Gun-shot Wounds. -- 4. Mortification. Mortification is another cause, which, When advanced to a certain degree, ren- ders amputation indispensably proper. We have noticed, that bad compound frac- tures, and wounds, often terminate in the death of the injured limb. Such surgeons as, at all events, have been determined to oppose the performance of amputation, have pretended that this operation is to- tally useless in the present instance. They assert, that when the mortification is only in a slight degree, it may be cured, and that when it has advanced to a considerable extent, the patient will perish, whether amputation be performed or not. But this Way of viewing things is so contrai \ to facts, and the experience of every impartial prac- titioner, that we shall make no at tempt io refute the assertions. Though we allow that it would be very bad practice, every time the slightest appearance of gangrene occurred y yet, when the mischief lias in- creased in such a degree, that all, or the greater portion of the soft parts are gan- grenous, as is too frequently the case, there exists no remedy for this state j oi, at least, none with which wre are acquainted, and amputation is absolutely necessary. Practitioners have entertained very op- posite opinions, concerning the period when one should operate in cases of mol- lification. Some pretend, that whenever the disorder presents itself, and especially when it is the effect of external violence, we should amputate immediately the mor- tification has decidedly begun to form, and while the mischief is in a spreading- state. Others believe, that the operation should never be undertaken, before the progress of file disorder has stopped, even not till the dead parts have begun to sepa- rate from the living ones. The advocates for the speedy perform- ance of amputation, declare that the fui- ther progress of the mortification may be stopped, and the life of the patient pre- served, by cutting above the parts affected. Experience, however, has shewn such practice to be highly dangerous, and not deserving of confidence. M hatever pains may betaken in the operation, only to di- vide sound parts, there is no certainty of succeeding in this object, and the most skilful practitioner may be deceived. The skin may appear to be perfectly sound and free from inflammation, while the muscles which it covers, and the parts im- mediately surrounding the bone, may ac- tually be in a gangrenous state. But, even when the soft parts are found free from apparent distemper, on making the incision, still* if the operator should not have wailed till ihe mortification has ceased! to spread, the stump will almost alw ays he attacked by gangrene. Surgeons, who have had opportunities of frequently seeing wounds which have a tendency to mortify, entertain the latter opinion. Such was the sentiment of Pott, who says, that he has often seen the experiment made, of amputating a limb in which gangrene had begun to shew itself, but never saw it succeed, and it invariably hastened the pa- tient’s death. The operation may be postponed, how- ever, too long. Mr. Samuel Sharp, in particular, recommended too much delay, advising the operation never to be done till the natural separation of the morti- fied parts had considerably advanced. Mr. Sharp was a surgeon of immense experience, and his authority carries with it the greatest weight. But, perhaps, he was too zealous in his opposition to a practice, the peril of which he had so often beheld. When the mortification has ceased spreading, there is no occasion for further delay. We now obtain, just as certainly, all the benefits of the operation^ and get rid of a mass of putridity, the pre- sence of which may become highly perni- cious, should the absorbents take up any of the matter into the circulation. How- ever, this danger would not be so consi- derable as that which would arise from too precipitate an operation ; and it is better to defer amputation a little more than is absolutely requisite, than to run any risk of doing it, before being certain that the parts have lost their tendency to gangrene. Whatever may be the particular cause of the mortification, it makes no altera- tion in the above doctrines: the practice should always be the same. Though it has been thought that a distinction should be made, between cases in which mortifi- cation is the effect of an internal cause, and those in which it is the consequence of an external one ; yet, no practical ad- vantage can be deduced from this discri- mination. In no cases ought the opera- tion to be performed before the period above specified, and in all it may he un- dertaken, as soon as there is a positive cessation in the progress of the disorder. (Encyclopedic Methodique: Parlie Chirur~ gicale, p. 83, 82.) See Mortification. 5. White-Swellings. Scrofulous joints, with diseased bones,, and distempered ligaments, is another case, in which amputation may become absolute- ly necessary. There is one circumstance at- tending this complaint w hich often renders it particularly unpleasant, which is, that the subjects ace most frequently young children so as to be incapable of deter- mining for themselves, which inflicts a very distressing task on their nearest relations.