A dissertation on the inutility of the amputation of limbs

38

I have not experienced a better medicine in such cases, than the plentiful use of oxymel. Tissot.

39

An infusion of water-germander, and yarrow in water, with the addition of about a sixth or eighth of vinegar, is one of the most proper fomentations in such cases. Tissot.

40

Memoirs of the Academy of Sciences at Paris, for the year 1732.

41

I have not yet read the Dissertation on this subject, which obtained the prize from the royal Academy of Surgery; but by persons arrived from Paris, I have been informed, that the author carried a dog with him to the Academy, whose thigh he had cut off at the articulation.

Note by Tissot. There must be a mistake in this place, since the writers of these pieces for the prize never make themselves known. Not that I make any doubt of the possibility of taking off the thigh of a dog, but I don't apprehend that such a fact can be at all conclusive with respect to the same operation on the human species.

42

See Heister's Surgery, t. i. part i. ch. 13. Edinburgh Medical Essays, vol. ii. art. 15. vol. v. art. 17. The Promptuar. Hamburg. and the Collections of Breslau, in several places.

43

Anatomy, observations in surgery, and the opening of dead bodies, concur to establish Mr. Bilguer's opinion.

The anatomical proofs are drawn from the inspection of the arteries. I am persuaded, that unless the crural artery is wounded almost at its egress from the arch formed by the tendons of the abdominal muscles, where it loses the name of iliac, its being destroyed will very seldom occasion the loss of the limb; besides three small branches which it sends off almost at its egress, and on which, I own, should have no great reliance, for the nourishment of so large a limb, both on account of their smallness and their distribution, at about two or three inches distance from the artery, it sends off other branches much more considerable, among others, two called the muscular arteries, especially the external one, descends pretty large down the thigh, and very evidently contributes to the nourishment of the muscular parts; although their trunks have not been traced so far as the leg, I make no doubt but it may be discovered that their branches reach that part, and which, though scarcely visible in their natural state, would not fail to become larger, when the blood was thrown into them in greater abundance; besides, the anastomosis of any considerable branch with the trunk of the crural artery, conveys so much blood to it, that it may again become useful: Experience demonstrates that this happens in the arm, and it is highly probable that the same thing may take place in the thigh; the number of branches which spring from the brachial artery, almost from its beginning, and their distribution being very analogous to what we see in the crural artery.

The surgical observations which demonstrate the recovery of heat in the parts after the operation for the aneurism, although the brachial artery has been tied very high, are common, and may be found among other observators besides those quoted by Mr. Bilguer, and there are doubtless few physicians or surgeons who have not had opportunities of seeing such cases themselves.

It is a sight extremely interesting, to observe the gradual return of heat, strength and colour, to an arm on which the operation for the aneurism has been performed. I do not know that this operation was ever performed in the thigh, the artery being so guarded in this part, that an aneurism rarely forms here. I have seen the operation succeed very well in the inferior part of the leg, on the tibialis anterior, and the foot suffered but very little for a few days; it is true it is supplied with several other branches.

Some curious dissections of dead bodies afford a third argument, as the crural artery has been found quite obliterated in the upper part of the thigh, in consequence of a morbid cause, without the leg having been deprived of its nourishment, though supplied perhaps more imperfectly.

Warm water baths, in these cases where the circulation is to be promoted through the smaller vessels, and their diameters enlarged, are among the most efficacious remedies. Tissot.

44

See § XIII. (#pgepubid00044)

45

§ XXXII. (#pgepubid00117) It is long since the bolar earths have had the reputation of being useful in contusions, but this I am afraid is founded on a mistake; I have never, in any case, experienced the least effect from them that could induce me to think they possessed the virtues ascribed to them. True bole armenic might prove somewhat astringent in the first passages, but could not do any service in this way; or might suffer perhaps a small portion of the vitriolic acid it contains, to disengage itself; but four or five drops of the spirit of sulphur, would be more useful in this respect than a dose of the bole: Thus I am almost convinced it is of very little benefit in this composition, and if of any, it must be by blunting the action of the neutral salts, and preventing the uneasiness they sometimes occasion to persons of delicate stomachs. Tissot.

46

I have seen an officer, a captain in the French service, who received a musket shot, with the muzzle of the piece close to the part; the ball shattered the humeral bone near its head, close to the articulation: had the wound been somewhat lower, that is less dangerous, his arm would have been taken off; the impossibility, or the difficulty of the operation prevented it; he suffered all the inconveniencies that a wound can occasion, for a considerable time several splinters were extracted, at length at the end of five months he was cured. This case appears to me of consequence, because here we see a very bad wound of that kind for which amputation is performed every day, and the danger aggravated by the nature of the part where it is inflicted, where they do not amputate, because it cannot be done, yet it was cured. If this officer had been so fortunate as to be wounded a few inches lower, he would have had the misfortune of having his arm taken off. Tissot.

47

Fifty years, a compliment which Mr. Bilguer pays surgeons of a more modern date.

M. le Conte de B… a general officer in the Austrian service, received a wound much of the same kind, at Hochirken, and had the good fortune to be compleatly cured by M. Brunet, without amputation, which appeared indispensably necessary. He only continued a little weak, which in a man of his age and constitution generally goes off of itself: He was advised to go to the baths at Baden in Austria, and on his return was seized with an inflammatory fever, which proved mortal. Tissot.

48

I saw two patients who had each of them a troublesome caries, the one on the tibia, the other on the external protuberance of the fibula; their complaints, they told me, were of long standing, and that they were cured by a travelling quack, the one in six weeks, the other in a somewhat longer time. What I learned of the colour of the medicine, its properties, and of its effects on the ailment, induced me to think it was an acid spirit. This incident confirms what I was told by others, and what Mr. Bilguer now remarks. Tissot.

49

I have seen several times, as well as Mr. Bilguer, the teeth crumble away by degrees, after using the oil of cloves; I have seen the same thing happen without the use either of it or of acids; I have, at other times, employed it without any such effect, and although I am convinced that it does hurt sometimes, it is only, I imagine, when the caries is very considerable, and the tooth much wasted: This is not, however, sufficient reason to give up, entirely, a medicine often very serviceable in many cases of carious teeth. Tissot.

50

The indiscriminate use of viper broth is not proper at all times, or in all cases of carious bones.

51

The observations of M. Muzel, p. 83. confirm my opinion, where he says, that all those on whom amputation was performed on account of carious bones, died in consequence of it.

52

Such is that mentioned by Scultetus, Armentar. Chirurgicum, obs. 81. in which we see a callus supply the place, not only of the tibia, but also of a part of the fibula, which he had extracted, and at the close of the cure, the patient walked without the help of a staff. – See also the Medical Essays of Edinburgh, vol i. p. 312. – Ubersatzt durch D. Carl. Cristian Krausen, p. 51. And the same Essays, vol. v. p. 371. mention one much more surprizing, “for the whole tibia of one leg came out, and the tibia of the other leg separated in small pieces. Nevertheless the patient, who was a boy of 10 or 11 years of age, in four months was able to walk without crutches, with his legs straight, and continued well afterwards, and fit for country work.” These cases are so much the more decisive in favour of the method I employ, as the callus much more easily repairs the fragments of bone taken away by the surgeon after an external hurt, and where there is no morbid cause, which was very considerable in the case I have cited.

53

See § XXXVI. (#pgepubid00124)

54

See the Dissertation of M. Kattschmied, on this subject.

55

When the cancer is evidently the consequence of an external accident, neglected or injudiciously treated, amputation performed in time, may effect a cure; but when the disease has come on gradually, without being able to assign any external cause for it, I have almost constantly observed, although it be performed in time, it accelerates the patient's death; and sometimes after having been made undergo a degree of torture more painful than that of the cancer itself. It is hoped, that the virtues of hemlock will make the frequency of amputation in these cases be discontinued: It appears, however, by the conclusion of the section, that Mr. Bilguer had not seen Dr. Stork's pamphlet.