A treatise on the operations of surgery : with a description and representation of the instruments used in performing them : to which is prefixed an introduction on the nature and treatment of wounds, abscesses and ulcers / by Samuel Sharpe, fellow of the Royal Society, and member of the Academy of Surgery at Paris.

  • Sharp, Samuel, 1700?-1778.
Date:
1788
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the operations of surgery : with a description and representation of the instruments used in performing them : to which is prefixed an introduction on the nature and treatment of wounds, abscesses and ulcers / by Samuel Sharpe, fellow of the Royal Society, and member of the Academy of Surgery at Paris. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

    125/142 (page 93)
    C H A P. XXXVII. OF AMPUTATION. ^ Spreading mortification has been always efleemed fo principal a Knife for amputation, that it is a fa- shion with writers to treat of the na- ure of a gangrene, previous to the tiefcription of this operation j and I rhink they have all agreed, that what- ever the fpecies of it be, if the reme- dies they prefcribe do not prevent its rcrogrefs, the limb muff be amputated : However, this operation is fpoken of =.s frequently unfuccefsful, and, in engthoftime, its want of fuccefs has ween fo unquertionably confirmed by repeated experiments, that fomc of whc molt eminent practitioners here •n England, make that very-circum- itance an exception to the operation, which fo few years fince was the great inducement; and the maxim now is, never to extirpate till the mortification H abiohitely (lopped, and even ad- /anced in its feparation. Gangrenes may be produced two ways ; either by indifpofiticn of bo- ti ' °r b>' accident in a healthful •tare; for as the life of a part depends ;ipon the circulation of its fluids bhatever (hall make the circulation keafe, will inevitably occalion a gan- grene. Thus, a mere comprefs, pre- t'-enting the courfe of the blood, as *ffe«ually caufes a mortification, as tuny indifpofition in the fluids or vef- rcls. It frequently happens in old age. hat the arteries of the lower extremi- rics oflify, which, dcllroying their fihcity, mft In confequenee pro- luce a gangrene in the toes firft/and ittcrwards m the limb nearly as high is where the oflification terminates ; ro that in mortifications arifing from this caufe, we at once fee why ampu- tation during their increafe, is offo Rttle fcrvice, unlefs performed above fhe oflification; but we have noway to judge where the oflification ends, but by the inference we make from the gangrenes Hopping} hence we may or Si/Rcur, 9$ learn the propriety of our modem practice in this cafe. If by any accident the limb ha$ been injured to that violent degree as to be5in to mortify, it will be no more fit to operate here till it (lops, than in the other inftance ; becaufeall parts that are mortified, have had the difpofi'tion to become fo, before the effect is produced ; and cutting off a limb, half an inch above the abfolute dead (kin, is generally leaving a part behind with the feeds of a mortifi- cation in it; ib, unlefs we can be hire the veffels are not affected to the place of amputation, which will be hard to know but from the confe- quence, the operation, will be ufelefs. Sometimes the fluids of the body are fo vitiated, as to lofe their pro* per nutritious qualities; and the limb becomes gangrened, not from' any alteration it its venels, but chiefly from its fituation, which bcino- at a great diftance from the heart, will be more prone to feel the ill effects of a bad blood than any other part,-as the circulation is more languid in the ex- tremities: and it fecms not very im- probable that in fome difpofitions of the blood, a mortification may alfo> be a kind of critical difcharge. Wher* therefore a gangrene arifing from either of thefe caufes, is running on, amputation above it will, for th« moll part, be ufelefs, fince it is only removing one degree of the effects o* the bad juices, and leaving them in, the lame ftate to produce the like mif- Chief in other parts; thus we fee, af- ter amputations on this account, the gangrene fometimes falls on the bow- els, or the other extremeties; from which obfervation, I think we may conclude it not fafe to amputate till the fluids are altered j and this altera- tion will prefcntly difcover itfelf by the (lopping of the mortification. 1 nave laid it down as a rule, that the mortification (houId not only be flopped, but advanced in its fepara- .tl<m; the rc-afon of which is, that though the blood is fo much altered tor the better as to occalion a ftop- ™ * pages