A dissertation on the inutility of the amputation of limbs. Johann Ulrich Bilguer

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СКАЧАТЬ more effectually accomplish my design, or do a greater service, than by demonstrating, that the cases wherein amputation is necessary, are much less frequent than has been hitherto supposed, and that it may even be almost totally dispensed with.

      SECT. II

      My first thoughts on this subject arose from observing what passed under my own inspection in the military hospitals.

      In the first place I remarked, that in a very great number of cases, where amputation was judged necessary by the physicians and surgeons of the army, and even by the wounded themselves, in order to preserve life, it seldom or almost never answered the end.

      In the second place, I saw and had under my immediate care, a great number of patients whose limbs had been carried off by cannon balls, and in such a manner too, that all those who adhere to, and are afraid to deviate from established rules, would have performed a fresh amputation on the remaining stumps, whom I cured, as far as they were capable of being cured, without having recourse to such disagreeable means.

      And lastly; many others, whose limbs were not intirely separated off, but so much detached, wounded, shattered and contused, that the ablest surgeons deemed it necessary to take them wholly off, were nevertheless, by my endeavours, contrary to the general opinion, cured without amputation.

      SECT. III

      This success, partly owing to the efforts of nature, and partly to the means employed by art, strongly encouraged me almost never to have recourse to amputation, but to try every kind of remedy, internal as well as external, calculated to preserve the lives as well as the limbs of the unfortunate sufferers. My first attempts, so far from being unfavourable, confirmed me more and more in the opinion, that parts which have sustained the most considerable injuries, will much oftener get well than what is commonly believed: And although this opinion does not seem to be countenanced by many eminent physicians and surgeons; although I do not flatter myself I shall be able to induce them to alter their sentiments, I hope nevertheless, that some others, encouraged by my example, and this account of my success, will have the courage to follow the same method, and that their authority may afterwards contribute to convince the most incredulous.

      SECT. IV

      But supposing, what I do not apprehend can be the case, that all the gentlemen of the profession should agree in declaring my method absolutely useless, the rest of mankind at least, will be obliged to me for my endeavours to mutilate the wounded as little as possible; as most people are shocked at the mention of any amputation, or at the sight of a poor creature who has lost an hand, an arm, a foot or leg, wretchedly crawling along upon crutches or a wooden leg; and consider the total privation of a limb, as a much greater misfortune than when it is preserved, though perhaps unshapely, and uncapable of performing several of its primitive functions. If one reflects how much every body dreads the pain occasioned by the slightest incision, he will easily conceive the degree of horror a person must feel at the thought of amputation, and why many patients chuse rather to die than to submit to it2. Hence it is so uncommon to find men, like count Mansfeld, so famed in the war that lasted thirty years, who caused his wounded arm to be taken off amidst the sound of trumpets and beating of drums; or like the country fellow, whom Dr. Schaarschmid, late an eminent physician at Berlin, mentions in his collection of observations and remarks on physic and surgery, who cut off his own mortified leg with a saw, very unfit for such an operation3.

      SECT. V

      But lest I should be charged with being weakly influenced by the cries of the patient, and with wanting that kind of fortitude which Celsus4 thinks requisite in a surgeon, in treating of this operation, I shall take it for granted that the patients are men like those I have just now mentioned, and that an inordinate desire of life, an uncommon strength of mind, religion, and other moral reasons, induce them to consider pain as nothing, when it affords them any hope of preserving life.

      It is foreign to my plan to inquire who was the first who attempted this operation, or to trace the history of it in the works of the ancients. I shall only take notice, that such wounded men as recovered, after having lost a limb by some accident, without doubt, shewed the possibility, and suggested the first hint of trying this operation. Neither shall I dwell upon the various methods of performing it from the infancy of the art to the present time; they are described in other books5, and I do not purpose giving a compleat treatise on amputation. I shall not even touch upon what is already generally known on this subject, but as little as I possibly can: This is the best way of handling any particular point; and I hope all those who pay more regard than I do to scholastic form, will pardon my inattention to regularity of method and stile, when they are informed how much my time is engaged; others will excuse me, when they call to mind the remark of Celsus, that diseases are cured by proper remedies, not by a display of eloquence.

      SECT. VI

      To prove what I have advanced, I shall begin with enumerating those accidents for which amputation has been hitherto deemed necessary. I shall reduce them to six.

      First, A mortification, which spreads till it reaches the bone.

      Secondly, Any limb so greatly hurt, whether by fracture or dilaceration, that there is room to dread the most fatal consequences, a mortification and death.

      Thirdly, A violent contusion of the soft parts, which has at the same time shattered the bones.

      Fourthly, Wounds of the larger vessels, which convey the blood into the limb, either, as the only means of stopping the hemorrhage, or through the apprehension the limb should perish for want of nourishment.

      Fifthly, An incurable caries of the bone.

      Sixthly, If any part is either attacked with a cancer, or is in danger of being so, it is customary to take it off.

      I shall treat of these different accidents more or less particularly, in proportion to the number of observations I have made on each of them, as no method of cure, however doubtful and alarming, should be rejected, till a better can be pointed out. Thus, this treatise contains only, in effect, an account of the methods I successfully employed in the military hospitals, for the relief of the above disorders; together with a few observations, and still fewer hypothetical reasonings, which induced me to condemn the use of amputation.

      SECT. VII

      I shall begin with an account of the means I make use of, internal as well as external, when a limb is mortified, the effects of which have convinced me, that in such cases amputation is not necessary; and here I shall first gratify the curiosity of those readers who, doubtless, are desirous to know what I have learned from the extensive opportunities I must necessarily have had, with respect to the use of the Peruvian bark.

      Experience has taught me, that this admirable medicine is possessed of a singular and specific virtue in mortifications.

      I know that several physicians and surgeons only recommend it in those which proceed from weakness. I have heard it reported by others, that they found it of little service after the famous battle of Dettingen6. But perhaps the other circumstances, with regard to the treatment of the patient, did not contribute to promote those good effects which I always observed attended it when judiciously administered. And I make no doubt, but every practitioner who, in prescribing it in cases of mortification, observes the rules laid down by Dr. Pringle, Dickins, Wade, Cheselden, Douglas, Rushworth, Amyand, Shipton and some others, will find it very efficacious. I do not mean, nevertheless, that it should be considered СКАЧАТЬ