The proper period for the performance of amputation in cases of traumatic injuries / by B.A. Watson.

  • Watson, B. A. (Beriah André), 1836-1892.
Date:
[1880]
Catalogue details

Licence: Public Domain Mark

Credit: The proper period for the performance of amputation in cases of traumatic injuries / by B.A. Watson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    mediate amputation is proper ; and in a considerable num- ber of cases of injuries to larger limbs, when it is clearly seen that the patient is not faint, or depressed, or suffering under great nervous commotion. But I cannot accept of the doctrine of Pard, Wiseman, Larrey, McLeod, and others, without liberal qualifications, and a careful specification of the cases to which their rules are to be made applicable.” In accordance with the views expressed by Hamilton and others, the immediate amputation differs in no essential particular from the primary, except so far as the operation may be influenced by shock and this condition may be entirely absent, or present in varying degrees, after the receipt of an injury during the first few hours, or even days, but its period of duration is of great uncertainty. Neither is this the only dangerous complication that must necessarily influence the action of the surgeon dur- ing the first few hours after the receipt of injury by his pa- tient. Already attention has been called to certain forms of haemorrhage which demand the prompt removal of the injured limb, as well as other lesions which ought either to expedite or delay operative procedure. In consideration of these facts, it seems to me advanta- geous to drop the term “ immediate ” and employ the word primary when speaking of any operation which has been, or is to be performed prior to the development of the symp- toms which indicate the existence of any form of septic in- fection. This term primary should be employed with sole reference to the pathological condition, and without the slightest regard to the lapse of time after the receipt of the injury. The necessity for adhering strictly to this rule is found in the fact, that septic diseases arise in some patients much sooner than in others, while the surroundings of the case will be found to influence greatly the development of this important complication. Favorable hygienic surround- ings will unquestionably, in certain cases prevent these dis- eases, while in other instances it will only delay the evil day, and vice versa. Another particularly important factor in cases of com- pound fractures and similar lesions, is the local treatment