By DR. TISSOT.
An extract of the Dissertation, of which I now publish a Translation,
had given me a very high opinion of it; but on a perusal of the whole,
I found it still better than I had imagined: It seemed to me one of the
most useful and best executed performances on Surgery, and I hoped it
would very soon be translated into French.
Eighteen months having elapsed without any such translation appearing,
I thought of procuring one. I then endeavoured to find a translator,
but failing in that, I determined to do the office my self. I imagined,
that, in thus dedicating a few hours of my time to this work, I should
do a considerable service to many unfortunate people. I shall rest
well satisfied if, by rendering this excellent book more common, I
prove the means of adding to its influence, and of inducing a great
number of surgeons, who may now read it, to quit the cruel and fatal
practice of amputation, for the method which Mr. Bilguer proposes, with
a degree of sincerity and precision which leaves no room for doubt.
The title of the original is, _Dissertatio inauguralis
medico-chirurgica, de membrorum amputatione, rarissime administranda
aut quasi abroganda, quam, pro gradu doctoris medecinæ et precipue
chirurgiæ rite consequendo, die vigesima una Martii, A. S. 1761. In
alma Regia Fridericiana speciminis loco, publicæ eruditorum censuræ
submisit_, JOHANNES ULRICUS BILGUER, curia-rhœtus _generalis præfectus
chirurgorum exercitûs regii Borussici_.
This work contains a much greater variety of matter than its title
implies, for it not only shews the inutility and danger of amputation,
by several arguments, to which many others might be added; but not
satisfied with levelling a tottering edifice, Mr. Bilguer frames and
describes a plan for preventing and curing those accidents, which
oblige surgeons to have recourse to amputation; and this is properly
the most considerable and most essential part of the performance, which
is, in fact, a treatise on gunshot wounds.
I have scarcely done Mr. Bilguer justice with regard to style: I
hope, however, I have given his meaning, without depriving it of its
perspicuity or strength. This work will begin a new æra in Surgery, and
will reach posterity. I should have been sorry in any shape to have
disfigured it.
It will give me very great pleasure, if the pains I have taken, and the
notes I have added, prove agreeable to the author. He may be convinced
that, being engaged in business as I am, his performance must have
appeared to me extremely well executed, and much wanted, before I
undertook to translate it.
I am informed he has lately published a work on Surgery, in the German
language; I am persuaded it contains much valuable matter: He seems
to me to have a genius for discovering new expedients to lessen the
sufferings of human kind. I would have given this book the title of a
_Manual for the Surgeons of the Army_, which it deserves to be, were
there not already another so called[1], which, although very little
known, is by no means contemptible. The author had, even at that time,
remarked that wounds of the tendons are not troublesome, owing to
their want of sensibility, that the actual cautery is seldom proper;
and some other facts, almost forgotten since that time. He describes
wounds near the articulations with dislocation and fracture, he points
out the accidents attending gunshot wounds, and, what deserves notice,
he only admits of amputation in one case; namely, that of an incurable
mortification, and mentions it as a cruel and doubtful expedient. I
shall here cite his own words; they plainly shew that, if he lived in
our time, he would be one of the most zealous encouragers of the new
method, since he was so sensible of the defects, and grieved at the
barbarity of the old. “If, unfortunately,” says he, “a mortification,
from whatever cause it proceeds, gains ground in such a manner as
to baffle all our care and applications, there is then no expedient
left but that of taking off the limb; the success of which is very
uncertain, for if it be dubious in a healthful subject, it must be
much more so in one which is otherwise: It is, however, the only
method, dreadful as it is, of putting astop to the ailment, and saving
the rest of the body. This nevertheless ought not to be done, except
when the consent, age and strength of the patient permit us to try so
dangerous an experiment.”
This author's manner of thinking is very far from being established as
might be wished, amputations being still too frequent. Mr. Bilguer's
work ought at this time to be so much the more favourably received,
as a celebrated company, whose decisions ought to have great weight
in matters relating to surgery, has formally declared, about seven
years ago, _That amputation is absolutely necessary in gunshot wounds,
complicated with fracture of the bones_; and have left unfortunate
wounded men no other alternative, but that of losing the injured limb
on the spot, or a few hours later. That line of Juvenal seems very
applicable on the occasion:
_Nulla unquam de morte hominis cunctatio longa est._