[41] Memoirs of the Academy of Sciences at Paris, for the year 1732.
[42] 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.
[43] 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.
[44] 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.
[45] See § XIII.
[46] § XXXII. 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.
[47] 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.
[48] _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.