“A memoir on amputation of the thigh at the hip joint with a successful case” William Sands Cox

1845

The progression of wound healing during the period 1776-1899 as depicted in various works of the Plymouth Historic Collection

Wendy Slater Student I.D. 91027353

Objective: Discover how the treatment and understanding of open wounds has developed throughout history; focussing on infection, inflammation and amputation.

Moses Griffiths 1776

Practical observations ….to which is added, a

method of treating several kinds of

internal haemorrhages.

John Bell 1795

Discourse on the nature and healing of

wounds

A.P. Buchan 1804

Practical observations concerning sea

bathing

Astley Cooper 1821

A series of lectures on the most approved

principles and practice of modern

surgery.

William Sands Cox 1845

A memoir on amputation of the

thigh at the hip joint with a successful case

Thomas Pridgin Peale 1858

On amputation by a long and short

rectangular flap

Florence Nightingale 1860

Notes on nursing: what it is and what it

is not

H. Helfeich 1899

On fractures and dislocation

Amputation:

Thomas Peale 1858 constructed a statistical analysis of a new amputation technique, using long and short flaps to create a stump that could weight bear comparing it to the usual “circular amputations” that were happening in London, with poor patient outcomes.

Inflammation and healing:

Although infection was poorly understood; inflammation due to tissue damage was noticed clinically and commented upon throughout all historical works:

“Arteries…inosculate mouth to mouth…each cut surface throws out mucus…entireness of the part is so quickly restored” Bell 1795

“the necessary leakage from [tissues] produces a swelling… the equable bondage of nature …confining the limb in the situation the animal placed it…continuing till the injured ligament or tendons have recovered themselves” Griffiths 1776

“Slight febrile disturbance is produced” Helfriech 1899

John Bell [on amputation techniques 30 years previously] “no motive for saving skin…no notions of adherence…6-8 inches of skin amputated”

Bell criticised certain surgeons in his day: “They all still dress their amputations as separate soles till the twelfth day”.

“Illustrations of the great operations of surgery: trepan,

hernia, amputation, aneurism and lithotomy” Charles Bell (n.d.)

“On fractures and dislocation” H. Helfriech 1899

“A system of operative surgery” Charles Bell 1809

Glossary of Terms• Gleety: sticky, pus-like• Sanies: a thin, foul-smelling greenish fluid discharging from a wound or

ulcer• Intemperably: in a poor condition• Mortified: gangrenous, dead tissue.• Putrid fever: Typhus• Adhesion: tendency of similar surface to cling together• Circular amputation: circular incision through the skin, higher up

through the muscle and even higher through the bone.• Inosculate: to unite and become continuous• Febrile: fever, high temperature.