A dissertation on the inutility of the amputation of limbs

by Johann Ulrich Bilguer

SECT. [XXXVIII].

I have treated hitherto of accidents which quickly carry off the patients; I come now to consider those where the danger is not so pressing, and which terminate in death by slow degrees, a caries of the bone, and a cancerous state of the parts; for it is well known, that in these circumstances amputation is often deemed necessary.

A caries of the bone is either superficial or deep seated, recent or inveterate, occasioned by a vicious state of the fluids, or the consequence of some external hurt.

When it is recent and inconsiderable, whatever be the cause, there is no room to think of amputation at all, but the bone must be laid bare according to the extent of the caries, and scraped with a scalpel, or perforated in sundry places with the spike of a trepan; when the caries has gained the opposite part of the bone, we must then use the crown of the trepan, in order to take out the entire piece. I do not however propose entering into a detail of the manner of performing these operations.

With respect to the medicines proper in a caries of the bone, without the application of instruments, or which finish what the instruments have begun, we are furnished with a great many, of which it would be too tedious to give a list: I must only give a caution not to employ the mineral acids, even the anodyne mineral liquor of Hoffman, so much boasted of by some practitioners in diseases of the bones; for they all do hurt. It is well known that when these acids are used for the teeth, they whiten them, but at the same time destroy their substance, rendering them crumbly and friable like limestone; now the other bones being less solid and hard than the teeth, there is so much the more reason to apprehend the same effect, by their penetrating from the affected part of the bone, where they are applied, to that which is sound. In consequence of this, the bones which appear mended after the use of these liquors, are, in a short time, worse than before[49].

The real method of doing service to bones consumed by a caries, is like what happens to boards joined together with nails, if you make them excessively dry, the nails fall out of themselves; and doubtless it is this notion that has given rise to the practice of employing hot irons, and acid liquors, as driers, to promote the exfoliation of bones. But both these methods are attended with the inconvenience I have already mentioned, with respect to acids, of acting with so much violence on the diseased parts, that they extend their action in a dangerous manner, to those that are sound. We may nevertheless employ hot irons with success in constitutions abounding with moisture, or when it is of consequence immediately to stop the progress of the disease. The following medicines act efficaciously, but with less violence, frankincense, mastich, myrrh, balsam of Peru, and essential oil of cloves; but this oil should be used with moderation, since when it is employed for carious teeth, they become friable, and crumble away by degrees in a short time[50].

When the caries is removed, in order to compleat the cure, we ought to prescribe a nourishing diet, but not too oily; broth, in which viper flesh is boiled, is very useful[51]. The dressing should then only consist of dry lint, taking all imaginable care to hinder the contact of the external air. When the caries is accompanied with a vitiated state of the blood, the external treatment is the same, and succeeds equally, provided internal medicines, suitable to the nature of the ailment, be joined with it; with this precaution, a caries from a venereal cause, may be cured like any other.

FOOTNOTES:

[49] I saw two patients who had each of them a troublesome caries, the one on the tibia, the other on the external protuberance of the fibula; their complaints, they told me, were of long standing, and that they were cured by a travelling quack, the one in six weeks, the other in a somewhat longer time. What I learned of the colour of the medicine, its properties, and of its effects on the ailment, induced me to think it was an acid spirit. This incident confirms what I was told by others, and what Mr. Bilguer now remarks. Tissot.

[50] I have seen several times, as well as Mr. Bilguer, the teeth crumble away by degrees, after using the oil of cloves; I have seen the same thing happen without the use either of it or of acids; I have, at other times, employed it without any such effect, and although I am convinced that it does hurt sometimes, it is only, I imagine, when the caries is very considerable, and the tooth much wasted: This is not, however, sufficient reason to give up, entirely, a medicine often very serviceable in many cases of carious teeth. Tissot.