[51] The indiscriminate use of viper broth is not proper at all times, or in all cases of carious bones.

SECT. [XXXIX].

It will certainly be asked, What must be done when the best applications fail, and must we not amputate when the caries is very extensive? I answer, that amputation is to no purpose if the caries be attended with a bad habit of body, and while the morbid cause remains; when this is removed, we ought not to despair of a cure, although the greater part of the bone be carious, as the cases I have already related plainly demonstrate[52]. We ought therefore to try other means, and trepan the bone in several places, till whatever is rotten be taken away. There are many bones, whereon amputation, even if it were of use, is not practicable; if, for instance, the caries has attacked the upper parts of the humeral, or thigh-bone, the jaw-bone, &c. The method of treating the diseases of the bones, may be learned from the cases of so many soldiers wounded at the articulations of the elbow, knee, &c. and who, by the care bestowed on them in our hospitals, had their limbs saved, notwithstanding they lost very large pieces of bone; some of which were separated by nature, and some by the help of the surgeon: And as no person will deny that the wounds made by a surgeon, with an exceeding sharp instrument, and with much circumspection, in order to remove the pieces of corrupted bone, are more easily cured than wounds that are lacerated and contused, by means of a ball, grape-shot, or splinters, &c. If the habit of body allows of any hope of curing the caries, the method I have pointed out [§ XX.] may also be practiced in this case. It is true, the limb often remains deformed after it, but this does not always happen; and frequently the callus fills up the whole vacuity left by the part of the bone which is taken out, however considerable it may have been. We read of successful cures, where even the loss of the entire bone has been supplied by means of a callus[53]; besides, the deformity of the limb does not take away the total use of it[54].

FOOTNOTES:

[52] The observations of M. Muzel, p. 83. confirm my opinion, where he says, that all those on whom amputation was performed on account of carious bones, died in consequence of it.

[53] Such is that mentioned by Scultetus, Armentar. Chirurgicum, obs. 81. in which we see a callus supply the place, not only of the tibia, but also of a part of the fibula, which he had extracted, and at the close of the cure, the patient walked without the help of a staff.—— See also the Medical Essays of Edinburgh, vol i. p. 312.—— Ubersatzt durch D. Carl. Cristian Krausen, p. 51. And the same Essays, vol. v. p. 371. mention one much more surprizing, “for the whole tibia of one leg came out, and the tibia of the other leg separated in small pieces. Nevertheless the patient, who was a boy of 10 or 11 years of age, in four months was able to walk without crutches, with his legs straight, and continued well afterwards, and fit for country work.” These cases are so much the more decisive in favour of the method I employ, as the callus much more easily repairs the fragments of bone taken away by the surgeon after an external hurt, and where there is no morbid cause, which was very considerable in the case I have cited.

[54] See [§ XXXVI.]

SECT. [XL].

It now remains, that I should say something concerning cancers; on which subject I shall be brief, as it has been treated of by very able hands[55]. If the complaint be recent, the constitution good, if internal medicines and outward applications have produced no effect, the vitiated part must be extirpated before the disease takes root, and communicates the infection farther. But the greater number of those who have the misfortune to be attacked with this disease, putting off the amputation from time to time, it happens when they do resolve on it, either that it accelerates their death, or the humour falls upon another part: For this reason, the operation for extirpating it, should be performed much more seldom than it is[56]; and it were greatly to be wished, that physicians would endeavour to find out some remedy for this horrid disease, without having recourse to amputation; but it is not my intention to dwell on this topic.

FOOTNOTES: