Johann Bilguer - A dissertation on the inutility of the amputation of limbs

It is with particular pleasure I present the English reader with a translation of Mr. Bilguer's celebrated performance: It will meet, I doubt not, with the approbation of those, who have the true honour of surgery at heart, and are at the same time friends to humanity. After what is said by so eminent a judge as Dr. Tissot, as well as many others who are an ornament to the profession, I shall not launch out into any eulogium on the author: there is a spirit of modesty, candour and ingenuity runs through the whole, that to every sensible reader will prove a sufficient recommendation of the work. – If it in the least contributes to check the cruel and precipitate practice of taking off limbs that might be saved, thereby preserving the lives, as well as preventing the mutilation of numbers of our fellow creatures, I shall think myself amply recompenced for the labour I have taken in thus endeavouring to render Mr. Bilguer's beneficent design more extensively known.

Physician in Ordinary to Her Majesty, Fellow of the Royal Society, &c.

SIR,

Your excellent work on the Diseases of the Army , so useful to physicians in general, will always be considered as a standard for the practice of those in particular, who are intrusted with the important office of superintending the health of the soldiery. Mr. Bilguer has performed, on his part, what you have so ably done on yours, in pointing out to his colleagues and successors, the plan which they ought to follow. It has given me pleasure to translate his Dissertation, and you must derive a peculiar satisfaction from the perusal of it, because, from the extensive and painful experience you have had of the bad consequences resulting from the operation this able Surgeon so warmly opposes, you can more readily perceive the usefulness and value of this little work. It is therefore my duty to address it to you, and I eagerly embrace so favourable an opportunity of thus publicly declaring the sentiments of esteem and particular respect, with which I have the honor to be,

Sir,

Lausanne,

1 April, 1764.

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 1 Le Manuel du Chirurgien d'Armée ; or, The Art of methodically curing Gunshot Wounds, &c. By L. L. M. C. Printed for Houry, at Paris. My edition is the second, published 1693. , 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.

Having resolved some little time since to publish in this learned university a Dissertation which might serve as a specimen of my Medical Acquirements, the subject which appeared the most suitable to my purpose, is one, that may improve the art of surgery, which I practised for several years during the heat of the late bloody wars, and may at the same time wipe away the old aspersion, first broached at Rome against Archagates, and so often repeated since, that surgeons are executioners, who cut and burn without mercy.