Beschreibung
Chirurgie Clinique de Montpellier, 1. - Paris et Montpellier, Chez Gabon et Co., 1823-1828, 4°, (6), VIII, 496 pp., 16 gestochene Tafeln, orig. broschur.; unaufgeschnittenes minimal fleckiges Expl.; kleiner Wurmgang im Innensteg; St.a.Tit. First Edition! "Delpech described (pp.183-192) the beneficial effect of section of the tendo Achillis for club foot, HE PERFORMED THE OPERATION ON May 9, 1816, and although not first to do so, he was the first to demonstrate the value of tenotomy in the correction of contracture deformities of the extremities." GM No.4312 "The legacy of Jacques-Mathieu Delpech (1777-1832) is much more than a series of interesting pictures, however. He was one of the first surgeons to attempt to correct deformities by surgical methods, and his success gave a new dimension to the practice of orthopedics. In a collection of papers from his clinic published in 1823 is one entitled Considérations sur la déformité appelée pied-bots, which describes the treatment of seven patients with clubfeet.The first six were treated with the application of the usual types of apparatus with varying degrees of success. He recounts all of the complications and difficulties, including noncompliance of the family with these prescribed regimens. The seventh patient, a boy of nine with a severe equinus deformity, had undergone treatment with braces without benefit. Drawing upon his experience with patients with spontaneous ruptures of the Achilles tendon that had healed with the formation of material between the ends of the tendon, Delpech considered the possibility that such a healing process would occur if the tendon were surgically divided. He decided to divide the tendon completely close to its insertion in such a way that air did not enter the wound. The foot would then be placed in an apparatus in its deformed position until the tendon had healed, and then be slowly brought up to a right angle with the leg. After discussing the procedure with the boy's parents, he performed the operation on 16 May 1816. With the patient lying on his abdomen, two small wounds were made with a bistoury on either side of the Achilles tendon. A second sharply curved knife was then used to divide the tendon transversely. Fortunately for the patient, the procedure was not very painful. After dividing the tendon, the foot could be brought up to a right angle with the leg easily, but after applying a small dressing the foot was bound in an apparatus in its original position. The wounds healed slowly. On the tenth postoperative day a small hematoma was evacuated; two days later, a small amount of pus. On the twentieth postoperative day there was still a slight serous drainage. By the twenty-seventh day, the wounds were well healed and there appeared to be good adhesion between the ends of the tendon. Correction of the deformity was then commenced and at the end of a month was complete. After the description of this case, Delpech discusses the role of tendons and muscles in the etiology of various deformities and the potential value of tenotomy and myotomy, concluding, "We believe that today the operation is practical and can be applied in all areas where the tendons oppose the normal position of the extremities and are the cause of the deformity." It is important to understand that Delpech did not describe simply the operation of subcutaneous tenotomy of the Achilles tendon, but the whole genus of subcutaneous tenotomies and myotomies of which heel cord tenotomy was but one species. The operation was based on his conception that tendon and muscle contractures were the basic cause of the deformities and that by releasing the contractures, prevention of further deformity, or partial or complete correction of the deformity, could be achieved." Leonard F. Peltier, Orthopedics - A History and Iconography (1993), pp.28-32 Garrison & Morton No. 4312. Bestandsnummer des Verkäufers 63965
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