Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

    88/1282 (page 76)
    practice, like the innovation of cutting off the half of each ligature, has been common in the London hospitals, and at St. Bartholomew’s in particular, many years earlier, I presume, than the case referred to by this gentleman, since it thas been familiarly adopted in those institutions ever since 1797, as I can testify from my own personal observation. ‘These remarks are offered, -without the slightest intention of detracting from the merits of the above-mentioned paper, which is replete with valuable advice; nor am I influ- enced by any design of throwing honor on the ‘memory or character of any other individual at the expense of Mr. Veitch, being at this time un- acquainted with the exact periods, when either this improvement, or that of removing the half of ‘each ligature, commenced. M. Roux is one of the few remaining modern surgeons, who declare their preference to the method of bringing out all the ligatures at the lower angle of the weund, the benefit of having them brought out thus low, so as to keep upa drain for any pus that may form, being in his opinion greater, than that of arranging them at the points of the wound nearest tothem. (Mém. sur la Réunion -de la Plate aprés V Amp. p. 12.) As Dr. Hennen observes, the reducing the immoderate size of ligatures, the separating the -threads of which they were composed, and placing them at convenient points along the face of the stump, or wound, and the actual removal of one half of each ligature, were amendments very slowly made ; but, (says he,) “an improvement, which appears to me of great consequence, was adoption, although the artery once secured, and the value of adhesion duly acknowledged, it is the most obvious of all. J allude to the plan of removing the ends of the ligature altogether, and thus leaving to an extensive wound the greatest possible chance of immediate union.” ‘The first Hennen's investigations have discovered, was in a letter written by Mr. Haire, dated Southmin- gentleman, “sometimes became troublesome and An intimate friend of mine, a surgeon of great abilities, proposed to cut the ends. of them off close to the knot, and thus leave them to themselves. By following this plan, we have seen stumps healed in the course of ten days. The short ligature thus left in, commonly made its way out by a small opening in a short time, without any trouble, or the patient being sensible of pain.” (See Lond. Med. Journ. Vol. 7.) Certainly, considering the thickness of the liga- tures in use at the above period, this testimony of the success of the method, as Dr. Hennen remarks, is very satisfactory. (Principies of Military Surgery, p. \8\, Ed. 2.) na letter received by me from Mr. Dunn, surgeon at Scar- borough, and dated June 3, 1819, he tells me, <<‘ My predecessor, Mr. J. Wilson, the late partner of Mr. Travis, amputated a limb in 1792, or 93, and cut off the ligatures close to the arteries, and no trouble ensued. He did this at the recom- mendation of Dr. Balcombe, of York, who had seen the method practised on the continent.” In September, 1813, Dr. Hennen, who was serving with the army in Spain, began the adop- tion of this plan, which, he expected; would not only prove useful in promoting immediate union, but in obviating any accidental violence to the li- gatures, and the wrong interference of the younger dressers in trying to pull them away. Between September and January, thirty-four cases were treated in this way, without any inconvenience following, or the small particles of silk left behind giving rise to any apparent irritation. Dr. Hennen also presented to Sir J. M‘Grigor some of the small circles of silk, a part of which had come away with the dressings, while others had floated out on opening the little pustules, which formed over the face of the stump at the points, where the arteries had been tied. Some few of the ligatures never made their appearance; and the patients complained of no uneasiness whatever. Convinced of the utility of the method, Dr. Hennen afterwards published an account of — it. (See Lond. Med. Repository, Vol.3, p- 77, and Vol. 5, p. 221.) This gentleman subse- quently found, that Dr. Maxwell of Dumfries had adopted the plan as far back as 17983; and Dr. Ferguson, who was at Stockholm during the peace of Amiens, saw it also then followed by some of the surgeons of that city, without any ill effects. (Hennen’s Military Surgery, p. 175-178, Ed. 2.) In July, 1814, Mr. Law- | rence communicated to the Medical and Chirur- — gical Society of London, some cases and obser- vations highly in favour of the practice; and the — particularity, which he lays much stress upon, is | using for the purpose minute firm ligatures, com= | posed of what is called-dentist’s silk. (See Med. Chir. Trans. Vol. 6, p. 156.) And, ina paper | of later date, he says, his further experience had confirmed the usefulness of the method, ‘that | this plan, by diminishing irritation and inflam- | mation, and simplifying the process of dressing, | very materially promotes the comfort of the — patient, and the convenience of the surgeon, | while it has not produced ill consequences, or | any unpleasant effect, in the cases, which have f come under his own observation.” According | to Mr. Lawrence, the small knots of silk gene- | rally separate early, and come away with the | discharge; that where the integuments have | united by the first intention, the ligatures oftem { come out rather later, with very trifling suppu- | ration, and that, in some instances, they remain i quietly in the part. (Op. cit. Vol. 8, p. 490.) After the battle of Waterloo, it was tried in many cases both by Mr. Collier, and myself, - though our ligatures were certainly not so minute _ and eligible as those employed by my friend | Mr. Lawrence, whose plan essentially requires the | use of minute ligatures made of dentist’s silk. As I joined the army in the field after nine days, | and was therefore obliged to leave my patients at Brussels to the care of others, I lost the oppor-| tunity of witnessing the effects of this method. But, from Mr. Collier, I afterwards learned, | that the new plan and the common one appeared. in his judgment to answer about equally well, which report, considering that we did not use. the smallest ligatures, must be regarded as favour- able. When the planis tried, single strong threads and silks, or rather the kind of ligature, which will be described in another place, (See Ligature) should be employed: for, otherwise, the knots would be large, and likely to create suppuration and future trouble. The practice-has likewise