The ligation of the larger arteries in their continuity : an experimental inquiry / by Charles A. Ballance and Walter Edmunds.

  • Ballance, Charles Alfred, Sir, 1856-1936.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: The ligation of the larger arteries in their continuity : an experimental inquiry / by Charles A. Ballance and Walter Edmunds. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    II.—Historical 8hetch. Centuries before the discovery of the circulation^ of the blood the ligation of arteries for wounds^ and aneurisms^ was practised. A great diversity of opinion has always existed as to tbe best metbod of performing the operation. The practice of surgeons from tbe earliest times to the present day seems to have been based on one or other of two great opposing principles : ' Harvey, ' De motu cordis et sanguinis,' 1618. 2 Celsus (book v, chapter 26, paragraph 21) :— But if pressure and astrin- gents are ineffectual to restrain the hsemorrhage, the bleeding vessel is to be taken up, and a ligature having been applied on each side of the wound in it, the vessel is then to be divided; the two parts of the vessel will become united by anastomosing branches, and the orifices will become obliterated. ' Galen (Kuhn's edition, chap. 23, vol. xi, p. 313) :— If the artery be large, and if it be cicatrized beyond the aneurism, the whole of it should be cut through, and oftentimes that very practice prevents the danger from hajmor- rhage; for it appears plainly that when a complete transverse division is made both portions of the artery retract on either side, the one above the part, the other below. Pare (Works, 1579, translation by Johnson, 1665, p. 323), was the great advocate of the ligature after Galen. He says, concerning the stanching of bleeding in amputation: The ends of the vessels lying hid in the flesh, must be taken hold of and drawn with this instrument (forceps) forth of the muscles, whereinto they presently after the amputation withdrew themselves. In performance of this work, you need take no great care, if you together with the vessels comprehend some portion of the neighbouring parts, as of the flesh, for hereof will ensue no harm; but the vessells will so be consolidated with more ease, than if they being bloodlesse parts should grow together by themselves. P. 325:— Wherefore I must earnestly entreat all Chirurgeons, that leaving this old and too cruel way of healing [actual cautery], they would embrace this new, which I think was taught me by the special favour of the sacred Ueity; for I learnt it not of my masters, nor of any other; neither have I at any time found it used by any; only I have read it in Galen, that there was no speedier remedy for stanching of blood, than to bind the vessels (throiigh which it flowed) towards their roots, to wit, the liver and heart. This precept of Galen, of binding and sowing the veins and arteries in the new wounds, when as I thought it might be drawn to these which are made by the amputation of members, I attempted it in many. Ambrose Par6,1582 (Par^, Works, Lyon, 1641, quoted by Erichsen):— Divide the skin above the aneurism, and, separating the artery, pass a seton needle armed with a strong thread under it, and allow the ligature to fall of itself. Nature will then generate flesh which will block up the artery.