A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    169/878 (page 145)
    surgeon possesses, is ligature of the vessel with which the disease is connected. Pressure has sometimes proved successful, and in all eligible situations there need be no hesitation in giving it a trial, although it would be wrong to be sanguine as to the favourable issue. It may be applied over the tumour, on the artery leading to the disease, or partly on both. I know of no other remedy on which the smallest reliance should be placed : the different proposals of causing coagulation, or deposits of fibrin, by means of cold, passing threads through the tumour, or heated wires into it, by electricity, and by other methods, are all, in my opinion, of the most futile character; and the trials that have been made of them on the living body, should be considered valuable, chiefly on account of the assurance which they have given, that their success has not been such as to encourage repetition. Success, in a single instance, with one or other of such plans, may possibly occur; but I should deem it unjustifiable, in most examples, to tamper either with the disease or the patient’s credulity, in per- sisting in their use, or even applying them at all. In internal aneurisms which are beyond the reach of surgical art, there is, of course, every propriety in resorting to a trial of one or all of those methods which have been proposed for the purpose of en- couraging a spontaneous cure; but as it is not my purpose to speak particularly of what is usually termed the medical treatment, I need not refer to such modes of practice, further than to add the testimony of my own limited experience to the vast amount of evidence already obtained, that, however laudable it may be to resort to such treatment in cases which are so fatal in their character, we possess no internal remedy which seems to have the smallest specific influence on the disease; at all events, such an influence as to lead to a certain cure. In the practice of surgery, the application of a ligature to the vessel with which the disease is connected, has a powerful and specific effect; and although the operation for its accomplishment is not without dan- ger, both at the time and subsequently, it possesses such advantages over all other modes of practice, that the surgeon who, when other circumstances are favourable, hesitates to adopt or recommend it, may with justice have either his skill or his sincerity called in question. The immediate effect of a ligature is to check the flow of blood through the disease, either entirely or to such an extent as shall, by impeding the influence of the heart’s action, permit the contents of the sac to consolidate. In aneurisms at certain parts of the body, it cannot be doubted that after the main vessel has been obstructecfby operation, circulation still goes on, though with diminished force and quantity. Sometimes this is quite appreciable; as, for example, in the popliteal artery, where pulsation often can be felt after obstruction of the femoral; the same has occurred, too, in an inguinal aneurism after ligature of the external iliac; at other times the surgeon cannot feel pulsation, although a very considerable current of blood may be pass- ing along, as is proved by what sometimes happens after ligature of the subclavian artery for wounds and aneurisms of the axillary. A L