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.

    170/878 (page 146)
    case will be referred to afterwards where such an operation failed,— bleeding continued; a similar case has lately been described in The Lancet,—the collateral vessels keep up the hemorrhage; and, indeed, in my opinion, complete obstruction through the main vessel, at the I seat of injury or disease, does not occur in all instances of such operations, and is not absolutely necessary for the cure of aneurism. It is on such views that Mr. Wardrop has proposed his operation of impeding the circulation through the subclavian artery, or through the carotid in aneurism of the innominata, by placing a ligature on the vessel on the distal side of the tumour, being a modification of the original proposal of Brasdor, who imagined that obstructing the vessel beyond the disease might have the desired effect. The operations of Brasdor and of Wardrop are resorted to only in cases where all other modes of treatment are unavailable, especially when Hunter's cannot be put into practice, such as in aneurism at the root of the neck. All experience goes to show that the proposal by the two first-named authorities can be undertaken only as a last resource, and one, also, on’which no great reliance can be placed ; whereas Hunter’s operation may be resorted to with every probability of success: but here it must be remembered that no one would re- commend the former when the latter is applicable ; — in other words, the instance where Hunter’s operation is practicable, is not altogether so desperate, as when either of the others alone holds out a ray of hope. It may be said that Brasdor’s and Wardrop’s operation, the latter in particular, has been more successful in aneurism at the root of the neck than Hunter’s ; — ligature of the innominata for aneurism beyond having never entirely succeeded, whilst deligation of the sub- clavian for aneurism of the innominata has actually, in some instances, been followed with every good result that could be anticipated. But more will be said on these interesting subjects when I come to the head and neck; meantime I shall limit my observations to Hunter’s / operation. The usual circumstances which induce the surgeon to hasten an operation of any kind whatsoever, or to wait a more favourable oppor- tunity, will always influence him in selecting a proper period for such a momentous one as ligature of a main artery. I do not apply such a high-sounding term to the mere manual proceeding, for that is of minor consideration in comparison with the effects which may be produced on the patient: a pupil from the dissecting-rooms may place a ligature on the femoral, subclavian, or other large vessel, with as much precision as the most experienced operator, but the most skilful surgeon cannot foretell what may be the result; and it is in this light I that the proceeding must be deemed momentous. Experience has taught that it is wrong to wait, after an operation has been determined upon, in the hope that by allowing time for the collateral vessels to enlarge, there will thus be less chance of mortification occurring im- mediately afterwards. This doctrine formerly prevailed with reference f to the popliteal and axillary aneurisms, and the tumours were occa-