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.

    171/878 (page 147)
    sionally allowed to attain an immense size; now, however, it is the practice to operate in such cases at an early date, mortification being rarely dreaded, and being moreover as likely to happen in the one in- stance as the other, perhaps most so when the tumour has attained a great size. Instances, however, are not wanting to prove, that when the swelling is very small there is no immediate hurry; I have mvself watched one, of undoubted character, on the axillary artery, for several years, and could observe no perceptible increase in its size; and ex- amples where spontaneous cures have occurred within a certain period might also be adduced to sanction the advice against precipitancy. I have seen a case of popliteal aneurism, where all the symptoms were distinct, and where an operation was contemplated within a brief period, m which, before the time agreed upon had arrived, all pulsa- tion in the tumour had ceased, and the disease underwent a spon- taneous cure. But I believe the general rule of operating at an early period to be a good one, and would not delay, when such a proceeding was deemed necessary, excepting for some other and better reasons than those above referred to. Two aneurisms, one in the ham and the other in the groin, on the same limb, have been cured by one operation on the external iliac artery; and the disease has been successfully treated by the Hunterian operation, first in one limb and then in the other, as has occurred in the practice of Sir W. Newbigging. In such cases I deem it almost as unnecessary to inform the young surgeon that he may operate, as to remind him of the impropriety of tampering with an external disease, whilst there is an incurable internal affection present. It may be well, however, to keep this circumstance in view, that when aneurism has come on spontaneously in one part of the body, it may possibly have done so in another; and therefore in all external cases of this disease, a strict investigation should be made as to the condition of the large internal vessels. I need not here allude to all- the circumstances that may have influence for or against an operation, but I cannot help referring to one case which has come under my notice. Mr. Watson, my former colleague in the Royal Infirmary of Edinburgh had a case of popliteal aneurism in a female six months gone with child; an operation was determined on, but circumstances occurred to prevent it. In the mean time the late Professor Hamilton’s opinion was taken as to the propriety of operating on a female in this con- dition, and he advised against it. The patient returned to the coun- try, and in due time was delivered. In the interval the disease had greatly increased in size; in childbed the limb became additionally swollen, the limits of the tumour became less distinct, and death, from puerperal fever, occurring ten days afterwards, afforded Mr Watson an opportunity of ascertaining by dissection, that the aneu- nsm had suppurated and burst into the knee-joint during the course ot the fever. Although the advice for delay under the peculiar cir- cumstances came from such a high obstetrical authority, and admit- ting, as I do, that all formidable operations should, if possible, be