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.

    172/878 (page 148)
    avoided at such periods, I think it may fairly be doubted whether in this case it would not have been better to have operated at the earliest I date at which the patient sought advice. Were a similar case to occur to me, I should feel inclined to proceed at once, although it' must be admitted that many circumstances might lead a judicious surgeon to delay. The individual operations for aneurism will be particularly described afterwards: but, to save frequent repetition, I may here state, that the incisions through the integuments over a large artery should always, if there is no reason to the contrary, be very free; and that those in the vicinity of the vessel should be limited, and so cautiously made as to disturb it in the smallest possible degree. The old prac- tice of carrying the finger under an artery, is now out of date, and the same may be said of that of passing a couple of threads or more around the vessel at different points;—a precaution which was, erro- neously, supposed to guard against secondary hemorrhage. Among surgeons of the present day, the general custom seems to be that of only exposing such an extent of the vessel, as to make sure of its identity, and to permit the introduction around it, of such a needle as that delineated atp. 40, and such a ligature as that described at p. 35. The treatment of the wound must be conducted according to the or- dinary principles of surgery, and the most probable after-events will be specially referred to, when each individual operation is under con- sideration. The same kind of practice, with reference to the ligature, which I have inculcated in previous pages, should be adhered to in the opera- tion for aneurism. The thread should be drawn sufficiently tight to prevent it from slipping from its place on the artery, or the knot from loosening. In tying a ligature in this operation, as well as in ampu- tations and other large wounds, I imagine that, if these two objects be kept in view, it signifies little about the particular effects on the arterial tunics, or whether the two innennost be divided or not. I believe it will scarcely be possible to sink the noose sufficiently deep in the artery, without dividing the inner and middle coats, and am also of opinion that the adhesive inflammation is much more certain after such an injury than when the tunics have been merely laid in apposition: but it cannot be doubted that adhesion and obliteration will occur under either circumstance, and the nicest perception in him who draws the noose will not, on all occasions, indicate the exact amount of laceration of these tunics. The proposal of using temporary ligatures, by allowing the thread to remain on the vessel any period from a few hours up to fifty or more and then removing it, although successful in the practice of Travers, Roberts, and others, seems to possess no decided advantage, whilst there are strong and obvious reasons against it; and the same may be said of gut, wire, and other materials not referred to pre- viously, which have been proposed as ligatures in operations for aneurism.