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.

    185/878 (page 161)
    If the limits of the disease are well defined, there need be little dread of bleeding; for incisions in the healthy parts around will not give rise to greater trouble than under other circumstances. The principal objection to this plan is the size of the wound and conse- quent scar; and, besides, there are few instances in which it is admissible. Within these few years I have had reason to doubt the correctness of John Bell’s views, as applied to all growths of this kind, and though I still advisa caution in cutting into such masses, I have seen in- stances where incisions may be made with little more bleeding than from ordinary cellular tissue. These have been cases which I was about to treat by incision and ligature. In some I have thought it advisable to apply the ligature to the deep part of the tumour, and in others I have continued the dissection so as to remove the greater part of the substance. Some years ago I had in King’s College Hospital a young lad who had been declined as a recruit for the army, in consequence of a vascular growth over the outer malleolus on one leg. The tumour was chiefly venous, and disappeared rapidly on pressure. It covered an extent equal to the diameter of an orange, and at its most prominent part was about three-fourths of an inch in thickness. Here, after making crucial incision with the view of raising the skin from the mass before introducing the threads to cause strangulation, I found the escape of blood so trifling from various points of the surface, when I had actually cut into the substance of the tumour, that I was induced to cut deeper, and so remove the greater part of the disease with the knife. Such parts as were left behind, I expected would be obliterated by the subsequent inflamma- tion. The result was ultimately satisfactory, although slight secondary bleeding occurred on several occasions, and the inflammation for a time was not of a healthy character. In several other instances, in other parts of the body, I have seen subsequent hemorrhage and severe inflammation follow, and, on the whole, I cannot recommend this partial kind of excision. I have referred to these cases chiefly with the purpose of showing, that there need not be that great dread of hemorrhage in many of these cases, such as must be entertained by all who have read John Bell’s descriptions. These cases, it must be remembered, however, were chiefly venous tumours. When the arteries have been in greater size and number, the bleeding has been more remarkable. To avoid the danger of bleeding, it has been a frequent custom to encircle these tumours with a stout thread, which is drawn sufficiently tight to cause strangulation and sloughing. This has been done by Sir Benjamin Brodie and others, as above referred to, by means of needles passed through or under the disease, and strong thread twisted round, with tightness sufficient to cause the whole mass to slough; and it has been a common practice to push a needle through the centre at the disease, to convey a double ligature across, one of which has been tied round the root of one half of the tumour, the other round the M