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.

    188/878 (page 164)
    tion of the knife until the ligatures are adjusted, I imagine that less blood is lost than would otherwise he the case. In certain instances, when the skin is involved in the disease, it answers no good purpose to preserve any of it. In such cases the nooses may be drawn upon the skin, but I believe that it causes less suffering, and probably expedites the separation of the slough, if a slight cut be made through the skin exactly where the nooses would fall upon it. When the thread is tightened, it sinks into these notches, and perhaps a more exact limit to the part to be strangulated can thus be made at the will of the surgeon, than by drawing the thread directly upon the surface of the skin. The mass generally sloughs in about five or six days after this operation. A comparatively large gap is thus left, but in a few days, as granulations spring up, and by drawing the edges together by adhesive plaster, the sore diminishes in size, so that, when cicatrization is perfect, a wonderfully small scar remains. Instances occasionally occur, where even the above method can- not be resorted to with propriety. Some years ago I treated a case of this disease in a lad about the age of puberty. The tumour was situated on the outside of the thigh, midway between the trochanter and the external condyle; it was but slightly prominent; and although its diameter in all directions seemed three or four inches at least, its exact limits could not be made out. On all sides large pulsating vessels could be felt passing into it, and there was every reason to suppose that the affection was deeper than the aponeurosis. It had been present from infancy, but had only lately come near to the surface, where several small ulcers had formed, from which the blood flowed copiously on any unusual effort being made. Being unable to com- mence active occupation, the patient was willing to submit to whatever plan of treatment might be advised. Excision seemed out of the question, incision equally so; and the breadth, flatness, and supposed depth of the affected mass, precluded any attempt to cause the part to slough away with ligatures. The parts were not favourable for pres- sure, and vaccination or caustics seemed insufficient for the bulk of the disease. I used a variety of needles in the manner already described, and with some good effect. Still, however, the formidable part of the disease remained. I then passed several large cords, as setons, and these, too, had a favourable influence, but the affection was far from being cured. Ultimately, finding that these measures excited far less inflammatory action than might have been expected, I introduced, by means of long slender needles, a variety of single threads in all directions. More severe inflammation ensued, and when the swelling thus produced had subsided, the tumour was smaller, and firmer than it had ever been; there was less distinct pulsation in it, and a thrill, which was perceptible previously, could not now be detected. When the various apertures on the surface had firmly cicatrized, the boy was allowed to move about as he thought proper ; and after watching him for more than a year, I could perceive