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.

    60/878 (page 36)
    off, and the other left hanging out of the wound. In all instances where a wound is dressed with a view to union by the first intention, this plan is preferable to that advised by Dr. Hennen and others, of cutting away both ends of the ligature, close by the knot; and so far as my experience goes, I would rather even permit both portions to remain than leave the noose to find its own way to the surface, a process which is sometimes both tedious and troublesome, as well as the source of much anxiety and pain to the patient. Taking into con- sideration the injury inflicted, and the extent of wound when a liga- ture is required, I deem the presence of one, or even both of its ends, a matter of little additional consequence. I have on many occasions left both ends of a ligature on the main artery hanging out of the wound, as was the custom before Mr. Veitch proposed to remove one of them, without having had cause to regret doing so, and in instances where numerous ligatures have been applied, have had more trouble with some small part of the wound (perhaps the aperture of a stitch) than with the tracks of all the ligatures used. When a wound is expected to heal by granulation, both ends may be cut away; but even here, though I often practise the plan, much annoyance may be caused by the noose remaining imbedded in the granulations. The ligature which I generally make use of is small, smooth, and well-spun twine, which, as it comes from the manufacturer, is suffi- ciently stiff, without the aid of bees-wax, to permit a noose to be cast without trouble from the ends being too limber. Silk may be used, but it should not be supposed that the finer material produces less irritation in the wound; indeed I think that some practical surgeons have been far too nice regarding the size and material of ligatures. In my own practice I am in the habit of using a greater number of ligatures than is the custom of many other surgeons,—often preferring the thread to the chance of the vessel closing naturally, and I feel bound to say, that on no single occasion have I ever had reason to suppose, that any subsequent unpleasant occurrence has been in any way attributable either to the size or number of ligatures. I do not wish it to be imagined, however, that I am an advocate for thick liga- tures, or for applying more than may be reasonably deemed proper; but I decidedly recommend a substance of such bulk that the person who uses it can, in the bustle of an operation, readily feel that there is something between his fingers. Fine dentist’s silk is objectionable on the latter account, and also because it may possibly cut the textures through altogether, instead of merely making a groove as the other does, sufficient to keep it in its place, until it is separated by nature. Mr. Lawrence recommended fine silk, with the object of cutting away both ends of the ligature, and leaving the smallest possible size of foreign substance (the noose and knot) in the wound; but although the objections stated above may be avoided, by great care, and by not pulling too hard, I cannot see any particular advantage in the plan, even though the part left may not weigh more than -^th or -g^th part of a grain. In my own cases, in removing both ends (for I have fre-