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.

    63/878 (page 39)
    as to allow a thread to be applied. A pointed hook or tenaculum (fig. 43) will then he of advantage; some even prefer it to the forceps on all occasions. The sharp point is thrust through the bleeding vessel and some of the surrounding parts (for we can scarcely avoid including some of the neighbouring tissues where all are thickened and matted together) and then raised, so that the thread may be tied beyond the convexity. Of these methods I give the preference to that with the common forceps, and either of them I consider superior, both in point of facility and security, to that of twisting the ends of the vessels till the blood ceases to flow. Whichever instrument is used to seize the vessel about to be surrounded with a ligature, the utmost care should be taken to exclude all the neighbouring tissues,— veins, nerves, sheaths, or others, and this, in my opinion, can be most readily done with the forceps. In- cluding the artery alone in the ligature may be justly alluded to as one of the characteristics of modern surgery. I do not myself look with such dread upon the inclusion of a vein with an artery in the same noose as some do, but as it is not required, and may possibly be the cause of after mischief, it ought never to hap- pen when it can be avoided. Torsion of the main arteries, to suppress hemorrhage, seems to be gaining few advocates among British surgeons, notwithstanding the examples of Velpeau, Fricke, Amussat, and others on the Continent; and so far as my experience enables me to judge, I have never seen reason to prefer this plan to that with the ligature. Small vessels may, however, be advantageously treated in this way, and such a practice has been long followed. I cannot, however, perceive any advantage in the practice. The objection to the ligature is, that it is a foreign body, but I doubt if the same objections may not be raised to torsion, for in order to make this process secure, the vessel must be twisted to such an extent that, in all probability, its vitality is destroyed, and the slough thus occasioned must prove equally injurious as a ligature. Supposing that torsion and the ligature are produc- tive of much the same extent of local injury at the time, and subse- quent mischief, it seems to me that the ligature gives such an amount of temporary security, that it ought as a rule to be preferred. When a vessel is easily pulled out of its sheath, torsion is readily effected; but the same is the case with the application of a ligature. If, per- chance, it is desired to try this plan, it may be effected thus: the Fig. 43.