Report of the surgical cases and operations that occurred in the Massachusetts General Hospital from May 12, 1837 to May 12, 1838 / by George Hayward.

  • Hayward, George, 1791-1863.
Date:
1838
Catalogue details

Licence: Public Domain Mark

Credit: Report of the surgical cases and operations that occurred in the Massachusetts General Hospital from May 12, 1837 to May 12, 1838 / by George Hayward. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    Tt would probably be thought best in any similar case to tie the fe- moral artery instead of searching for the bleeding vessel in the stump. Be that as it may, it was clearly the only course that could have been safely adopted In this Instance. The patient could not, probably, have borne the suffering and loss of blood to which the other method would have subjected him, and if the artery could have been found and tied, it is not likely that It would have answered the purpose, as the vessel at that part was in a diseased state. Prolapsus Ani.—When this complaint is in an aggravated form, it is well known that an operation is often performed for its relief. This consists in removing a part of the prolapsed portion, and when cicatriza- tion takes place, the contraction is such that the difficulty is in a great measure obvlaied. This opei'alion was formerly done either with a knife or scissors, and 1 should have continued to have used one or the other of these Instruments, if I had been guided by my own experience alone. In no case has the use of them In n)y practice been followed by alarming hemorrhage, and only in one instance by a serious one. But with others the result has sometimes been different. There are accounts of severe and even fatal hemorrhage after this operation with the knife, and a prudent surgeon, therefore, would hardly feel justified in exposing his patient to so much hazard, if any other mode could be devised. I am satisfied, from several trials, that the operation by the ligature is perfectly safe, equally efficacious, and hardly, if at all, more painful than the old method. The operation can be readily done in the fol- lowing way. An enema of warm water should be first administered, and when this comes away the prolapsed portion can usually be thrown exterior to the sphincter. It can then be seized with a double hook, which should be held by an assistant. A needle, armed with a double ligature, should then be passed under the base of the prolapsed portion, the needle cut out, and one string tied firmly in one direction, and the other in the opposite. The part should then be carefully returned within the sphincter, and the ligatures allowed to hang out at the anus. If the pain be severe, an anodyne enema, or an opiate by the mouth, or both, should be administered. The patient should keep in a horizontal position, and live on a mild, liquid diet for kv^ days, and take a gentle laxative on the second day after the operation. The ligatures usually separate in from five to ten days ; I have rarely known them to come away sooner than this, and in some cases I have seen them retained much longer. This operation is the same as the one recommended by the late Dr. Bushe, though I had practised it some time before the publication of his work. It will be found, also, a very safe and effectual mode of remov- ing hemorrhoidal tumors, there being the same objection to the use of the knife in this case as in that of prolapsus. When the tumors are