The ligation of the larger arteries in their continuity : an experimental inquiry / by Charles A. Ballance and Walter Edmunds.

  • Ballance, Charles Alfred, Sir, 1856-1936.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: The ligation of the larger arteries in their continuity : an experimental inquiry / by Charles A. Ballance and Walter Edmunds. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    1. That of tying witli considerable force in the belief that damage to the arterial wall was either essential to obliteration or a necessary safeguard against hgemorrhage. 2. That of treating the artery with gentleness in the endeavour to cause its obliteration without inflicting the least injury to it. The earlier surgical writers, Galen/ Paul us -^^jgineta,^ and others recommend the application of two ligatures and the division of the ai'tery between them ; an opera- tion which now bears the name of Abernethy^ (1827), but many others have practised it. This way of tying an artery probably originated in the observation that arteries in amputation stumps are less prone to secondary haemor- rhage than those tied in continuity ; a fact which explains the favom* with which the operation has lately been received, and gives the reason for its attempted revival.* The validity of this analogy was questioned by Sir Charles BelP sixty years ago, and the procedure appears unneces- sarily severe. The earlier surgeons belong to the severer school, and with them must be placed Jones^ (1805), who from experi- ments upon the lower animals considered that he had demonstrated conclusively that the tunics should be ruptured in tying an artery in its continuity. He advo- cated also the isolation of the vessel and the use of the small round ligature. He says you must divide the two inner coats because if you do not adhesion will not take place, and, as the ligature ulcerates through, heemor- ' Loc. cit. 2 Paulus iEgineta (seventh century) :— The artery having been cleared of the surrounding parts is to be exposed with the same scalpels with which the membranes have been divided; a needle being then passed under it, the artery is to be tied with a double ligature, having previously been punctured in the middle; suppuration must then be promoted till the ligatures fall out. (' Observations on Aneurism,' collected and translated by John Erichsen, Sydenham Society, 1844.) ' Abernethy, Surgical Works, new edit., 1827. * Walsham, ' Brit. Med. Journ.,' 1883, vol. i, p. 660. » Bell, The Great Operations of Surgery,' 1821. « Jones, 'On Hjemorrhage,' 1805, p. 170.