The treatment of haemorrhage from the posterior-tibial artery in the upper two-thirds of its course / by William Harrison Cripps.

  • Cripps, Harrison (William Harrison), 1850-1923.
Date:
[1875]
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of haemorrhage from the posterior-tibial artery in the upper two-thirds of its course / by William Harrison Cripps. 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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    (d) Pressure and bandaging. (a) There may be complications in wounds of the posterior tibial which may demand amputation. The limb may be so severely crushed, or so extensively fractured, as to render unwise any attempt to preserve it. From whatever cause the haemorrhage occurs, amputation im- mediately reduces a highly-complicated case, involved in uncer- tainty and. risk, to one in which the chances for or against life admit of accurate calculation. But that the limb should be im- mediately amputated whenever the haemorrhage is complicated by fracture, whether simple or compound, and generally when secondary haemorrhage occurs, appears hardly to be supported by surgical history, although the first is an axiom of Erichsen,* the second of Lawrence.f Since death follows amputation of the leg in nearly forty per cent, of the cases in which the operation is performed for ‘ injury,’ and since success means permanent mutilation, it seems that this operation should only be adopted as a desperate alternative; and if by a simpler operation in a large proportion of cases both life and limb have been saved, the surgeon should discard amputation, except as a last resource. {h) The second method of treatment. The ligature of both ends of the wounded vessel, either in the original opening, if an incised wound, or within an enlargement of the wound, if it should be necessary, will at once recall the remarks of Guthrie, who, after the manner of enthusiasts, was too much impressed with his so- called golden rule to allow that it could have any exceptions. Of the operation he states, at a time when it does not appear that he had ever tied the posterior tibial during life,J ‘ The edges of the long incision being easily separated, and to such a distance as to admit of the exposure of the great nerve, artery, and veins, in as distinct a manner as any other nerves, arteries, or veins can be exposed in the human body, the tourniquet is now to be unscrewed, and the bleeding, if the wound did not bleed before, leads to the spot where the artery is injured. The knife may be applied perpendi- cularly to the fascia, and the artery laid bare three or four inches in extent, hy as common a piece of dissection as any ever prac- tised, and nothing can interrupt the application of the ligature. The nerve and the fascia cease to be surgical bugbears, and the operation is as simple as any in surgery. No surgeon or anato- mist will dispute this statement.’ Guthrie was enabled, by the many and striking cases which he had collected, to support the * Erichsen, Surgery, vol. i. p. 302. t Clinical Lecture, St Bartholomew Hospital, 1853. J Guthrie on Diseases of the Arterie.s.