A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese.

  • Cooper, Samuel, 1780-1848.
Date:
1844
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Licence: Public Domain Mark

Credit: A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese. Source: Wellcome Collection.

Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.

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    with the effect of completely removing the turnout On the eighteenth day aflerward, however, a small slough was detached from the cicatrix, and about three o'clock next morning, a violent hemorrhage took place. Mr. Liston then deemed it necessary to lay open the sac, and tie the artery above and below the wound in it.—(See Edinb. Med. Journ. No. 90, p. 4.) Scarpa mentions a. case, where the dorsal artery of the thumb was wounded; but as the hemorrhage re- turned several times, and pressure failed in suppress- ing it, the surgeon took up the radial artery at l he wrist. After cutting off this direct current of blood towards the injured vessel, pressure on the wound proved effectual. Three months afterward, the pa- tient having died, the radial artery was found impervi- ous for three fingers' breadth below where the ligature had been applied, and the dorsal artery was likesvi.se obliterated from the root of the thumb to the begin- ning of the palmar arch. Mr. Todd has published a case in which he cured a large aneurismal swelling of the posterior side of the forearm, by tying the brachial artery. From the de- scription, I conclude that the disease was an aneurism by anastomosis, as it is termed; but the particulars given by the author leave us in doubt on this point.— (See Duolin Hospital Reports, vol. 3, p- 135.) The manner of exposing and tying the principal ar- teries of the leg and forearm, will be described under the term Arteries. OF ANEURISMS HIGH UP THE FEMORAL ARTERY. Several facts already specified in the preceding co- lumns as having occurred many years before the ope- ration of tying the external iliac artery was attempted, amounted to a full proof, that the circulation might go on in the lower extremity notwithstanding the artery in the groin were tied or obliterated. On this point, some of Guatfani's cases were most decisive. The ligature of the external iliac artery, for aneu- risms of the femoral artery in the bend of the groin, has now been practised so frequently, and the instances of success are so numerous, that all doubt concerning the propriety and utility of the attempt has entirely ceased. The French, who have evinced great back- wardness in espousing the Hunterian method of ope- rating for aneurisms, though it is decidedly one of the greatest improvements in modern surgery, have also shown great reluctance even to believe, much less to practice, the operation of tying the external iliac artery. A Parisian surgeon, however, who was in London a few years ago, saw the thing done, and the eye3 of his brethren in the capital of France have since been a little more open. Still, as Roux remarks, We can- not but blame the indifference with which the opera- tion is mentioned in some of the latest French surgical publications. At this moment (1815) we can reckon twenty-three facts relative to tying the external iliac artery, and on fifteen of the patients it has perfectly suc- ceeded. In these twenty-three operations, I compre- hend the two which were done in France; one at Brest, by Delaporte, and the other at Lyons, by Bouchet; cases, the authenticity of which cannot be doubted. In the number of successful cases, is to be comprised Bouchet's operation, since the patient lived more than a year afterward, and then died of the con- sequences of an inguinal aneurism of the opposite side. Of the other twenty-one operations, fifteen were performed in London only, in the several hospiials of this metropolis, by Abemethy, Ramsden, A. Cooper, Brodie, and Lawrence; gentlemen who would never pubiish forged cases. Sir A. Cooper alone had tied the external iliac ar- ery six times before my journey to London, and dur ing my stay there. I saw him perform the operation once. Four of his patients were entirely well; one of the three others died, the thirteenth week after the operation, of the bursting of an aneurism of the aorta. At this period, the circulation in the limb had been re- established. I saw the limb after it had been injected among Sir A. Cooper's anatomicai preparations. Large and beautiful anastomoses existed round the pelvis, between the dilated branches of the internal iliac and femoral arteries, the Francois, p. 275, 27G.) Sir Astley Cooper has now tied the external iliac artery in nine cases— (S>ee Lan- cet, vol. 1, p. 44.) The many facts already published, exemplifying the propriety of this operation, must be highly gratifying to Mr. Abernethy, by whose judgment it was first sug- gested, and by whose enterprising hand it was first practised. Mr. Abernethy has been called upon in several cases to take up the external iliac artery, and they all prove that the anastomosing vessels were fully capable of conveying blood enough into the limb below, and that a vessel even of this size could become permanently closed after being tied. Three of the operations done by this gentleman. I was an eye-witness of, and it is therefore with confidence that I can speak of the ease and simplicity of the requisite measures for securing the external iliac artery.—(See Aberaethy's Surg, and Physiol. Essays; and Surgical Observations, 1804; Edin. Med and Sv.rg. Journal for January, 1807 ) In Mr. Abernethy's first operation, performed in 1796, an incision, about three inches in length, was made through the integuments of the abdomen, in the direc- tion of the artery, and thus the aponeurosis of the ex- ternal oblique muscle was laid bare. This was next divided from its connexion with Poupart's ligament, ii? the direction of the external wound, for the extent of about two inches. The margins of the internal ob- lique and transverse muscles being thus exposed, Mr. Abernethy introduced his fingers beneath them to pro- tect the peritoneum, and then divided them. Next he pushed this membrane, with its contents, upwards and inwards, and took hold of the external iliac artery with his finger and thumb. It now only remained to pass a ligature round the artery, and tie it; but this required caution, on account of the contiguity of the vein to the artery. These Mr. A. separated with his fingers, and introducing a ligature under the artery with a common surgical needle, tied it about an inch and a half above Poupart's ligament.—{'•urg. Essays.) The following was the method which Mr. Aber- nethy adopted, the second time of tying the external iliac artery. An incision three inches in length was made through the integuments of the abdomen, beginning a little above Poupart's ligament, and extending upwards; it was more than half an inch on the outside of the up- per part of the abdominal ring, to avoid the epigastric artery. The aponeurosis of the external oblique mus- cle being exposed, was next divided in the direction of the external wound. The lower part of the internal oblique muscle was thus uncovered, and the finger being introduced below the inferior margin of it and of the transversalis muscle, they were divided with the crooked bistoury for about one inch and a half. Mr. Abernethy now introduced his finger beneath the bag of the peritoneum, and carried it upwards by the side of the psoas muscle, so as to touch the artery about two inches above Poupart's ligament. He took care to disturb the peritoneum as little as possible, detach- ing it to no greater extent than was requisite to admit his two fingers to touch the vessel. The pulsations of the artery made it clearly distinguishable, but Mr Abernethy could not put his finger round it with fa- cility. In order to be able to do so, he was obliged to make a slight incision on each side of it. Mr. A. now drew the artery gently down, so as to see it behind the peritoneum. By means of ah eye-probe, two ligatures were nnveyed under the vessel; one of these was carried upwards as far as the arterv had been detached, and the other downwards; they w'ere firmly tied, and the vessel was divided in the interspace between them. — Surg. Observ. 1804.) In a third instance of tying this vessel, Mr. Aber- nethy operated exactly as in the foregoing case, and with complete success.—(See Edin. Surg. Journ. Jan. 1807.) Mr. Freer, of Birmingham, who may be said to claim the honour of having seconded Mr. Abernethy in this new practice, made an incision about one inch and a half from the spine of the ileum, beginning about an inch above it, and extending it downwards oral arteries. With respect to the sixth pa.ient, Sam^'Z^c^^Ln^J^^X leg mortified, and the thigh was amputated with-1 base of the tmZ.^^ta^'^^S ob!