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
Catalogue details

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.

    150/1188
    eye of one of the above-described needles, and screwed the needle into a handle, he pressed with its convexity the cellular membrane and pleura carefully down- wards, while he carried it from below upwards round the artery. As the point now appeared oti the other side of the vessel, the above-mentioned hook was passed into its eye. and the handle unscrewed from the other end of it, when it was easily drawn out from under the artery, and the ligature left under the vessel. In this part of the operation, Dr. Mott urges the ne- cessity of being particularly attentive to two impor- tant circumstances; one is, to convey the ligature round the artery from below upwards, as the only way to prevent injury of the pleura; and the other is, to fix the hook in the e*ye of the needle, before the handle is unscrewed from its other end, because, after this has been done, the needle loses all steadiness, and it is then difficult to get the hook into the eye. With respect to the foregoing instruments, I may ob- serve, that they are superseded by the needle lately constructed by Mr. Weiss. Dr. Mott now made a noose, pressed it with the fore-finger down to the artery, and tightened it very gradually, in order not to stop the flow of blood through the vessel all at once. A moderate constric- tion was kept up some seconds, so that the effect of the ligature upon the heart and lungs might be ob- served; and as no disturbance was produced in the functions of these organs, Dr. Mott tightened the liga- ture, and stopped the current of blood through the vessel. At this instant, the pulsation of the right tem- poral and radial arteries ceased. The noose was tightened still more with the above-mentioned ligature irons, and then a second knot was made. Dr. Mott was greatly pleased at finding his patient's counte- nance remain perfectly unchanged, and no complaint made of pain in any other ,part. Immediately after the ligature had been applied, the aneurismal swell- ing lost one-third of its size, and the clavicle could be felt through its whole extent. The divided muscles and detached skin were now brought into their natu- ral situation, the wound closed with three sutures and adhesive plaster, and a compress applied. In the ope- ration three small arteries were tied: the first lay under the sternum, and seemed to be a branch of the internal mammary; the second was a descending branch of the superior thyroideal; and the third a branch of the inferior thyroideal. From two to four ounces of blood were lost, most of which came front an injured small branch of the subclavian. The ope- ration took up about an hour. The curved spatulas recommended by Dr. Colles, were found very useful for holding the carotid and parvagum aside, while, by (heir uniform pressure, they materially assisted in re- straining the effusion of blood from small vessels, and as taking up little room, were infinitely more conve- nient in a deep narrow wound, than the fingers of an assistant. The day after the operation, the veins of the right forearm and hand had a turgid appearance. When the circulation in them was promoted by pressure, they became empty for some distance above the pressed part, but filled again immediately the pressure was re- moved; a circumstance that seemed to show, that the circulation in this arm, notwithstanding the ligature of the arteria innominata, still went on with great ce- lerity, though no pulse could be felt in the brachial and radial arteries. On the contrary, the poise was very plain in the front brauch of the temporal artery, just above the outer angle of the orbit. The left external carotid beat with unusual force. In a few days, how- ever, the pulse became perceptible again at the right wrist. My limits will not allow me to enter into all the de- tails of this interesting case : suffice it to mention, that the patient suffered considerable febrile disturbance at some periods after the operation, and it was neces- sary twice to have recourse to venesection. He was also afflicted with a severe cough. The discharge from the wound was copious and fetid. The main liga- ture separated on the fourteenth day. On the twen- tieth day, the patient was1 sufficiently recovered to walk in the garden. On the twenty-first day, the wound was almost closed ; the patient could move his right arm with the same facility as his left, and he was gaining such strength, that no doubts were enter- tained about the successful result of the operation. l On the twenty-third day, hemorrhage came on from the wound: it was stopped by the introduction of lint and the employment of pressure. About twenty-four ounces of blood were lost, whereby the patient was so depressed that the pulse was no longer distinguish- able. On the twenty-fourth day, in the evening, he lost four ounces more blood ; on account of his rest- lessness and the painful state of-his arm, two grains of opium were administered to him. After one or more returns of bleeding, he died on the twenty-sixth, day. When the body was opened, no traces of inflamma- tion or its consequences were found either in the arch of the aorta, the origin of the innominata or the lungs. The aorta was now slit open longitudinally, and a probe then cautiously passed through it into the inno- minata, when the instrument went through the latter vessel into the cavity of the wound. The inner coat of the innominata was smooth and soft; but about half an inch from the place where the ligature had cut through the vessel, marks of inflammation were no- ticed, and a coagulum adhered to the sides of the ar- tery with considerable firmness, so that nature had probably endeavoured, by means of adhesive inflam- mation, to close the vessel, but had been prevented from completing the salutary process by the destruc- tive ulceration. One portion of the parietes of the innominata was thickened by inflammation, and an anomalous branch, as large as a crow's quill, arose from this artery. The ulcer was twice as extensive inwardly as it was superficially, reaching laterally to the trachea, and un- der the clavicle to the swelling. The tripod of great vessels, viz. the innominata, the subclavian, and the carotid, was destroyed by ulceration to the extent of about an inch, and the ends of both the last vessels opened into the wound. At this place the pleura was considerably thickened by a layer of organized lymph. The inner surface of the carotid was covered witk a coagulum, and its coats so much thickened, that a probe could hardly be passed into it. The consolida- tion reached up to the division into the external and in- ternal carotid. The subclavian was pervious as far as the situation of the disease. The diameter of the bra- chial and other arteries of the right arm was natural. The external mammary artery was enlarged, but not the internal. The clavicle was carious, and several lymphatic glands under it in the state of suppuration. Though the result of the operation was unsuccess- ful, it proves, as Dr. Mott correctly remarks, some in- teresting points; namely, that tying an artery of such, magnitude, and so near the heart, may be done with- out occasioning any disturbance either in the functions of the brain, the heart, the lungs, or the right arm. The suppuration, which continually extended itself more and more deeply, is set down by Dr. Mott as the cause of the patient's death; for, as no bleeding took place for several days after the detachment of the prin- cipal ligature, it is plain that this must have fulfilled its duty, and that the artery had been closed.—(See New-York Med. and Surgical Register, 1818, vol. 1.) [This new and formidable operation, the practicabi- lity of which Dr. Mott has thus demonstrated, and the safety of which is now decided in any future aneu- rism in which it may become necessary, is justly con- sidered one of the most splendid achievements ever accomplished, and is destined to give the author's name immortality; and this, with the successful case of liga- ture of the iliacus communis, confers upon American surgery imperishable laurels. As an evidence of the estimation in which this operation is held in Europe, I feel a national pride in inserting the following extract of a letter from that distinguished surgeon, Professor- Colles, of Dublin, written to Dr. Mott soon after his case of ligature on the innominata had reached him. . I think this tribute to the able operator is the more im- portant, since efforts have been made by the envious to detract from the merit of the operation; and it has been publicly stated that the same operation has been performed in Europe, and even by Dr. Colles himself That this is not the fact will be obvious from the ex- tract which follows, and which I introduce without any farther Comment. I shall not attempt to say how much the profession is indebted to you for this bold and splendid operation. That it did not succeed I lament on your account; that it will hereafter succeed, there cannot be a doubt in.