Case of aneurism of the innominata, treated by ligature of the right carotid artery; with observations / [Sir William Fergusson].

  • William Fergusson
Date:
1841]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the innominata, treated by ligature of the right carotid artery; with observations / [Sir William Fergusson]. Source: Wellcome Collection.

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    the pupils of the hospital, I placed a ligature on the common carotid, immediately below its bifurcation. Having ascertained from Mr Bulley, that the patient had actually fainted on one occasion, in consequence of pressure with the fingers in the course of the carotid, I resolved, before tightening the ligature, to mark the effects of obstructing the course of the blood in that vessel by itself; and accordingly, when the needle was under the artery, I ascertained, by pressing with the fore finger, that sud¬ den obstruction produced no immediate remarkable symptom, such as had been previously experienced. I therefore, without further hesitation, cast a firm noose upon the vessel, and, after removing one end of the thread, brought the edges of the wound into apposition, and kept them thus by means of stitches and adhesive straps. Nothing very unusual occurred during the ope¬ ration. I made the incisions very oblique to the course of the artery, with the object of leaving the tumour undisturbed, and thus averting as much as possible any immediate danger of wounding the sac, or the chance of subsequent inflammation. The ligature was consequently placed very high. The artery was only uncovered to such an extent as to allow the needle to be slipped around it. The proceedings were somewhat retarded by hemorrhage from a small artery and a vein situated imme¬ diately under the skin; but by means of a ligature, and the pressure of a curved copper spatula, which was used to assist in keeping the wound open, this annoyance was quickly overcome. Before the patient was removed from the table, the tumour seemed slightly diminished in size, and the pulse in the right wrist was fuller and more bounding than it had been previous to the operation, and much more distinct than that in the left; on being placed in bed, he expressed himself cheerfully, and seemed unconscious of any change produced by the recent proceedings. At seven o'clock—pulse 80 ; complains of slight dizziness, and difficulty of breathing ; otherwise comfortable. At nine o'clock—the giddiness and difficulty of breathing have gone off. At eleven o'clock—pulsation in the tumour much the same as immediately after the operation ; a slight thrill is perceptible in the right temporal artery; pulse 80, soft, and now nearly the same in both wrists; feels easy ; has dozed at intervals, and has now taken an opiate draught. 23d. Nine a.m. Did not sleep till morning; perspired freely during the night; pulse 90, soft; complains of slight pain in the neck during deglutition. One p.m. Pulse 100, full and strong; tongue moist; slight thirst; skin covered with gentle perspiration ; cough less trouble¬ some than before the operation.
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