TORSION. 223 



operator does not intend to produce that effect, he ceases, after from 

 four to six revolutions of the vessel on its axis for the small arteries, and 

 from eight to twelve for the large ones. The hemorrhage instantly stops. 

 The vessel which had been drawn out is then replaced, as the surrounding 

 parts give support to the knot which has been formed at its extremities. 

 The knot becomes further concealed by the retraction of the artery, and 

 this retraction will be proportionate to the shortening which takes place 

 by the effect of the twisting, so that it will be scarcely visible on the sur- 

 face of the stump. It is of the utmost importance to seize the artery 

 perfectly, and to make the stated number of twists, as otherwise the secu- 

 rity against the danger of consecutive hemorrhage will not be perfect. 



Mr. W. B. Costello, of London, was present when the operation was per- 

 formed at Paris. He brought back a full account of it as performed there, 

 arid availed himself of an early opportunity of putting it to the test before 

 some of our metropolitan surgeons. A dog was placed on the table, the 

 forceps were applied, and the operation perfectly succeeded. 



A few days afterwards a pointer bitch was brought to my infirmary, 

 with a large scirrhous tumour near the anterior teat on the left side. It 

 had been gradually increasing during the last five months. It was becom- 

 ing more irregular in its form, and on one of its tuberculous prominencies 

 was a reddish spot, soft and somewhat tender, indicating that the process 

 of suppuration was about to commence. 



I had often, or almost uniformly, experienced the power of iodine in 

 dispersing glandular enlargements in the neck of the dog, and also those 

 indurated tumours of various kinds which form about the joints of some 

 domesticated animals, particularly of cattle ; but frequent disappointment 

 had convinced me that it was, if not inert, yet very uncertain in its effect 

 in causing absorption of tumours about the mammae of the bitch. Having 

 also been taught that the ultimate success of the excision of these enlarge- 

 ments depended on their removal before suppuration had taken place, and 

 the neighbouring parts had been inoculated by the virus which so plenti- 

 fully flowed from the ulcer, I determined on an immediate operation ; and, 

 as the tumour was large, and she was in high condition, I thought it a 

 good case for the first trial of torsion. She was well physicked, and on 

 the third day was produced before my class and properly secured. I had 

 not provided myself with the torsion forceps, but relied on the hold I 

 should have on the vessel by means of a pair of common artery forceps ; 

 and the effect of these imperfect instruments beautifully established the 

 power of torsion in arresting hemorrhage. 



Two elliptical incisions were made on the face of the tumour, and pro- 

 longed anteriorly and posteriorly about an inch from it. The portion of 

 integument that could be spared was thus enclosed, while the opposed 

 edges of the wound could be neatly and effectually brought together after 

 the operation. The dissection of the integument from the remaining part 

 of the face of the tumour was somewhat slow and difficult, for it was in a 

 manner identified with the hardened mass beneath ; but the operation soon 

 proceeded more quickly, and we very soon had the scirrhus exposed, and 

 adhering to the thorax by its base. About two ounces of venous blood 

 had now been lost. 



I was convinced that I should find the principal artery, by which the 

 excrescence was fed, at its anterior extremity, and not far from the spot 

 where the suppuration seemed to be preparing : therefore, beginning pos- 



