WOUNDS. 



force employed in drawing the ligature, the ends of the 

 thumbs are found moft convenient. When the bleeding 

 arteries are not very large and diftinft, they are generally 

 taken up with a tenaculum ; and of late years a double 

 tenaculum, the points of which fliut together, like the 

 blades of a pair of forceps, has been occafionally ufed, and 

 we have heard fome well-informed furgeons fpeak highly of 

 the invention, which we believe was originally made by pro- 

 feflbr Afalini, an ingenious furgeou at Milan, in Italy. 



Thehgatures having been applied, one end of each is to 

 be cut off clofe to the knot, in order to diminilh the quan- 

 tity of extraneous matter in the wound. 



When a large artery, like the brachial or femoral, is 

 opened, but not cut through, it often happens that the fur- 

 geon cannot get at it without making a dilatation of the 

 wound, and Ijringing the wounded part of the veffel more 

 fairly into view. In cafes of this defcription, the firft duty 

 of the praAitioner is to comprefs the artery above the 

 wound, and apply a tourniquet. Thus he will put an im- 

 mediate flop to the bleeding ; but if he omit this effential 

 ftep, the veffel will continue to bleed fo profufely and ra- 

 pidly, that in the inevitable obfcurity and confufion thence 

 refulting, the patient may aftually lofe his life before the 

 veffel is fecured. When, however, a tourniquet has been 

 applied, the furgeon can examine the wound, and fearch for 

 the artery with much greater fuccefs, as now the ftate of 

 things is no longer concealed under a continual ftream of 

 blood. 



As foon as the wounded portion of the artery is difco- 

 Tcred, it ought not to be extenfively diffefted and feparated 

 from its furrounding conneftions in order to let the furgeon 

 pafs his finger under it. This mode of proceeding is now 

 acknowledged by fome of the bell furgeons to be unneceffary 

 and injurious ; and it will be quite fufficient to feparate the 

 artery fufficiently to pafs an eye-probe or aneurifmal needle 

 under it, with which a double ligature is to be drawn beneath it. 

 The probe or needle having been cutofr,one ligature is then to 

 be tied above the aperture in the artery, and the other below it. 

 Were only afingle ligature apphed above the wound in the ar- 

 tery, the bleeding would ilill be kept up, becaufe the blood 

 pafies into the lower continuation of the veffel through 

 numerous large anaflomofes, in a quantity that is truly 

 furprifing. 



The principles which fiionld guide the furgeon in the 

 life of the ligature, were not known until the late Dr. 

 Jones publifhed his valuable treatife on hemorrhage. As an 

 able furgeon has obferved, " he has banillicd the ufe of thjck 

 and broad threads, of tapes, of referve ligatures, of cy- 

 linders of cork and wood, linen compreffes, and all the con- 

 trivances, which, employed as a fecurity agaiufl bleeding, 

 only ferved to multiply the chances of its occurrence." 

 Lawrence in MedicoChir. Tranf. vol. vi. p. 162. 



In the article Surgery, we have noticed the method of 

 cutting off both ends of the hgature clofe to the knot on 

 the face of the flump, with a view of leffening the quantity 

 of extraneous matter in the wound, and promoting a com- 

 plete union of the divided parts, without any fuppuration. 

 The period of the firfl invention of this method appears 

 uncertain. Mr. Hennen, who feems to have been the firfl 

 who adopted the method in the army, had it fiiggefled to 

 him in 1813 by a Mr. Hume, as the pradice of fome 

 American naval furgeon ; and he has fmce found that it 

 had been done in Scotland 16 years before the above year. 

 Dr. Ferguffon alfo faw the pradlice adopted in Sweden as 

 f arly as the peace of Amiens. Mr. Hennen mentions 34 

 impu'ations, in which this treatrr.ent was followed by fuc- 



cefs. His accounts are highly in favour of the method. 

 See Hennen's Military Surgery, p. 189, &c. 



This plan has been tried by Mr. Lawrence : " The 

 method I have adopted (fays this gentleman) confifls in 

 tying the veffels lu'ith Jine ftlk ligatures, and cutting oft the 

 ends as clofe to the knot as is confiflent with its fecurity. 

 Thus the foreign matter is reduced to the infignificant 

 quantity, which forms the noofe aftually furrounding the 

 veffel, and the knot by which that noofe is faflened. Of 

 the filk which I commonly employ, a portion fufficient to 

 tie a large artery, when the ends are cut off, weighs between 

 -^xh and -j-'iith of a grain : a fiinilar portion of the thickefl 

 kind I have tried weighs ^Vth of a grain, and of the Qen- 

 derefl -r^l^th." 



Mr. Lawrence ftates, that the kind of filk twid which 

 is commonly known in the {hops by the name of dentifl's 

 filk, and which is ufed in making fifhing-lines, is the flroug- 

 ell material, in proportion to its fize, and therefore the befl 

 calculated for our purpofe, which requires confiderable 

 force in drawing the thread tight enough to divide the 

 fibrous and internal coats of the arteries. This twifl is 

 rendered very hard and fliff by means of gum, which may 

 be removed by boiling it in foap and water ; but the twift 

 then lofes a part of its flrength. The floutefl twifl which 

 Mr. Lawrence has ufed, is a very fmall thread compared 

 with ligatures made of inkle. The quantity of fuch a 

 thread neceffary for the noofe and knot on the ihac artery 

 weighs -rVth of a grain ; or, if the gum has been removed, 

 about T^th. But the finefl twill kept in the filk fhops is 

 flrotig enough in its hard flate for any furgical purpofe ; 

 and the noofe and knot, according to Mr. Lawrence's flate- 

 ment, would not weigh ^'^th of a grain. 



It farther appears from the report of this gentleman on 

 the fubjecl, that there is no danger of thefe ligatures cut- 

 ting completely through the veffel, as fome furgeons have 

 apprehended ; and that although he has not yet afcer- 

 tained what becomes of the pieces of ligature after the 

 wound is united, he has never feen abfcefs nor any other 

 bad fymptora occafioned by them. At the time when Mr. 

 Lawrence wrote, he had employed this method of fecuring 

 the arteries in ten or eleven amputations, in fix operations 

 on the breafl, and in the removal of two teflicles. The 

 cafes all did well, excepting a tpan who loft his thigh, and 

 who died of an affeftion of the lungs. See Lawrence on a 

 Nev¥ Method of tying the Arteries in Aneurifm, Amputa- 

 tion, 5cc. in Medico-Chir. Tranf. vol. vi. p. 156, &c. 



It merits notice, however, that the propofal of cutting 

 off the ends of the ligatures clofe to the arter)' has not 

 received the univerfal approbation of furgeons ; and, in 

 particular, Mr. Guthrie, of London, and Mr. Crofs, of 

 Norwich, have urged objeftions againll the praftice. The 

 former gentleman, at the fame time, does not entirely con- 

 demn the method, but merely argues that it is liable to in- 

 conveniences, when adopted in wounds which are to be 

 healed by the firfl intention. See Obf. on Cun-fhot 

 Wounds of the Extremities, p. 93. 



Profeffor Scarpa alfo, whofe experiments lead him to 

 prefer large hgatures and intervening fubilances between 

 them and the veffel, muft be numbered amongll thofe who 

 difapprove of the new plan. Like all his writings, the 

 memoir which he has recently publifhed refpefting the 

 ligature of arteries is highly interelling, and drawn up with 

 the greateft candour. 



Mr. Crofs, of Norwich, is more decidedly advcrfe to this 

 new pradice ; End he fouodi his objeftions chiefly upon 



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