WOUNDS. 



lome experiments which were made upon animals, and 

 which, he conceives, juftify the following; conclufions : 



Firft, If the wounds do not unite by the firft intention, 

 the ligatnr'S may efcape with the difcharge, without any 

 inconveni -nee. 



Second' V, If common ligatures of twine are cut (hort, 

 the wound may unite over th'>m, and they may be found 

 in abfcefles alter an interval of many weeks. 



Thirdly, If the finell d ntill's filk be employed in the 

 fame way, the wound uniting over it, the ligature may be 

 detached from the vefFel, and remain buried in an abfccfs, 

 where it will be found at different periods, from one to 

 feven months ; and this may happen whettier ihe vcfT;! be 

 firmly comprefled with a fingle ligature, or div:ded between 

 two ligatures, fo as to imitate the circumftances under 

 which vetTels are tied after operations. 



Fourthlv, If Indian filk, fine as hair, be put round a 

 Teflel, fi) as to diminifh its diameter, or to effeft its obliter- 

 ation, bv juft compreffing its fides together, it may remain 

 in this fituation without exciting abfcefs, or producing any 

 inconvenience. The ligature may be thus applied to com- 

 prefs an artery for the cure of aneurifm ; but not to fecure 

 veflcls divided in operations. If a thin ligature be drawn 

 fufficientlv tifrht upon a veflel on the face of a ftump to be 

 fecure, Mr Crofs is perfuaded, that the extremity of the 

 veffel, which becomes infulated as it were, mud die. (See 

 London Med. Repofitory, vol. vii. p. 363.) In one cafe of 

 amputation alfo, in which the praftice was tried, the ftump 

 was long in healing, and feveral fmall abfcefles repeatedly 

 formed. 



On the other hand, we muft take into confideration, that 

 M. Delpech, of Montpellier, has pradlifed it to a con- 

 iiderable exfent for feveral years pall, without any incon- 

 venience M. Roux has alfo tried the plan in three oper- 

 ations on th- breaft ; the cafes did well, and no ill confe- 

 <}Uences arofe from the prcfence of the bits of thread under 

 the cicatrix. See Relation d'un Voyage fait a Loiidrcs en 

 1S14, ou Pdrallele de la Chirurgie Angloife avec la Chi- 

 rurgie Fran^oife ; Paris, 1815, p. 134 — 136. 



Mr. Hennen, in anfwer to Mr. Guthrie, alfo obferves, 

 that in the cales where it wa? tried at Bilboa, " neither pain, 

 heat, nor tumour, ftbrile exacerbation, nor formation of pus, 

 "ould be fairly traced to the fhort cut ligatures, which 

 •vvould not ill all human probability as readily have fuc- 

 ceeded to the ligaturec ufually employed ; while, on the 

 contrary, the progrefs of healing has been fenfibly more 

 rapid where they have been ufed." Obf. on Military 

 Surgery, p. 193. 



Since Mr. Lawrence communicated to the Medical and 

 Chirurgical Society of London the defcription of a " New 

 Method of tying the Arteries in Aneurifm, Amputation, 

 and other Surgical Operations," he has conllantly employed 

 the method therein propofed, both in St. Bartholomew's 

 hofpital and in private praflice ; and, as he informs us, he has 

 now tried it in many operations of almoll every defcrip- 

 tion. " The general refult of my experience is (fays he), 

 that tliis plan, by diminifhing irritation and inflammation, 

 and fimplifying the procefs of dreffing, very materially pro- 

 motes the comfort of the patient, and the convenience of 

 the furgeon, <iuhile it has not produced ill confequencts or any 

 iinphafent effed in the cafes luhich have come under my own 

 obfervalion. 



" I have found in my own praftice, what has been con- 

 firmed by others, who have communicated to me the refult 

 of their experience, that the fmall knots of filk generally 

 Separate early, and come away with the difcharge ; that 

 where the integuments have united by the firft intentioDj the 



ligatures often come out rather later, with very trifling fup. 

 puration, and no painful inflammation ; and that, in fome 

 inrtances, they remain quietly in the part. 



" In two or three inftances, I have been told that th? 

 ligatures feemed to have caufed irritation and pain. Thele 

 were amputations ; and we are accullomed to fee effefts, 

 quite as confi ierable as were alluded to here, produced by 

 the ftate of the bone and other caufes, where the ordinary 

 method of f;curing ihe arteries is praCtifed ; fo that I could 

 not, on clofe inquiry, find any reafon to alcribe what was 

 complained of to the ufe of the filk ligatures, and the praftice 

 of cutting off their ends clofe to the knots." Medico-Chir. 

 Tranf. vol. viii. p. 490. 



Mr. Lawrence contends, that under fome circumftance* 

 the method will be attended with peculiar advantages, as in 

 crowded military hofpitals, where the deftruftive hofpital 

 gangrene either exiils, or may make its appearance. Every 

 mealuro tending to accelerate the union of wounds, whether 

 after operations or under other circumlf ances, is of great 

 importance in averting the probability of this calamitous 

 occurrence. 



This mode of cutting off both ends of the ligature clofe 

 to the knot has now been fuccefsfuUy applied to operations 

 for aneurifm. Mr. Lawrence has himfelf found it anfwer 

 his expeftations ; and we learn, that Mr. Carwardine, of 

 Thaxted, tied the femoral artery with a fmall filk ligature, 

 in a cafe of pophteal aneurifm, and cut off the ends clofe to 

 the knot. The wound united entirely by the firft intention, 

 not a particle of pus having been for.ned at any time ; and 

 it continued perfectly found at the diftance of fome months 

 from the operation. Op. cit. p. 492. 



If this praftice prove generally beneficial in operations 

 for aneurifm, there can be no doubt it will alio be advan- 

 tageous in other cafes, in which the furgeon is called upon to 

 cut down to and take up punftuied or partially divided 

 arteries in accidental wounds. 



Although doubts are yet entertained by fome praftitioners, 

 whether this new method of applying ligatures is entitled to 

 praife and imitation, all furgeons are unanimous about the 

 propriety of lefTening as much as poffible the quantity of 

 extraneous bodies in wounds : hence, even they who dif- 

 approve of cutting off both ends of the ligature clofe to the 

 knot, fanftion and adopt the praftice of cutting off one-half 

 of each ligature dole to the veffel, as the other portion will 

 fufRce for the removal of the knot and noofe as foon as they 

 are detached from the tied artery. When the wound is 

 brought together, the ligatures are to lie in the neareft in- 

 terfpaces left between the plafters. 



2. Of thi- Removal of Clots of Blood, extraneous Suhjlances, 

 foreign Bodies, life, from the IVound. — This forms the fecond 

 indication to which the attention of the furgeon is particu- 

 larly required, when he is firft called to an incifed wound. 

 It is, indeed, an objeft of very material importance, becaufe 

 if it be not attended to, the wound may be brought together 

 as nicely, as accurately, and as flcilfully as poffible, and every 

 thing look well in the beginning ; yet that defirable event, 

 union by the firft intention, will not follow, but inftead of 

 it a fevere degree of pain, confiderable f welling of the 

 circumference of the injury, extenfive rednefs, and fuppu- 

 ration and abfceffes. AH thefe fevere and untoward confe- 

 qnences arife from the irritation produced by the prefence 

 of foreign bodies in wounds ; and as an incifei wound can 

 generally be examined with the utmoft facility, and made 

 properly clean, without putting the patient to much pain, 

 the negled on the part of the furgeon becomes the more 

 blameable. In other deep, narrow, lacerated wounds, and 

 io many gun-/hot injuries, it is often difficult zl firft to afcer- 



tain 



