The operation of applying a ligature on the vessel at a distance from
the tumour, and thus intercepting or weakening the flow of blood into
the cavity, so as to allow complete coagulation to take place, is of
comparatively modern invention, and is the one now practised with
almost invariable success. To John Hunter without doubt belongs the
merit of proposing and putting it in practice; it has been claimed also
for the celebrated Desault. This operation has been variously modified.
Some have advocated the temporary application of a ligature, conceiving
that the effects produced will be as complete and permanent when it
has been allowed to remain only for a certain time, as when it is left
undisturbed and ultimately separated by nature. Such a theory, however,
has proved to be incorrect in most of the instances in which it has
been reduced to practice on the human subject; and the operation is
at best very uncertain, and not to be relied on. Others have employed
a double ligature, and some of the Continental surgeons have applied
a great many; some were tightened, others left loose, and looked upon
as ligatures of reserve to be tightened, should hemorrhage take place,
an occurrence likely enough to follow their clumsy and unsurgical
proceedings. A thick broad ligature like tape has also been used, from
an ill-grounded apprehension that all the coats of the artery would
be cut completely through by the tight application of a thin and firm
one. With the same view, a roll of linen or plaster has been interposed
betwixt the noose and the vessel, and this practice has been advocated
even by good surgeons—as Scarpa. Such complications can do no good,
and may do much mischief. The artery must be greatly detached from its
surrounding connections before the numerous and flat ligatures can be
applied, in consequence of which its coats will be apt to slough or
ulcerate, and hemorrhage occur. When, from any cause, the vessel has
been detached to a greater extent than is sufficient for the passing of
one ligature, two ought undoubtedly to be used, and one applied close
to each extremity where it is attached to the surrounding parts.
Again, it has been proposed, after the application of a double
ligature, that the vessel should be cut through betwixt the two
deligated points; it being supposed that in this way the closure of
each extremity will be more rapid, the cut ends retracting, and being,
in fact, in the same circumstances as the extremities of arteries
which have been tied on the face of a stump. Mechanical contrivances
have also been invented for the compression of the artery,—such as the
serrenœud and presse artere; these, however, are clumsy, insufficient,
and often injurious.
Public-domain text, read in full here on John Shaqi.
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