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Related post: tion. What wonder that the new system was neglected and forgotten ! During the following half-century surgeons learned that it was not necessary to amputate the leg of a pa- tient because the femoral artery was wounded ; liga- ture of the wounded artery had been successfully practised as early as 1646, and again in 1688, but it was not formally proposed as a substitute for amputa- tion until nearly a century later. And, at about the same time, the '* old operation ** was first employed in a case of popliteal aneurism successfully (Keys- Idre, 1744), and, twenty years later, again success- fully for femoral aneurism (Burchell, 1765). The attention of surgeons was now fully directed to the treatment of spontaneous aneurisms of the lower extremity, to the search for a proper substitute for the amputation which hitherto had been the only resource. The first substitute was to extend to them the old operation, to repeat, in a somewhat modified form, what had been done by Antyllus more than fifteen hundred years before. Papers were written to prove that the obliteration of the artery would not cause the limb to fall into gangrene, and experience by actual operation rapidly accumulated. The results of that experience were far firom satis- factory. Pott (" Surgical Works/' edited by Earle, vol. iii. p. 220) says of this operation : "I have tried it myself more than once or twice â I have seen it tried by others ; but the event has always been fatal . . . Nor have I ever seen any other operation than that of amputation which has preserved the life of the patient ; * ' and, as Mr. Holmes points out, the immediate success of the treatment of popliteal aneurism by proximal ligature (the "Hunterian" method), which itself has a mortality equal to that of amputation of the thigh, shows that the mortality after the old operation must have been something frightful. Something better needed to be found, and the times were growing ripe. Men were begin- ning again to think ; the long blank period of tradi- tion and dogmatism was coming to an end, and men stood at Phenergan 10mg Tablets the threshold of the new era in which, under the influence of the intellectual upheaval of the French Revolution and the leadership of the French physi- cians, medicine was to become a science based on objective knowledge. It had been learned that a popliteal or a femoral aneurism could be cured by opening the sac and tying the artery above and below, but that the opera- tion carried with it an enormous risk of death by secondary hemorrhage and the accidents arismg from a large irregular, suppurating wound. And in de- scribing the operation as incision of the sac and ligature of the vessel, it must be remembered that this Phenergan 12.5 Mg Iv order was frequently reversed and the artery tied before the sac was opened ; the object was a double one : to close the vessel and to empty the sac, and the order in which these objects were attained was immaterial. Desault's first operation of ligature on the proximal side was done Junfe 22, 1785, and Hunter's December 1 2th of the same year; but nine years before this, 1776, Desault* had had an opportunity to dissect a specimen of popliteal aneurism that had undergone spontaneous cure, and he had found the popliteal ar- tery plugged by clotted blood, the femoral obliterated " as far up as the origin of the muscular branches," and likewise the upper third of the tibial arteries. An Italian surgeon, Assalini, who spent a year in Paris, and a few months subsequently in London, and had the good fortune to see both Desault's and Hunter's operations in 1785, published a book* in 1787 in which he reports Desault's teaching in 1785 ; referring to this dissection of 1776, he says, "he [Desault] thought the obliteration of the upper and lower portions Phenergan Sleeping Tablets of the artery was the result of the stagnation of the blood in them, produced by plug- ging of the aneurism, Phenergan 20 Mg and for this reason, in the treatment of true aneurisms of large vessels, he did not apply two ligatures and did not open the sac ; he placed a single ligature above the aneurism if that was possible, or below it if the condition of the parts made that necessary By this simple ligature he prevented the blood from entering the sac and circulating in the dilated vessels." 1 Broca. Des An^vrysmes, p. 449, from Journal de mW. (V«n- dermonde), vol. Ixx. p. 473. * Essai medical sur les vaisseux lymph atiques. Tuxin, 1787. November i, 1884.] THE LIGATURE IN THE TREATMENT OF ANEURISM. 481 This report is the substance of a clinical lecture given by Desault at the time of his first operation. It shows his conception of \he method of spontaneous cure and of the means by which that method could be imitated ; he sought to obtain coagulation of the blood through arrest of the current by placing an obstacle Phenergan Tablets 10mg on either the proximal or distal side, and he knew â he had known for nine years â that it was not necessary to turn out the clots, that the incision of the sac could be dispensed with if the artery could be otherwise closed. But how was that to be done ? Naturally enough, he first tried compression, and, that failing, then the ligature in continuity. Broca tells us that the first case of which we have knowledge that came under Desault* s care was an axillary aneurism, shortly before February, 1785, and he attempted to treat it by compression of the sub- clavian artery. Ligation of the subclavian was at that time an unknown operation. For some reason the patient left Desault and put himself under the care of another surgeon, who mistook the tumor for an abscess and opened it. The idea of compression of the artery above the tumor was not new 9r unknown In 1761 Kretsch- mer treated a traumatic aneurism, resulting from a Related links: 25 mg of zoloft, Nolvadex Buy Uk, Cytoxan Iv, Salbutamol Albuterol, Order Neggram Online, Prazosin Ptsd, Buy Advair Diskus 250 50, Lansoprazole Tablets, Buy Betnovate, lisinopril buy online