Torsion
To M. Amusat, of Paris, we are indebted for the introduction of the artery-forceps for the arresting of hemorrhage. I shall do but justice to him by describing his mode of proceeding. He seizes the divided vessel with a pair of torsion-forceps in such a manner as to hold and close the mouth of the vessel in its teeth. The slide of the forceps then shuts its blade, and the artery is held fast. The artery is then drawn from out of the tissues surrounding it, to the extent of a few lines, and freed, with another forceps, from its cellular envelope, so as to lay bare its external coat. The index and thumb of the left hand are then applied above the forceps, in order to press back the blood in the vessel. He then begins to twist the artery. One of the methods consists in continuing the torsion until the part held in the forceps is detached. When, however, the 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 surface 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 security against the danger of consecutive hemorrhage will not be perfect.
Mr. W. B. Costello, of London, was present when the operation was performed at Paris. He brought back a full account of it as performed there, and 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 becoming more irregular in its form, and on one of its tuberculous prominences 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 mammæ of the bitch. Having also been taught that the ultimate success of the excision of these enlargements depended on their removal before suppuration had taken place, and the neighbouring parts had been inoculated by the virus which so plentifully 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 imperfect instruments beautifully established the power of torsion in arresting hemorrhage.
Two elliptical incisions were made on the face of the tumour, and prolonged 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 posteriorly, I very rapidly cut through the cellular texture, elevating the tumour and turning it back, until I arrived at the inner and anterior point, and there was the only source of supply; the artery was plainly to be seen. In order to give the experiment a fair chance, I would not enclose it in the forceps, but I cut through it. A jet of blood spirted out. I then seized the vessel as quickly as I could, and began to turn the forceps, but before I could effect more than a turn and a half I lost my hold on the artery. I was vexed, and paused, waiting for the renewed gush of blood that I might seize the vessel again; but to my surprise not a drop more blood came from the arterial trunk. That turn and a half, considerable pressure having been used, had completely arrested the hemorrhage. I can safely say that not more than four drachms of arterial blood were lost.
The wound was sponged clean: there remained only a very slight oozing from two or three points; the flaps were brought together, secured by the ordinary sutures, and the proper bandages applied. The weight of the tumour was twenty-two ounces; there was no after-bleeding, no unpleasant occurrences; but the wound, which had been nearly six inches in length, was closed in little more than three weeks.
He will essentially promote the cause of science, and the cause of humanity, who will avail himself of the opportunity which country practice affords of putting the effect of torsion to the test: and few things will be more gratifying than the consciousness of rescuing our patients from the unnecessary infliction of torture.
In docking, it will be found perfectly practicable: our patients will escape much torture, and tetanus will often be avoided. The principal danger from castration has arisen from the severity with which the iron has been employed. The colt, the sheep, and the dog will be fair subjects for experiment. The cautery, as it regards the first, and the brutal violence too frequently resorted to in operating upon the others, have destroyed thousands of animals.
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