C H A P. XXII.
Of the Operation of the Aneurism.
This Operation is perform'd when the Surgeon hath prickt an Artery, or when a Tumour ariseth in an Artery.
To this purpose the Patient is set in a Chair, and a Servant employ'd in holding his Arm in a Posture proper for the Operation; then a Bolster is to be laid four double, following the Progress of the Artery, to the end that the Ligature may better press the Vessel; and the Arm may be also surrounded with another single Bolster, on which is made a Ligature screw'd up with a Gripe-Stick, provided the Arm be not too much swell'd; for in this Case it wou'd be more expedient to deferr the Operation for fear of a Gangrene. The Artery being thus well stopt, the Surgeon lays hold on the Arm with one Hand, below the Tumour, and with the other makes an Incision with his Lancet, beginning at the bottom of the Tumour, and ending on the top along the Progress of the Artery. When the Tumour is open'd, the coagulated Blood may be discharg'd with a Finger; and if there are any Strings at the bottom, they may be cut with a crooked Pair of Sizzers, to the end that all the Clods of Blood, and other extraneous Bodies which are sometimes form'd in Aneurisms when they are very inveterate may be more
easily remov'd. But the Gripe-Stick must be loosen'd, to discover the Opening of the Artery with greater facility, and the Artery separated from the Membranes with a Fleam; for it wou'd be dangerous to cut it with a streight Incision-Knife: The Artery must also be supported with a convenient Instrument to divide it from the Nerve and Membranes; and to be assur'd of the Place of its Opening, the Gripe-Stick may be somewhat loosen'd, and afterward screw'd up again. In the mean time the Surgeon gives the Instrument to a Servant to hold, whilst he passeth under the Artery a crooked Needle with a wax'd String, cuts the Thread, and takes away the Needle: Then he begins to make the Ligature beneath the Opening of the Artery, tying at first a single Knot, on which may be put (if you please) a small Bolster, that may be kept steady with two other Knots: It is also necessary that another Ligature be made in the lower part of the Artery, by reason that the little lateral Arteries might otherwise let out Blood.
The Artery ought not to be cut between the two Ligatures, lest the first Ligature shou'd be forc'd by the Impulsion of the Blood; but the Thread must be let fall, that it may rot with the Suppuration. Then the Wound may be dress'd with Pledgets, Bolsters strew'd with Astringent Powders and a Plaister; a Bolster being also laid in the Fold of the Elbow.