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