Ligature Applied to the Aorta

1829 Boston Medical and Surgical Journal  
experience, that on the third day from the operation the calculus would be easily removed, with scarcely any pain to the patient. Accordingly, on the day appointed, those who were present at the operation were in attendance, and saw Mr. Lizars gently introduce his finger into the wound, while the patient lay in bed, and then, guiding a scoop along the finger, bring out the calculus, which was as large as a chicken's egg. with all the ease imaginable. The patient, a gentleman of sixtyfour years
more » ... f age, had a quick recovery. Mr. Lizars speaks highly of leaving the calculus till the third day, when it cannot be readily extracted at the time of the operation. By that time the suppurative process has commenced, and all the parts concerned are quite relaxed. This is the method introduced by the French surgeon Franco, as the operation a deux temps, and which has been condemned by some of our modern writers. Mr. Samuel Cooper strongly reprobates the practice of putting a patient to bed with a stone in his bladder ; and advises that, rather than do this, we should make an opening adequate to its abstraction ; or if this cannot be done, he tells us to break down the calculus and remove its fragments. If the long and constant irritation of a calculus, or calculi, has the effect of thickening the coats of the bladder, and diminishing its capacity ; and if the cutting into that viscus causes its fibres to contract, and firmly grasp the calculus, as the uferus does its placenta when about to throw it off,-both of which occurrences experience shows us to be almost invariable attendants on the disease, and the operation for its removal,-then all reiterated and painful attempts to remove and break down the calculus will not only be improper, but must also tend greatly to endanger the life of the patient. The cases in which Mr. Lizars has tried this operation a deux temps have been attended with the greatest success, and he has removed, on the third day after the operation, very large calculi with the utmost ease. He has hitherto made one or two gentle endeavors to bring away the calculus at the time of the operation, but if he does not readily succeed, the patient is put to bed. So convinced is this expert operator of the superiority of this plan, that he declared to his medical brethren, at the operation I have just mentioned, that were it his misfortune to be obliged to submit to the operation of lithotomy, he would not suffer the forceps or scoop to be used before the third day.-Gibson's Medical Sketch of Dumfries-shire. The patient, a man aged 44, had an aneurism of the external iliac. The situation and size of the tumor seemed to preclude any attempt to tie it above ; and I was induced to adopt the plan revived by Mr. Wardrop, of applying a ligature on the femoral below it. This was done on the 2d of June, and it was at first followed by a very sensible decrease in the tumor ; but shortly the ground gain-
doi:10.1056/nejm182910130023506 fatcat:xr4nptj67renbip2ggywjdv7q4