Protheroe Smith
1867 The Lancet  
Since writing on the 29th of April I have received a letter from Mr. Grant, our late house-surgeon, in every particular confirming the statement of Mr. Strahan, both in regard to the introduction of the pin and its uselessness. To the Editor of THE LANCET. SIR,—On reading a letter on this questio vexata in your impression of last week, by Dr. Fiddes, of this town, I was much struck by his minute description of an operation which he says he performed, but which appears to me a physical
more » ... ity. To arrest secondary haemorrhage in an amputated stump, he pinned the femoral artery, thus :-" The forefinger of my left hand I put upon the artery and compressed it; and with my right hand I plunged in the point of the pin, about an inch from the iliac side of the artery. The head of the pin was then depressed, and the point brought through the skin close to the iliac side of the artery. 1 then raised the head of the pin and pushed the point of it into the stump between the artery and vein, and brought it out again on the pubic side of the vein. " Now, apart from the physiological question whether the amount of blood in the femoral artery can be arrested by pinning, every one at all conversant with the anatomy of the parts must know that the artery and vein are so closely united by their areolar investment, that, even after opening the crural sheath, it requires delicate dissection to separate them. Still, were a person to plunge a pin in a perpendicular direction between them, he might by a lucky hit manage to do so without wounding either artery or vein. But, unless provided with a pin possessing the remarkable property of Baron Munchausen's gun—that of shooting round a corner-I am at a loss to conceive how any surgeon, however expert, could avoid transfixing the femoral vein. He has first to take up an inch of integument with a straight pin, then with this encumbrance to raise up the head so as to introduce it between the artery and vein, pinning down the former. and pinning up the latter. The writer of this letter further tells us that, "By-and-by the stump began to swell from venous congestion, for the vein was unavoidably slightly compressed at the same time. This swelling of the stump I have no doubt pressed out the blood from the artery, on the elastaL side of the acupressure, and the blood froin, between the flaps. " , In any other document I should have considered such a sentence a mere confusion of ideas ; as it is plain that the swelling of the stump would rather have the opposite tendency-that of retaining the blood instead of squeezing it out. But taken in connexion with this remarkable operation I presume it must refer to some new doctrine in surgical pathology of which I am as vet entirelv ignorant.
doi:10.1016/s0140-6736(02)51650-0 fatcat:35nprcorcbhsrpcomji7a6buki