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One of the temporal arteries was ligated, and the scalp cleansed and reapplied. The hanging ears and the skin of the forehead were successfully restored to their proper position. The patient had no bad symptoms and little pain, and the shock was slight. Where the periosteum had sloughed the bone was granulating, and at the time of the report skin-grafting was shortly to be tried.
Walters saw the woman twenty-one hours afterward, and ligated and severed the protruding omentum. On the twenty-eighth day, after a marvelous recovery, she was able to drive to the Royal Berkshire Hospital, a distance of five miles. At the time of report, two years and six months after the mutilation, she was in perfect health.
In his "Surgery" Gooch says that at the battle of Dettingen one of Sir Robert Rich's Dragoons was left all night on the field, weltering in his blood, his spleen hanging out of his body in a gangrenous state. The next morning he was carried to the surgeons who ligated the large vessels, and extirpated the spleen; the man recovered and was soon able to do duty.
The facial and carotid arteries had to be ligated and part of the inferior maxilla removed, but the patient insisted upon having the operations performed without an anesthetic, and afterward informed the operator that she had experienced great pleasure throughout the whole procedure. Pain as a Means of Sexual Enjoyment.
Swingler speaks of two girls joined at the xiphoid cartilage and the umbilicus, the band of union being 1 1/2 inches thick, and running below the middle of it was the umbilical cord, common to both. They first ligated the cord, which fell off in nine days, and then separated the twins with the bistoury. They each made early recovery and lived.
Warren has extirpated one lobe of the thyroid after preliminary ligation of the common carotid on the same side. Green practiced rapid removal of the tumor and ligated the bleeding vessels later. Rose tied each vessel before cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one of Rose's operations which lasted for four hours.
The spleen protruded, and the protruding part was ligated by a silver wire, one-half of the organ sloughing off; the patient recovered. Sir Astley Cooper mentions a curious case, in which, after vomiting, during which the spleen was torn from its attachments, this organ produced a swelling in the groin which was supposed to be a hernia.
The common carotid was divided and for five minutes there was profuse hemorrhage which, however, strange to say, spontaneously ceased. The patient died in thirty-eight hours, supposedly from spinal concussion or shock. Relative to ligature of the common carotid artery, Ashhurst mentions the fact that the artery has been ligated in 228 instances, with 94 recoveries.
Concurrently and by the same process the external clot is converted into scar tissue. If a divided artery is ligated at its cut end, the tension of the ligature is usually sufficient to rupture the inner and middle coats, which curl up within the lumen, the outer coat alone being held in the grasp of the ligature.
As there is little tendency to spontaneous cure, and as the aneurysm is liable to increase in size and finally to rupture, operative treatment is usually called for. This is carried out on the same lines as for aneurysmal varix, and at the same time incising the sac, turning out the clots, and ligating any branches which open into the sac. If it can be avoided, the vein should not be ligated.
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