180. The due appreciation of the means adopted by nature and by art
for the suppression of hemorrhage, as well as the proper treatment of
wounded arteries, is owing to the surgery of the war in the Peninsula.
They were suspected after the battles of Roliça, Vimiera, Oporto, and
Talavera, but did not receive their complete development until after
the battle of Albuhera. It was not until after that of Toulouse they
were partially admitted; and it is only of late that they have been
almost everywhere acknowledged, taught, and practiced.
Previously to the time of Mr. Hunter, the diseased or dilated state
of the coats of an artery which constitutes an aneurism was, when it
occurred in the ham, very often fatal. The operation of Anel, first
performed in 1710, of cutting down to the artery, and placing a
ligature upon it immediately above the dilated part, was not approved,
and Mr. Pott, the great contemporary of Mr. Hunter, recommended in bad
cases that amputation should be resorted to in the first instance;
although Desault had succeeded, in 1783, in a case of popliteal
aneurism, in which, after the manner of Anel, he had placed the
ligature on the artery a little above the aneurismal swelling in the
ham. Mr. Hunter’s contemplative mind, aided by his knowledge of anatomy
and of disease, led him to believe that the ligature thus applied on
the artery in the ham failed, because the vessel was unsound at that
part, and was therefore incapable of taking on those healthy actions
necessary for the obliteration of its canal above the ligature,
which are known to take place when the artery is in a normal state.
He concluded that this was sufficient to account for the failures,
without especially taking into consideration the difficulty of applying
the ligature in the ham immediately above the aneurismal sac, and
of the probability of the sac suppurating when thus molested; an
occurrence aiding materially in the necessity for the loss of the limb
by amputation, performed then under circumstances of constitutional
irritation, which would render it less likely to be attended with
success.
From the consideration of these and other circumstances, Mr. Hunter was
induced to propose, in 1785, that the ligature should not be placed on
the artery near the tumor in the ham, but at a greater distance on the
fore part or middle of the thigh, and Scarpa subsequently recommended
it to be placed even higher--a recommendation which has been generally
followed, and the spot now selected for this operation is at the lower
part of the upper third of the thigh. This operation was therefore
performed not only for aneurism, but improperly for a wound of the
artery, not only in the ham, but even in the leg; it consequently
failed in almost every instance of traumatic injury, thus rendering
amputation necessary, which was generally followed by death.