.A- 1t- 
"New, Simple and Safe Method 
of Preventing Hemorrhage, Treating 
Aneurisms, and Applicable 
to Other Surgical 
Conditions. 
A Paper read before the Academy of Medicine, 
BY 
C. S. Muscroft, M.D., 
March 14, 1887. A NEW, SIMPLE AND SAFE METHOD OF PREVENTING HEMORRHAGE, 
TREATING ANEURISMS, AND APPLICABLE TO 
OTHER SURGICAL CONDITIONS.’ 
PRESENTING A CASE OF SUCCESSFUL AMPUTATION OF THE HIP JOINT AND A 
CASE OF AMPUTATION AT THE SHOULDER JOINT, WHERE 
THE METHOD WAS PUT IN PRACTICE. 
A paper read before the Academy of Medicine, March 14, by 
C. S. Muscroft, M.D. / 
Mr. G. H. Kohrs, aged 58 years is suf- 
fering from the effects of epithelioma of 
the right leg and thigh. The leg had been 
amputated a year previously. On the tenth 
day of August, 1886, at the request of the 
patient, an amputation at the hip joint was 
performed in the presence of the following 
medical gentlemen, in the operating 
room of St. Mary’s Hospital, namely: 
Drs. F. Kramer, F. Kebler, J. B. Bertel- 
ing, A. Grimm, J. A. Thompson, B. F. 
Clark, and C. S. Muscroft, Jr., who ad- 
ministered the chloroform. 
Dr. Thompson, at the operator’s re- 
quest, furnished the following notes of the 
remarks made previous to the operation: 
“Before beginning the operation Dr. 
Muscroft said that in all his long experience 
as a surgeon this was the first time he had 
been called on to amputate at the hip joint. 
Naturally this greatest of all surgical oper- 
ations had been the source of much anx- 
ious thought. First as to the necessity of 
the operation: 
“We had a case of malignant growth 
involving the bone of the limb. It had re- 
turned after one amputation. There was 
room above the growth for an amputation 
in the upper third of the thigh, a compara- 
tively simple operation. But as the bone 
was already affected, he thought the 
chances of recurrence were much less after 
complete removal, so it was true conserva- 
tism to chose the graver operation. It 
gave the best promise of a radical cure. 
He had given much study to the details of 
the operation, and every step in the classic 
description of this amputation had been 
carefully considered. It was universally 
taught by surgeons that controlling hem- 
orrhage was the most difficult and most im- 
portant part of the operation. Two or 
three gushes of bloocl from an artery the 
size of the femoral are sufficient to produce 
fatal shock. 
Dr. Muscroft then briefly mentioned the 
different methods of controlling hemor- 
rhage adopted and recommended by differ- 
ent operators, and said that on mature de- 
liberation he had concluded to reject them 
all and employ a simple method of his 
own. 
“He proposed to pass a strong pm or 
needle under the femoral vessels en masse, 
high up in Scarpa’s triangle, and then by 
winding a cord around the exposed ends 
of the needle, protected by corks, 
in a figure of eight turn, to secure 
sufficient pressure to completely occlude 
the artery. This method of compression 
before the operation could not possibly do 
any harm, and if properly applied there 
could be no danger of hemorrhage. The 
additional advantage would be secured 
that there were no tourniquets or bandages 
to slip when their point of resistance was 
removed by the disarticulation of the head 
of the femur, and the apparatus for con- 
trolling the hemorrhage was not at all in 
the way of the operator or his assistants.” 
As soon as the patient was fully under 
the influence of the anaesthetic, a needle 
one eighth of an inch wide, slightly bent at 
the point, about the thickness of a dime, 
and four inches long, was introduced per- 
pendicularly into the front of the thigh, 
about an inch and a half below Poupart’slig 
ament. The exact point of entrance was one 
fourth inch internal to the combined sheaths 
of the vein, artery and nerve. The point 
was pushed beyond the vessels, then turned 
outward until the needle had passed beyond 
them; the point was then pushed out 
through the integument. The needle 
then behind the vessels and nerve. A 
piece of cord was passed under the heel 2 
and point of the needle, forming a figure of 
’ight ligature. Before the ligature was ap- 
plied the femoral artery could be felt puls- 
ating strongly, but when it was tightened 
the pulsation below the needle had ceased 
entirely. This, to say the least, was very 
encouraging. 
The form of operation decided upon 
was the oval. The incision, made with a 
bistoury, was commenced on the outside 
of the upper part of the thigh and pelvis, 
an inch above the trochanter major; it was 
carried down three inches, then a diversion 
was carried posteriorly through the gluteal 
muscles as far as the inside of the thigh, 
another diversion was made anteriorly 
nearly as far as the sheaths of the large 
femoral vessels. There was but little 
bleeding from the gluteal or sciatic ar 
teries. The head of the femur was readily 
dislodged from its cavity, and the upper 
part of the os femoris cleared from its at- 
tachments. A catlin was then used to sep- 
arate the remaining tissues containing the 
femoral artery. When this was done the 
profunda femoris had to be ligated. The 
femoral artery was perfectly compressed, 
standing out in bold relief from the sur- 
rounding tissues for three-fourths of an 
inch, but had not bled a drop. The artery 
was held by the finger and thumb till a lig 
ature could be permanently applied. The 
needle was then withdrawn, no blood 
whatever flowing from its presence. 
The perfect control of the artery filled 
the bystanders with admiration and de- 
light, as well as relieving the anxiety of all 
present from further fear, and established 
the most perfect confidence. 
The stump was then dressed and the 
patient put to bed. There was given him 
ten grains of carbonate of ammonia in 
camphor water at two doses. If he became 
restless he was to take a teaspoonful of the 
following mixture every hour: 
R. Morph, sulph, gr. 
Camphor water, Jjii. 
He only took three or four doses. 
The wound was very small considering 
the extensive operation. It was dressed 
by laying compresses soaked in a solution 
of dried sulphate of iron, to the pint. 
No drainage tubes were used or any of the 
so-called disinfectants. He slept well the 
first night after the operation. 
His recovery has been almost painless, 
and all that could be wished. 
A New, Simple and Safe Method of Preventing 
The history of the case of amputation 
of the right arm at the insertion of the del- 
toid muscle is recorded in the Buffalo Med- 
ical and Surgical Journal, of May, 1886, on 
page 452* The title of the report is “Ele- 
phantiasis of the Hand, Amputation, Re- 
covery, by B, P. Hoyer, M.D.” 
The Dr. first gives the pathology of the 
disease, then describes the condition of the 
patient previous to the operation. He lays 
a great stress upon the vascularity of the 
affected arm, stating that some of the 
“small arteries have become enlarged to 
the size of the brachial.” 
The patient, Mr. C. F. Albright, was 
placed in my charge by Dr. W. H. Dun- 
ham about the first of August last. At the 
time the stump of the arm was very painful 
and swollen, with an open ulcer in the 
center which imperfectly covered the end 
of the bone, and secreted a sanious pus. 
The entire stump was cedcmatous and shin- 
ing. The end of ihe bone, which was 
thickened, could be seen at the bottom of 
the ulcer, and was exquisitively sensitive 
to touch by the probe. 
The young man (whose age is twenty- 
six years) being fearful the primary disease 
had not all been removed, was anxious to 
have another operation performed, involv- 
ing the entire structure of the remaining 
bone. 
On the 12th day of August, 1886, the 
amputation of the right shoulder joint was 
performed at St. Mary’s Hospital in the 
presence of Drs. W. H. Dunham, Kebler, 
Clark, Thompson, and Muscroft, Jr., who 
administered the chloroform. The Larry 
operation was selected. 
Before the operation was commenced, 
the brachial artery was secured in the same 
manner as the femoral artery in the case of 
the amputation at the hip joint two days 
previously. 
As on the former occasion, when the 
amputation of the arm was performed by 
Dr. Hoyer, the arteries were found very 
much enlarged and bled excessively. Not 
less thain twenty vessels were ligated. The 
compression with the needle and figure of 
eight ligature was entirely successful in 
preventing any bleeding from the brachial 
artery. The needle was introduced from 
before backwards, and parallel to the bor- 
ders of the axilla. The point and heel of 
the needle were protected as on the former 
occasion by corks. 
The patient for a few days was attacked Hemorrhage, Treating Aneurism, etc.—Muscroft. 
3 
with epileptoid seizures, which in a few 
we< ks passed off entirely. 
The stump of the arm which was re- 
moved, was given to Dr. Jas. M. French, 
the pathologist of the hospital, who kindly 
made the following report: 
190 Baymiller Street, j 
February 15, 1887. j 
C. S. Mus croft, Sr., M.D., 
Dear Doctor :—The specimen which 
you sent me for examination represented 
about the upper two-thirds of the arm. The 
lower extremity of it, smooth and rounded, 
presented the characteristic cicatrices of an 
amputation stump. The upper extremity 
had the appearance of having recently 
been severed by an amputation at the 
shoulder joint. The specimen was about 
twice the usual diameter of the arm; its 
consistence was about normal, or a little 
softer, and its surface was smooth. 
Microscopic examination showed that 
the chief enlargement was due to a thick 
ening of the skin, due for the most part to 
a multiplication of connective tissue fibres. 
These ramified in all directions, forming a 
loose reticulated network. The meshes of 
this network were in part occupied by di 
lated lymphatic capillaries. In parts the 
walls of the capillaries were much thick- 
ened. 
The lesions are typical of an elephant- 
iasis. Very respectfully, 
James M. French, M.D. 
The patient made a good and speedy 
recovery, and walked about the ward in 
six days. 
It is not alone that this simple method 
of preventing bleeding in the manner al- 
ready mentioned, and proving successful in 
the two most dangerous and critical ampu 
tations known to surgery. The author 
claims it is also as readily applied in any 
case of severe hemorrhage from the extrem- 
ities, whether from gunshot wounds, rail- 
road accidents, or serious bleeding from 
any cause. In such cases it is only in- 
tended to restrain the bleeding until per- 
manent ligation can be accomplished. 
This form of compression can be used for 
hours or days, if need be, without compli- 
cating in any way other surgical proced- 
ures. 
It can be applied to any part of the ex- 
tremities in shorter time than the tourni- 
quet. It has the advantage of not causing 
the pain or swelling produced by the latter 
mode, nor does it require an assistant. 
The author has already applied this 
compression to shut off the circulation of 
the femoral artery below Poupart’s liga- 
ment for a secondary bleeding after ampu- 
tation of the leg. The result was all that 
could be desired. The pin remained in 
place four days. After removing the pin 
no dressing was needed, nor was there any 
unpleasant result. 
The author also claims this mode of 
cutting off the circulation will prove the 
simplest, easiest and most effective 
in the treatment of aneurism in any part of 
the lower extremities, or in the axilla or 
any other part of the upper extremity. In 
the latter the axillary artery can be readily 
compressed below the clavicle. This form 
of compression below Poupart’s ligament 
could be produced indefinitely. That the 
steel pin could be retained without pro- 
ducing serious irritation, in the treatment 
of aneurism, it has been proved for four 
days. Then should irritation or inflamma- 
tion threaten, another pin could be intro- 
duced either above or below the one al- 
ready in use, then after the ligature was 
properly adjusted, the first pin could be 
withdrawn. It would be a proper pro- 
ceeding to test the result of shutting off the 
circulation in the treatment of aneurism, to 
take off the ligature without withdrawing 
the pi i, and should there be any pulsation 
felt in the tumor the ligature should at 
once be reapplied. There is another ad- 
vantage, namely, the surgeon could apply 
the ligature in such a way that if he desir- 
ed the force of the circulation could be 
modified to any extent he might wish. Pins 
could undoubtedly be used in this way for 
weeks. For instance, insert a pin an inch 
below Poupart’s ligament, in the limb to 
be treated, continue its use until irritation 
set in, which in all probability would be 
not less than a week; at the end of that 
time insert another an inch below the first, 
then remove it, continue the second an- 
other week, then repeat the operation an 
inch below the last one. By this time the 
point at which the first pin was applied 
would be in a condition to have the opera- 
tion completed by the reinsertion of a pin. 
Of course at each insertion of a pin the 
ligature must be used. This will insure 
certainly a period of not less than sixteen 
days, and probably twenty-eight days that 
the circulation of the blood would be en- 
tirely shut off, surely time enough to cure 
any aneurism amenable to treatment Hemorrhage, Treating Aneurism, etc.—MuscrofU 
4 
Cases have been reported cured when the 
ordinary modes of compression have lasted 
but a few hours. 
The accompanying drawing represents 
the form of pin used by the author. 
A cork is always made to cover the 
point. 
This form of controlling arterial 
circulation will no doubt open a new 
field in surgical procedures, its appli- 
cation being so simple and easy of ac- 
complishment. 
Whether it would be a proper pro- 
cedure in controlling bleeding from 
the large arteries of the neck will be 
a matter that experience alone will de- 
cide. Yet if the surgeon could by 
this simple means preserve life for only 
a short time where death was inevit- 
able, it would be a triumph for him- 
self and a great consolation for the pa- 
tient and his friends. 
For aneurisms about the face or 
jaws, either of idiopathic or traum- 
atic origin, this would be par excellence 
the treatment. 
The two following cases where this 
hemostatic was used to arrest bleeding will 
serve to illustrate the origin of the sugges- 
tion which was carried out in the two am- 
putations, used as a prophylactic. 
The first was to the dorsum of the 
hand, where the artery had been cut by 
glass. The pin in this case passed under 
the arteries, was only in use three or four 
days. 
Another instance was one in which the 
ulnar artery had been wounded above the 
wrist. Secondary bleeding came on after 
midnight. A needle was passed through 
the integument under the artery and 
brought out again through the integument. 
The ligature was removed on the seventh 
day. There was no further bleeding. 
These were cases of arterial wounds in 
which the usual modes of compression had 
failed. The success which followed these 
cases (which occurred over two years ago) 
determined the operator to use the same 
treatment in other cases, no matter what 
the calibre of the artery involved or where 
located, providing the hemostatic pin and 
•igature could be applied. This in very 
many cases would obviate the necessity of 
the more serious operations for suppressing 
bleeding. 
It was undoubtedly the impression 
made by the result of these cases, and the 
determination to carry out the principle in 
any form of accident requiring such treat- 
ment, that led to the suggestion of com- 
pressing the artery by this form of pressure 
to secure the patient from bleeding, as was 
done in the amputation at the hip joint and 
of the shoulder joint. 
Another advantage which has not been 
mentioned, is that it allows the operator to 
take his own time and leisure in applying 
the final ligature (which may consist of 
catgut, tendon, strips from the aorta of the 
ox, or of silk or cotton) or other necessary 
details. This form of treating the artery 
for prevention of bleeding will not in any 
way interfere with the application of the 
Esmarch bandage should it be required to 
retain the residuary blood in a limb. 
In the operation where the hip joint 
was amputated, after making the final sev- 
erance of the tissues containing the femor- 
al artery, it was found the artery stood 
boldly out from the surrounding attach- 
ments, not being covered even by its 
sheath. This effect was undoubtedly pro- 
duced by the artery being held last by the 
compression used, so that it could not re- 
tract. Should this prove to be always so, 
it only adds another very important ad- 
vantage to the operation, and such results 
may be expected where the division of the 
tissues are in close proximity to the point 
of compression. 
The same principle can be applied if 
we should at any time meet with an abnor- 
mal distribution of an artery, as was the 
case in a successful amputation of the hip 
joint by Valentine Mott, the external iliac 
giving off two femoral arteries in the place 
of one. 
The results which have followed the 
application of this mode of prevention and 
suppressing bleeding have been so success- 
ful that the author feels confident it cannot 
fail to come into general use. 
Its first application in the gravest and 
most dangerous amputation known to surg- 
eons, illustrates its influence for good by 
converting its most serious complication 
into the simplest part of the operation. 
And certainly the best fitted to amputa- 
tions in any part of the superior or inferior 
extremity, unless the fingers or toes. Truly 
can we here with truth apply the aphorism 
of Desault, when he says: “the simplicity 
of an operation is the measure of its per- 
fection.” 
i Points to be considered in connection 
WAX WOCHER * BOR, C4R.O. A New, Simple and Safe Method of Preventing 
5 
with this haemostatic mode of preventing 
hemorrhage in amputations and other op- 
erations : 
The first to recommend it is its simplic- 
ity and ease. 
ad. There is no interference with the 
general venous circulation in nearly all 
cases. 
3d. The plan is so simple that it does 
away with all of the more complicated 
forms of compression of vessels by tourni- 
quets, bandages or tubing. 
4th. It is also a process for shutting off 
the arterial flow in cases of aneurisms. 
5th. The introduction of the pin or 
needle will in most cases be an entirely 
bloodless operation, and attended with very 
little pain. The pin used may be straight, 
bent at the point, or of any curve or shape 
to suit the operator. 
6th. It is also a ready, safe method of 
arresting hemorrhage in recent accidents 
from compound fractures or other causes. 
7th. Many cases will fall under the ob- 
servation of the practicing surgeon in which 
its utility will suggest itself. 
8th. The kind of metal of which the 
pin or needle is made is a matter of the 
utmost importance, experience teaching 
that steel or iron produces less irritation 
than the more costly metals, such as gold 
or silver. 
9th. Freedom from septicaemia. 
10th. The great facility with which the 
operator could obtain a pin suitable for the 
compression. For one of the larger ves- 
sels it could be obtained from a lady’s toil- 
ette supplies, by any of the long steel pins 
with glass heads, especially those used for 
fastening on their hats. Their being 
straight in most cases would be an ad- 
vantage. 
nth. This manner of preventing bleed- 
ing in operations about the hip joint (ex- 
section), shoulder joint or knee, will be of 
the greatest importance. 
12th. It does away with the necessity 
of a most important assistant. 
Dr. Conner congratulated the essayist 
on the favorable results of the hip joint am- 
putation, an operation that, so far as he 
knew, had been but three times successful- 
ly performed in this city during the last 
twenty-five years, once by the late Dr. 
Blackman, once by himself, and now a 
third time by Dr. Muscroft. The operation 
is necessarily one of great magnitude, 
about one-sixth of the whole body being 
taken away, and one of its greatest risks is 
in hemorrage. For the prevention of this 
many operative preceedures have been em- 
ployed. The flow of blood through the 
femoral artery can be absolutely controlled 
by the pressure of a finger. But a trained 
finger is not always to be had, nor even 
always to be relied upon. An aortic tour- 
niquet may cause fatal pressure inflam- 
mation. The Davy lever, or a hand in the 
rectum, can thoroughly compress the iliac 
artery, but the use of either is by no means 
devoid of danger. The Esmarch strap can 
be satisfactorily applied, after the method 
of Lloyd, of Birmingham, but there is dan- 
ger that unless properly handled it will slip 
after the division of the soft parts. Spence, 
of Edinburg, suggested the use of a flat 
steel pin passed under the femoral vessels, 
a method of controlling hemorhage suc- 
cessfully used by Varick, of Jersey City, 
and one essentially the same as that pre- 
DISCUSSION, 
sented to-night. The safest method of op- 
erating, when it can be employed, is a 
circular or modified circular amputation 
high up in the thigh, and the after disartic- 
ulation of the femur by an external incis- 
ion, such as is ordinarily employed in 
excision of the hip; a method with which 
is associated the names of Lacauchie and 
Furneaux Jordan. 
The speaker had twice performed the 
hip-joint amputation, once for osteo-sarco- 
ma, terminating fatally within twenty-four 
hours, and once for caries of the femur and 
associated epithelioma, consequent upon 
gun-shot fracture received over thirty years 
previously at the battle of Molino del Rey, 
in Mexico, the patient recovering to die of 
recurrence of cancer in the stump, nearly 
three years later. He exhibited the femur 
removed at this operation, as also a photo- 
graph of the patient after recovery. In this 
case the method of Lacauchie was used, the 
femoral artery being tied not far above the 
junction of the middle and upper thirds. 
1 In the other case the Esmarch bandage 
was used, which slipped, but by the very 
prompt and skillful digital compression of 
the common femoral artery by Dr. Dan- 
dridge, the hemorrhage was limited to the 
first spurt. 
The speaker is certain that when 
the Esmarch strap is properly applied 6 
and firmly held in position, the operation 
can be rendered almost bloodless, and 
there is in its use the great advantage of 
controlling the flow of blood through both 
the avterior and the posterior flaps, an ad- 
vantage all the greater because of the fact 
that occasionally—rarely, it is true—the 
companion artery of the sciatic nerve is not 
an insignificant vessel, but one of large 
size, taking the place, it may be, of the su- 
perficial femoral, as was the case in a 
patient successfully operated upon by Dr. 
H. H. Clark, of Illinois, a former student 
and graduate of the Medical College of 
Ohio. 
As respects the shoulder joint amputa- 
tion, the speaker cannot see the necessity 
of underpinning the vessels, which can be 
readily controlled by the hand of an assist- 
ant following the knife, or better yet, the 
Esmarch strap can be applied, as he himself 
had done several times. He would be 
afraid that in using the pin as Dr. Muscroft 
had advised, undue compression might be 
made upon the axillary plexus of nerves, a 
danger which does not attend the proper 
application of the rubber strap. We could 
all see a wide range of application of the 
pins presented by the essayist, but in 
essence Dr. Muscrofts method is but acu- 
pressure, which has been thoroughly tested 
and is not to-day regarded with very much 
favour. 
Dr. Ravogli remarked that after the 
expressed opinion of the previous speaker 
he will not enter in the discussion on the 
value of these hemostatic means. He can 
not agree with the essayist as to the 
novelty of the operation, which is nothing 
else than the acupressure that has been em- 
ployed for a long time in surgery. Vico 
Genoensis, surgeon, in 1520 in the article 
De Vulneribus, describes this operation : 
modus autem ligationis aliquando efficitur in- 
trommittendo acum sub vena desuper filurn 
stringendum. 
In 1739 Petit and Heister, Jr. men- 
tioned this operation of applying needles 
and thread so as to prevent and stop hem- 
orrhage of the humeralis in the same way 
as later proposed by Simpson in amputa- 
tions. 
Rizzoli, in Bologna, tried to revive this 
method; he applied acupression in a case 
of a small aneurism of the arteria brachi- 
alis. The pulsations ceased entirely in the 
tumor, and ten days thereafter the acu 
pleasure could be removed. The same 
A New. Simple and Safe Method of Preventing 
method was adopted in the removal of a 
sarcoma of the neck, upon the anterior ca- 
rotis primitiva, with the purpose of pre- 
venting hemorrhage. In this case, how- 
ever, the difficulty and danger of practic- 
ing acupressure consists in the possibility 
of compressing the pneumo gastric nerve 
which would arrest the heart’s action. 
The idea of passing a needle under the 
blood-vessels and ligating with the thread 
is an acupressure which has been used for 
a long time in surgical practice. 
Dr. Wilder had witnessed with much 
pleasure one of the operations alluded to 
by Dr. Conner, and can see the importance 
of devising means for the prevention of 
hemorrhage, since one or several gushes of 
blood may prove dangerous to the patient 
otherwise in good condition. 
The method proposed by the author of 
the |.aper is not a new one; and acupres- 
sure was probably employed by the an- 
cients. 
It is a serious matter to remove a limb, 
with the amount of blood contained there- 
in. The speaker thought that it could 
only exert a beneficial influence upon the 
case to apply an Esmarch bandage and 
thereby empty the blood from the ex- 
tremity into the body. 
Duncan, of Edinburgh, recommends 
transfusion in these cases to prevent shock. 
Dr. Muscroft, in conclusion, re- 
marked that he had listened with great in- 
terest to the gentlemen who had partici- 
pated in the discussion. Dr. Conner had 
laid stress upon the facility with which a 
reliable assistant was able to control the 
hemorrhage. He had forgotten that such 
an assistant is rarely present. If the 
speaker’s method is employed an assistant 
is not needed. 
In case of amputation at the hip-joint, 
the gluteal and sciatic vessels may be com- 
pressed just as easily as the femoral. 
The employment of the pin is only tem- 
porary, and can not, therefore inflict any 
serious damage on the nerves by pressure. 
The speaker’s method was not the acu- 
pressure Simp.-on employed; his acupres- 
sure was only used after the amputation, 
when a ligature would answer just as well, 
and in most cases would require much less 
time. 
The speaker had reviewed the history 
of the use of the ligature from 1500 B. C. 
up to the present time, and read the follow- Hemorrhage, Treating Aneurism, etc.—Muscroft. 
7 
ing extracts from a paper bearing upon his 
subject: 
Ligatures first used by Lus’ratus, in the 
year 1500 B. C., who tied the cord of ne.v 
born infants eight inches from the umbili- 
cus before cutting it. 
Some writers claim that Hippocrates in 
vented it, B. C. 460-377. 
Archigenes, B. C. 100, made free use 
of the ligature after amputations. 
Celsus, B. C. 30-25 and A. D. 45-50. 
Learned it from a physician of Alexand- 
ria. 
Galen, A. D. 131-211, used the liga- 
ture to the distal ends of vessels. Material 
—silk and catgut. 
Antythus, A. D. 300, used the ligature 
in treatment of aneurisms. 
Paulus Aginatas, 628-680, treats ex- 
tensively of the ligature. 
Rhazes, A. D. 850-922, used the liga- 
ture. 
Avicenna, A. D. 980-1037, also used 
the ligature (linen), and treated aneurisms 
after the method of Antythus. 
Averoza, A. D. 1113-1162 or 1196, 
and Averroes, A. D. 1198, were familar 
with the ligature. 
Roban in 1252 used the needle with 
the ligature. 
Roger of Parma, 1214, mentions the 
use of the needle with ligature, a practice 
followed by the most prominent Italian 
surgeons. 
Bruno of Castel Lougobrugo used the 
needle and ligature in 1252, both for arter- 
ial and venous hemorrhage, and also the 
hook to seize the vessels. 
Charteac, A. D. 1300-1363, preferred 
the ligature when the artery was deep seat- 
ed, the end of the artery being brought to 
view and then tied. 
Leonardo Bertapaglia, died 1460, mod 
ified the intermediate ligature by passing 
the needle around with a double thread, 
not under but through the artery, tying both 
ligatures firmly over each other. 
We have also the names of Giovanni 
Vigo, 1460-1520; Alfon Fern, about the 
same time; Angelo Botognini, 1508; 
Jacques Houllier, 1480-1508; Hans von 
Pfolsprevardt, in Germany; Huronymus 
Brusching, 1450-1533; Hans von Gers- 
dorf, 1517, a military surgeon; Walther 
Ryff. 
All of these men used the ligature, 
some of them as it is used at the present 
time. 
“Then comes Ambrose Pare, 1517— 
1490, to whom surgery owes a great debt 
of gratitude, not as the discoverer but as 
the first and most devoted champion of die 
ligature. 
Previous to his time the ligature had 
for the most part been used only as a der- 
nier resort in cases of wounds of vessels, 
while styptics and the actual cautery were 
still relied upon as the safest and easiest 
methods of arresting hemorrhage.” 
Even his methods were far from being 
perfect,” and it has taken centuries to es- 
tablish it in the confidence of the profes- 
sion. 
These quotations are taken from the 
“Handbook of References of Medical 
Science,” art. Ligatures. 
In no case was he able to interpret 
the sense of any operation as similar to 
that of his proposed measure. 
By adopting the latter we do away 
with all the disagreeable methods hitherto 
adopted. 
Granted that in amputation at the 
shoulder joint hemorrhage is more easily 
controlled than at the hip, yet by using 
the pin we do away with the necess- 
ity of assistants. 
The speaker claimed that his measure 
and acupressure are not identical. The 
latter never having been used as a pro- 
phylactic, and only in open surfaces, after, 
and not before, an amputation. 
| 533 an<* 335 John St. 
CINCINNATI : 
Reprint from The Cincinnati Lancet-Clinic, April 2, 
1887.