Ligation of the common carotid artery for malignant recurrent hemorrhage of the vitreous / George S. Derby.

  • Derby, George S.
Date:
1907
Catalogue details

Licence: In copyright

Credit: Ligation of the common carotid artery for malignant recurrent hemorrhage of the vitreous / George S. Derby. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    the collateral supply. That it was the operation winch caused the improvement is hardly open to question. For a time the patient was treated with lactate of calcium and gelatin on the theory that the coagulating power of the blood was diminished. As we were unable to determine then whether or not this was the case, and as there was no apparent improvement, this treatment was discontinued. Recently through the kindness of Dr. F. T. Lord, whom I here wish to thank, an estima- tion was made by Wright's method, and it was found that coagulation took place in 2 minutes and 50 sec- onds, the normal by this method being 1 minute 45 seconds to 2 minutes 10 seconds. Thinking that pos: sibly the former preparation of calcium may not have been efficient, the patient has again been given this drug. This method of determining the time of clotting is as vet in its infancy, but its great simplicity and avail- ability give great promise. Although Wright and his assistants have indicated that retarded coagulation may be responsible for many and various lesions, there has as yet been little confirmatory evidence, still as in this case we have no other clue to the etiology, and as many other similar cases occur in which the causation is like- wise obscure, the possibility of retarded coagulation as a cause is worthy of consideration in the future. There- fore, it would seem to be advisable to ascertain the clot- ting time in all such cases, and if it be slow the admin- istration of calcium salts is indicated and may prove of marked benefit to the patient. Whether we are justified, after medical treatment has failed, in proposing ligation of the carotid to these pa- tients is the question which more nearly concerns us here. Our first consideration may well be the danger of the operation. We have a large mass of statistics on the subject of carotid ligation and they are somewhat complicated, owing to the fact that in pre-antiseptie days the danger of sepsis and of secondary hemorrhage had to be seriously considered, and added very materially to the mortality of the operation. Moreover, the disease for which the operation is performed has a marked in- fluence on the mortality. It would seem fair to assume about the same rate of mortality after ligation for the cure of vitreous hemorrhage as that after the same opera- tion for the relief of pulsating exophthalmos. Keller,