Ligation of the common carotid artow. —Dr. Wyeth, in au essay on the surgical anatomy and history of the common, external, and internal carotid arteries, and which was awarded the first prize by the American rnedical association in 1878, reports 794 cases of li.,0-ature of the common carotid artery, 18 of the internal, and 91 of the exter nal carotid. These are collected from all parts of the world, and. embrace many in military surgery furnished durinoo- the late American and European "WM'S, the records of which, until recently, have not been accessible. The common carotid artery was first tied by Abernethy in 1803, the,patient surviving 30 hours. The operation was per formed six times by Dr. Gurdon Buck of New York between the years 1839 and 1857. All recovered from the operation but one; and three were cured. Fiye operations were performed by Dr. Den:at:old of New York, with four recoveries, two cures, and one. checking of malignant growth for several months. Dr. Frank H. Hamilton has tied the common carotid 11 times, with 8 recoveries, one cure, and one improvement. The case of cure was for aneurism. Most of the other cases were of malignant disease, in, which only temporary relief was expected. Three cases were by Dr. J. C. Hutchison: of Brooklyn, two of which were cured. One of these was a wound, and the other a. case of severe neuralgia, for which many teeth and portions of the alveolar process had' been removed. The fatal case was one of aneurism of the innominate artery, and the. patient survived till the 41st day. Five operations were by Von Langenbeck, with two. recoveries, including one cure. Four were by Liston, with one temporary recovery. Three were by Dr. George McClellan of Philadelphia, one for erectile tumor of orbit, one for erectile tumor of cheek, and one for vascular fungus of the dura-mater, All were cured. There are 31 cases of lioature of the common carotid given in Dr.Wyeth's table, performed by Dr. Valentine Zott, with 26 recoveries, including 9 cures and 6 improvements. Dr. A. B. Mott, son of Valentine, has performed the operation 11 times, with 10 recoveries, including 7 cures. Nunneley has tied the artery six times for aneu rism of the orbit, with five recoveries, including two cures, and one decided improve ment. There are 13 cases by Dr.Willard Parker. The first, in 1848, was'one of epilepsy. The patient had had a portion of skull removed by the trephine, -with temporary improvement; but, the attacks recurring, the carotid was tied. The patient died of some other affection 27 years after. Of the other 12 cases, 10 recovered, including 3 cured,
and 3 benefited. In four there was no benefit, but they were eases of malignant dis ease, which demanded interference. Pirigoff has tied the artery 12 times, with 6 recov cries, including 1 cure, but they were difficult cases; three for aneurism of the innomi nata, others for shot-wounds and tumors. Preston, in India, tied the artery six times, with recovery in all. One was for epilepsy- of 5 years' standing. There was no return of the attack for 5 months, and much improvement of the general health. Dr. Sands of New York has ligated the artery 8 times, with 5 recoveries, including 2 cures, one of which was in an operation for the removal of the lower jaw-bone. Syme has tied the artery 6 times, with 4 cures; Dr. John C. Warren of Boston tied the artery 8 times, with 8 recoveries, including 3 cures. The first operation was in 1827, for aneur ism of 4 years' standing, and was successful. Dr. James R Wood of New York has tied the artery 9 times, with 6 recoveries, including 2 cures and 2 improvements. The other cases were of a malignant nature, and incurable. Of 27 cases tabulated by Erichsen of lio-ature of both right and left common carotids, 19 recovered. There was an interval beCween the two operations of a few months; in one case of a year; and in one ease of 38 years; the right carotid having been tied by Dupuytren in 1819, the left by Robert in 1857, the latter operation being S0011 followed by death.
In regard to the effects upon the brain of ligation of the carotids, it may be remarked that ligature of one carotid causes cerebral disturbance in more than one-fourth of the cases, and of these more than one-half are fatal. The tying of both carotids, with at, interval of several days or weeks, appears not to cause more cerebral disturbance than when but one is tied. The cerebral symptoms caused by ligature of one or both carot. ids sometimes depend upon a diminished supply of blood, and consist of convulsive movements, syncope, and paralysis. In other cases there will be increased pressure upon the brain, followed by drowsiness, stupor, coma, and apoplexy. Inflammation is also one of the effects, usually coming on in a few hours after the operation. The • lungs are also frequently affected after ligation of the carotids, as has been specially pointed out by Jobert and Miller, becoming congested, with a tendency to a loNv form of infiatnmation, in consequence of deficient innervation.