An Inquiry into the Origin of 
the Use of the Ligature 
in the Treatment of 
Aneurysm. 
BY 
LEWIS A. ST1MSON, M. D., 
PROFEFSOR OF CUBICAL SURGERY IN THK MEDICAL DE- 
I'aUTMENT OF THE UNIVERSITY OF THK 
— (TTY OF NEW YORK. 
KEPKINTED FHOM 
ffbf Ncto Yovfc fttcDical journal 
for November 1, 1884. Reprinted from the NewYorlc Medical Journal for Nov. 1, 188Jf, 
AN INQUIRY INTO THE ORIGIN OF THE 
use of tiie ligature; 
IN TIIE TREATMENT oj ANEURYSM.* 
By LEWIS A. STIMSON, M. D., 
PROFESSOR OF CLINICAL SURGERY IN THE MEDICAL DEPARTMENT OF THE 
UNIVERSITY OF THE CITY OF NEW YORK. 
Among the many great advantages modern methods of 
treating wounds have conferred upon the art of surgery, one 
of the greatest is the security they have given to opera- 
tions upon the arteries. They have made it possible to tie 
the principal arteries of the limbs in continuity with almost 
absolute security against secondary haemorrhage, and with 
greatly diminished risk of causing gangrene. They have 
almost entirely done away with, or have relegated to the 
class of exceptions, that host of alternative methods by 
which for a century surgeons have sought to replace the 
ligature in the treatment of external aneurysms. It has 
become so safe to tie the femoral artery, for example, that 
the surgeon who, in an ordinary case of popliteal aneurysm, 
should resort to that operation in preference to any other 
method, would not be deemed indifferent to his patient’s 
best interests, or thought to have exposed him to any se- 
rious risk which might have been safely avoided. The effi- 
* Read before the New York Surgical Society, October 14, 1884. 2 
THE ORIGIN OF THE USE OF TIIE LIGATURE 
ciency, promptness, and painlessness of tlie method would 
he accepted as a complete equivalent for the advantages 
peculiar to such rival methods as digital pressure or the use 
of the elastic bandage. 
Such being the case, the question of priority in the 
introduction of the ligature gains in interest, and it is to 
that question that I ask your attention—a question that has 
been made to turn, not upon the simple fact of priority in 
the use of the ligature (concerning which there is no ob- 
scurity), but rather upon the motives, principles, and knowl- 
edge that guided those who first used it and who established 
the method. The facts are as follows: 
On the 30tli of January, 1710, Dominique Anel, a 
French surgeon practicing in Rome, operated upon a priest 
for a very large aneurysm of the brachial artery at the bend 
of the elbow, caused by an unskillful venesection; he ex- 
posed the artery above the tumor, and tied it as close to 
the latter as was possible; the patient made a good re- 
covery. 
The report of the case provoked much discussion, and 
a spirit hostile to Anel and to the new method showed 
itself in the country of his adoption, and it was charged 
against him, with a variety that testifies to the ingenuity of 
his detractors, that the case was not an aneurysm, that he 
had not cured it, and that the cure was only by a lucky 
chance. Against the first two charges he brought the writ- 
ten testimony of other surgeons who had seen the case; 
and against the third he offered arguments which show his 
correct apprehension of the manner in which the operation 
effects a cure. He says: “ I did not touch the sac at all, 
not doubting that the blood would leave it, since the way 
was open for it to pass down the limb, and that the sac, 
once emptied, would not refill; that the tissues of the mem- 
branes which formed it would not fail to shrink, and that IN THE TREATMENT OF ANEURYSM. 
3 
thus the tumor would disappear; which did not fail to take 
place as I had expected.” * 
The case, together with his reply to various criticisms, 
was published by Anel in 1714, and the account was repub- 
lished in various journals and books in 1716, 1739, 1749, 
and 1750 ; and the operation appears to have been repeated 
three times upon the brachial artery and once upon the 
temporal; in one of them the artery was tied “ on the inner 
side of the arm above the condyle ”; in all the aneurysm 
was traumatic. 
The question at once arises: Why was not this method 
at once accepted by the profession and generalized ? The 
answer is to be found, I think, in the attitude of the pro- 
fession toward aneurysms in general, and in the ignorance of 
the existence of the collateral circulation. At the time Anel 
operated, surgeons attempted the cure only of traumatic 
aneurysms of the brachial and temporal arteries following 
venesection ; against popliteal and femoral aneurysms they 
knew of no resource except amputation of the limb, and 
they had yet to learn even that the femoral artery could be 
tied without causing gangrene of the limb. One man 
(Morel, 1687) had applied the old method to a carotid 
aneurysm, but his patient died on the table, and the case 
served as a warning, not as an encouragement. The old 
method of laying open the sac and tying all bleeding points 
* “ Car au lieu que l’on a accoutuni6 de faire la ligature en haut et en 
bas de l’anevrisme, je ne la fis, dit il, que du cote du haut: d’ailleurs, ou 
ouvre le sac anevrismal, et je ne l’ai point touch6 du tout, ne doutant 
pas que le sang eontenu dans ce sac ne se dissipat, ayant la liberty de 
se porter du cote de l’extremit4, et que ce sac 6tant une fois vuide, ne 
se rempleroit plus de nouveau, que les tuniques des membranes qui le 
formoient, ne manqueroient pas de s’affaisser, et qu’ainsi la tumeur 
devoit disparoitre, ce qui n’a pas manqu6 d’arriver de meme que je 
l’avois pensd.”—Tr6voux, January, 1716, p. 163; reprinted in “Biblio- 
tht>que choisie de m6d,,” 1749, vol. ii, p. 472, art. “Anevrisme,” 4 
TIIE ORIGIN OF THE USE OF THE LIGATURE 
could be practiced without much difficulty and very success- 
fully upon these minor aneurysms, and, although Anel’s 
method recommended itself as easier of execution, it was, 
on the other hand, less certain to cure, because many of 
these aneurysms were arterio-venous aneurysms, and per- 
sisted or recurred after ligature of the artery. In two of the 
four cases above mentioned the disease returned, probably 
for this reason. In short, as regards some of the cases with 
which the surgeons of that time had most frequently to deal 
—arterio-venous aneurysms at the elbow—they possessed 
and successfully practiced the operation which to-day is still 
used in similar cases; and as regards the others, traumatic 
aneurysms of the brachial and temporal arteries, the same 
method was efficient; and, although the offered substitute 
was simpler, this advantage was offset by its failure when 
the aneurysm was arterio-venous ; and they did not recog- 
nize the cause of the failure, for they had not learned to 
discriminate between this variety (first described by William 
Hunter in 1757) and the ordinary aneurysm. They labored 
under no embarrassment, no great difficulty from which 
his operation could relieve them; it even exposed them to 
a variety of failure which they had not before known— 
the persistence or recurrence of the disease—and their 
knowledge of the resources of nature was not sufficient to 
enable them to extend their field of operation. What won- 
der that the new system was neglected and forgotten ! 
During the following half-century surgeons learned that 
it was not necessary to amputate the leg of a patient be- 
cause the femoral artery was wounded; ligature of the 
wounded artery had been successfully practiced as early as 
1G46, and again in 1688, but it was not formally proposed 
as a substitute for amputation until nearly a century later. 
And, at about the same time, the “old operation” was first 
employed in a case of popliteal aneurysm successfully (Keys- IN THE TREATMENT OF ANEURYSM. 
5 
lere, 1744), and, twenty years later, again successfully for 
femoral aneurysm (Burchell, 17G5). 
The attention of surgeons was now fully directed to the 
treatment of spontaneous aneurysms of the lower extremity, 
to the search for a proper substitute for the amputation 
which before had been the only resource. The first sub- 
stitute was to extend to them the old operation, to repeat 
in a somewhat modified form what had been done by An- 
tyllus more than fifteen hundred years before. Papers were 
written to prove that the obliteration of the artery would not 
cause the limb to fall into gangrene, and experience by 
actual operation rapidly accumulated. 
The results of that experience were far from satisfactory. 
Pott (“Surgical Works,” edited by Earle, vol. iii, p. 220) 
says of this operation: “ I have tried it myself more than 
once or twice—I have seen it tried by others; but the event 
has always been fatal. . . . Nor have I ever seen any other 
operation than that of amputation which has preserved the 
life of the patient”; and, as Mr. Holmes points out, the im- 
mediate success of the treatment of popliteal aneurysm by 
proximal ligature (the “ Hunterian” method), which itself has 
a mortality equal to that of amputation of the thigh, shows 
that the mortality after the old operation must have been 
something frightful. Something better needed to be found, 
and the times were growing ripe. Men were beginning again 
to think ; the long blank period of tradition and dogmatism 
was coming to an end, and men stood at the threshold of 
the new era in which, under the influence of the intellectual 
upheaval of the French Revolution and the leadership of the 
French physicians, medicine was to become a science based 
on objective knowledge. 
It had been learned that a popliteal or a femoral aneu- 
rysm could be cured by opening the sac and tying the artery 
above and below, but that the operation carried with it an 6 
THE ORIGIN OF THE USE OF THE LIGATURE 
enormous risk of death by secondary haemorrhage and the 
accidents arising from a large, irregular, suppurating wound. 
And, in describing the operation as incision of the sac and 
ligature of the vessel, it must be remembered that this order 
was frequently reversed and the artery tied before the sac 
was opened ; the object was a double one: to close the 
vessel and to empty the sac, and the order in which these 
objects were attained was immaterial. 
Desault’s first operation of ligature on the proximal side 
was done June 22, 1785, and Hunter’s December 12th of 
the same year; but nine years before this, 1776, Desault* 
had had an opportunity to dissect a specimen of popliteal 
aneurysm that had undergone spontaneous cure, and he had 
found the popliteal artery plugged by clotted blood, the 
femoral obliterated “ as far up as the origin of the muscular 
branches,” and likewise the upper third of the tibial arteries. 
An Italian surgeon, Assalini, who spent a year in Paris, and 
a few months subsequently in London, and had the good 
fortune to see both Desault’s and Hunter’s operations in 
1785, published a book f in 1787 in which he reports De- 
sault’s teaching in 1785; referring to this dissection of 
1770, he says he [Desault] thought the obliteration of the 
upper and lower portions of the artery xvas the result of the 
stagnation of the blood in them, produced by plugging of 
the aneurysm, and that for this reason, in the treatment of 
true aneurysms of large vessels, he did not apply two liga- 
tures and did not open the sac ; he placed a single ligature 
above the aneurysm if that was possible, or below it if the 
condition of the parts made that necessary. By this simple 
ligature he prevented the blood from entering the sac and 
circulating in the dilated vessels. 
* Broca, “Des anevrysmes,” p. 449, from “ Journal (le mod.” (Van- 
dermonde), vol. lxx, p. 473. 
j- “Essai medical sur les vaisseaux lyrophatiques,” Turin, 1787. IN TIIE TREATMENT OF ANEURYSM. 
7 
This report is the substance of a clinical lecture given 
by Desault at the time of bis first operation. It shows his 
conception of the method of spontaneous cure and of the 
means by which that method could be imitated; he sought 
to obtain coagulation of the blood through arrest of the 
current by placing an obstacle on either the proximal or 
distal side, and he knew—he had known for nine years—that 
it was not necessary to turn out the clots, that the incision 
of the sac could be dispensed with if the artery could be 
otherwise closed. But how was that to be done ? Naturally 
enough, he first tried compression, and, that failing, then the 
ligature in continuity. Broca tells us that the first case of 
which we have knowledge that came under Desault s care 
wTas an axillary aneurysm, shortly before February, 1785, 
and he attempted to treat it by compression of the subcla- 
vian artery. Ligature of the subclavian was at that time an 
unknown operation. For some reason the patient left De- 
sault and put himself under the care of another surgeon, 
who mistook the tumor for an abscess and opened it. 
The idea of compression of the artery above the tumor 
was not new or unknown. In 1761 Kretschmer treated a 
traumatic aneurysm, resulting from a gunshot wound of the 
brachial artery, by direct pressure upon the tumor and by a 
tourniquet on the lower portion of the axillary artery ; the 
latter was kept in place for three months, and the patient 
was completely cured. In 1765 Guattani treated a popliteal 
aneurysm by a bandage applied directly to the leg and 
tumor, and to the thigh over a long, narrow pad, placed 
along the course of the femoral artery, with the expressed 
intention of preventing, wholly or in part, the flow of blood 
to the tumor. And again, in September, 1785, at a consul- 
tation, held in London, on a case of femoral aneurysm as 
large as a middle-sized China-orange, at which eight sur- 
geons (of whom Hunter was one) were present, all “ were 8 
THE ORIGIN OF THE USE OF THE LIGATURE 
convinced of tlic impracticability of affording the patient 
any assistance by the operation usual for aneurysms,” and 
advised that the artery should be compressed at the groin ; 
the attempt was made, but soon abandoned, because of the 
pain.* 
We are now able to understand the position of the pro- 
fession at the time; we know the extent of their knowledge, 
and with what problems they were dealing; we can put 
ourselves in Desault’s place, interpret his act, and compre- 
hend his motives. Let us see if that act was, as the parti- 
sans of Hunter claim, merely a lucky blunder, conceived in 
ignorance and passed without appreciation. 
Desault knew an aneurysm could be cured without an 
incision to turn out the clot; he knew, as did most other 
surgeons, that the femoral artery could be tied without 
causing gangrene. He knew also that the principal cause 
of death after the common operation was secondary liremor- 
rhage, and the avoidance of this danger was his principal 
preoccupation, as it was also that of Hunter. Wc have seen 
that, far from trying to get rid of the clot, he sought to 
cause clotting, and at the same time avoid haemorrhage, by 
compressing the artery on the proximal side. The attempt 
failed, presumably because of pain, and, when the next case 
came under his care, he substituted the ligature for com- 
pression. 
The operation was done June 22, 1785, at the Hotel 
Dieu in Paris. The patient was thirty years old; the aneu- 
rysm, of the popliteal artery, was as large as a turkey’s egg. 
By an incision two inches long, Desault exposed the artery 
“ immediately below the ring of the third adductor,” sepa- 
rated it from the nerve, and tied it; he placed also a liga- 
ture d'attente above it, and tied this on the sixth day. The 
* “London Medical .Journal,” 1788, p. 149. “Cases of the Sponta- 
neous Cure of Aneurysm,” by Mr. Edward Ford. IK TIIE TREATMENT OF ANEURYSM 
9 
tumor promptly diminished to half its size, and the oedema 
of the leg disappeared. On the eighteenth day the ligature 
came away, and on the following day a large quantity of 
pus and blood escaped through the wound, apparently in 
consequence of rupture of the sac, and the wound then 
healed. 
Desault operated upon only one additional case; this 
was shortly after Hunter’s first case, and Desault, following 
Hunter’s example, which was known to him, placed the 
ligature on the femoral artery, but at a still higher point. 
The patient died. 
There remains now to he considered only the part taken 
by Hunter in the introduction of the ligature. AVe have 
already seen that in September, 1785, three months after 
Desault’s operation, he had nothing to suggest in the treat- 
ment of a femoral aneurysm as large as a medium-sized 
orange, except compression of the artery in the groin, and 
that this was unsuccessfully tried. Three months later, 
December 12, 1785, he tied the femoral artery for a popli- 
teal aneurysm. 
The case was reported by Everard Home, in the “ Lon- 
don Medical Journal,” 1780, p. 394, and again, with four 
similar operations done by Hunter and three by others, in 
“ The Transactions of a Society for the Improvement of Medi- 
cal and Surgical Knowledge,” London, 1793, p. 138. The 
date of the reading of the latter paper is not given, but that 
of the one that precedes it is September, 1789, and that of the 
one that follows it is September, 1790. The second account 
is almost a literal transcript of the first. I quote from the 
second: 
The patient was a coachman, forty-five years old, and 
the aneurysm “ was so large as to distend the two hamstrings 
laterally and make a very considerable rising between 
them. . . . The operation was begun by making an incision 10 
THE ORlGltf OF THE USE OF THE LIGATURE 
on the anterior and inner part of the thigh rather below its 
middle, which incision was continued obliquely across the 
inner edge of the sartorius muscle, and made large, to give 
room for the better performing of whatever might be. 
thought necessary in the course of the operation. The 
fascia which covers the artery was then laid bare about 
three inches in length, after which the artery was plainly 
felt. A slight incision, about an inch long, was then made 
through this fascia, along the side of the vessel, and the 
fascia dissected off; by this means the artery was exposed.” 
A double ligature was passed around the artery [and vein] 
and “ cut so as to form two separate ligatures. The artery 
was now tied by both these ligatures, but so slightly as only 
to compress the sides together. A similar application of 
ligature was made a little lower. The reason for having 
four ligatures was to compress such a length of artery as 
might make up for the want of tightness, it being wished to 
avoid great pressure on the vessel at any one part.” [A 
fuller explanation of this practice is given in an earlier sen- 
tence (p. 145) as follows: “ The cause of failure arises from 
tying a diseased artery, which is incapable of union, in the 
time necessary for the separating of the ligature.” Appar- 
ently, Hunter thought that by tying the artery loosely more 
time would be given for the artery to become sealed before 
the ligature cut through. Certainly his intention was not 
simply to diminish the stream, for the ligatures cut through, 
and in his subsequent operations he used a single ligature 
and tied it tightly.] Secondary haemorrhage occurred on 
the ninth day, but was controlled by a tourniquet; “ on the 
fifteenth day some of the ligatures came away, followed by 
a small discharge of matter, the tumor in the ham being 
lessened.” In April, and again in July, more of the liga- 
tures came away, and on July 8, 1786, he was discharged 
cured. April 1, 1787, fifteen months after the operation, IN THE TREATMENT OF ANEURYSM. 
11 
he died of remittent fever. Ilis following four operations 
were similarly performed, except that in the fourth and fifth 
the artery alone, and not the vein, was tied. The second 
died of secondary haemorrhage on the twenty-sixth day. 
This is followed by the account of three operations per- 
formed after the same method by other surgeons, of one of 
which, by Pott, he says: “ This mode of operating* was 
adopted by Pott in a case of popliteal aneurysm,” and he 
goes on to describe how the artery, probably the popliteal, 
was exposed by “an incision five inches in length, upon the 
posterior part of the thigh . . . between the two ham- 
strings”; and he adds (p. 173): “The mode of taking up 
the artery in the ham must be always unfavorable to the 
future success of the operation, if either the artery itself 
should be diseased, or if the tumor, by being so contiguous 
to the violence done in the operation, should be affected by 
the consequent inflammation, which seems to have been 
the case in Mr. Pott’s operation, as I understand two ab- 
scesses were found close to the sides of the sac.” Here is 
the same operation as that done by Desault (ligature of the 
popliteal artery) and quoted by Home, in the first author- 
ized account of Hunter’s method, as an example of Hunter’s 
method, and this in itself would be sufficient, even if it 
were not corroborated again and again in the article, to 
show that Hunter’s only idea was to tie the artery without 
opening the sac, and the reason he gives fur tying it at a 
somewhat higher point (two inches at the most) than De- 
sault and Pott did is (“ London Medical Journal,” and re- 
peated by Home, loc. cit., p. 14G) that, “ if the artery 
should afterward [after ligature of the popliteal] give 
way, there will not be a sufficient length of vessel remaining 
to allow of its being again secured in the ham. To follow 
the artery up through the insertion of the triceps muscle, 
* Italics mine. 12 
TlIE ORIGIN OF THE USE OF THE LIGATURE 
to get at a portion of it where it is found [? sound], becomes 
a very disagreeable part of the operation; and to make an 
incision upon the fore part of the thigh, to get at and secure 
the femoral artery, would be breaking new ground—a thing 
to be avoided, if possible, in all operations.” In one of the 
remaining two cases, a femoral aneurysm, extending to with- 
in two inches of Poupart’s ligament, Mr. Cline tied the 
artery half an inch below the origin of the profunda, and, 
as the dissection showed, two inches above the orifice of 
the sac. This also is given in illustration of the method, 
and yet there could have been no collateral branches be- 
tween the ligature and the sac; certainly none are men- 
tioned. 
In short, his one idea was to avoid secondary haemor- 
rhage by tying the artery at such a distance from the aneu- 
rysm that it would probably be found healthy, and to make 
the application of a second ligature easy if such haemorrhage 
should occur. Of the “excogitation of a principle by pro- 
found reasoning,” of which Mr. Holmes speaks, there is not 
a trace in this account; of the second “great merit” at- 
tributed to him by the same able writer, “ that it was not 
necessary to stop the circulation through it [the sac] abso- 
lutely, but only,” as he said, “to take off the force of the 
circulation,” there is no justification except this quoted 
phrase, which, in view of the fact that the ligatures divided 
the artery completely, although, perhaps, more slowly than 
if they were tied tightly, certainly can not have the mean- 
ing attributed to it of only diminishing the stream of blood, 
and which, even if it did, was abandoned after the first 
operation, when he substituted a single ligature tied tightly 
for four ligatures tied loosely. 
Moreover, the idea of curing an aneurysm by simply 
diminishing the flow of blood through it was by no means 
new; it underlay all the preceding attempts to cure by IN TIIE TREATMENT OF ANEURYSM. 
13 
compression, and was plainly included in Desault’s lecture 
reported by Assalini and quoted above. It was not until 
after the ligature in continuity bad shown that the danger 
of secondary haemorrhage was still present that very forcible 
compression, to effect complete and permanent closure of 
the artery, was tried as a substitute for the ligature. 
The three grand merits claimed for Hunter (Holmes’s 
“ System of Surgery,” art. “ Aneurysm ”) are that he had 
seen: 1. That it was not necessary to turn out the clots; 
2. That it was not necessary to stop the circulation through 
the sac absolutely, and that, therefore, the artery might be 
tied at some distance above it; and, 3. That the ligature of 
the main artery would not involve gangrene of the limb. 
Now, of these, the first was certainly known by Desault, 
through a post-mortem examination, and probably by most 
other surgeons, as is proved by their attempts to cure by 
compression. As regards the second, the fact contained in 
the first clause, that it was not necessary to stop the circu- 
lation completely, had been long known before his opera- 
tion ; and the inference stated in the second clause was not 
drawn by Hunter, and was not given as his reason or justi- 
fication for placing the ligature at a higher point. Home’s 
paper (which, it must be remembered, is an official one, and 
made in Hunter’s name) does not contain a single reference 
to collateral branches given off between the ligature and 
the aneurysm.* The phrase “that simply taking off the 
force of the circulation is sufficient,” which is also quoted 
as meaning that a diminished stream of blood was expected 
* The only reference to collaterals in the first paper is one (p. 399) 
to the effect that “ surgeons have laid too much stress on the necessity 
of large collateral branches being present to insure the success of this 
operation, . . . since we find that the trunk of the femoral artery may 
be taken up in any part of the thigh without producing mortification 
of the limb,” 14 
THE ORIGIN OF THE USE OF THE LIGATURE 
to be brought to the aneurysm by collaterals, is the only 
thing in the entire paper that can suggest such an idea; 
and that neither this meaning nor the one above referred to 
—of only partly compressing the artery—was intended to 
be conveyed by it, is shown not only by actual statement 
of the reasons and objects of the operation, but also by a 
case which he quotes (p. 156) in illustration of his argu- 
ment—a case of spontaneous cure of an aneurysm by in- 
flammation of the sac, accompanied by arrest of pulsation 
in the sac and in the artery immediately above it. If the 
phrase were written out in full to express the entire idea, it 
would read : “ It is sufficient simply to take off the distend- 
ing force of the arterial stream from the blood contained 
within the aneurysm ; the blood will then coagulate in the 
sac and in the adjoining part of the artery, and the prog- 
ress of the disease will be stopped; it is not necessary to 
open the sac.” * The opening of the sac is what he was 
thinking of when he used the word “ simply,” not of the 
presence or absence of collateral branches, not of merely 
diminishing the stream. 
* Compare the corresponding paragraph in “ London Medical Jour- 
nal,” letter of Home, November, p. 393. 
“ From these considerations [those quoted above about the desira- 
bility of not breaking new ground], suggested by the accident of the 
artery giving way, which happened several times to Mr. Hunter, he 
proposed, in performing this operation, that the artery should be 
taken up at some distance from the diseased part, so as to diminish 
the risk of haemorrhage ami admit of the artery being more readily 
secured, should any such accident happen. The force of the circulation 
being thus taken off from the aneurysmal sac, the cause of the disease 
would, in Mr. Hunter’s opinion, be removed; and he thought it highly 
probable that, if the parts were left to themselves, the sac, with the 
coagulated blood contained in it, might be absorbed, and the whole of 
the tumor removed by the actions of the animal economy, which would 
consequently render any opening into the sac unnecessary,” [Italics 
mine.] IN THE TREATMENT OF ANEURYSM. 
15 
The third great merit—that Hunter saw that the liga- 
ture of the main artery would not involve gangrene of the 
limb—had been known for a hundred years, and had been 
proved by every successful case in which the old operation 
had been used, and also by Desault’s ligature in continuity 
six months before. 
Both Desault and Hunter had the same object in view : 
to cure the aneurysm without opening the sac. Desault 
had a small aneurysm, and tied the popliteal at its upper 
end. Hunter had a large one, and tied the artery a little 
higher up (he could not well have done differently). De- 
sault, in his second operation, went still higher, and tied a 
little below the apex of Scarpa’s triangle ; subsequent opera- 
tors have habitually tied in the triangle itself. Even the 
observation claimed for Hunter—that the artery was diseased 
above the aneurysm, and that this was the cause of the 
secondary haemorrhage—had been made before him, and 
was given by Pott as a reason for preferring amputation to 
the old operation (Pott, loc. cit., p. 220). 
I see nothing in Hunter’s operation radically to differ- 
entiate it from Desault’s and to justify the ascription of the 
method to the English surgeon. It seems to me to be be- 
yond question that Desault had grasped the principle, and 
the difference of an inch, or two or three or six inches, in 
the distance, is a matter of detail which is to-day subor- 
dinated to the rule that the artery should be tied at the 
nearest accessible point that does not directly involve in- 
jury to the sac.* 
* It seems unnecessary, in view of these facts, to consider the ques- 
tion, whether or not Hunter knew of Desault’s operation before per- 
forming his own. The facts bearing upon it are, that Assalini was at 
Desault’s operation, afterward went to London, and was present at 
Hunter’s operation, and that Hunter, three months before his operation, 
seems to have made no suggestion of this treatment in the case of 16 
THE LIGATURE IN THE TREATMENT OF ANEURYSM, 
Why Hunter’s name should have become so pre-emi- 
nently identified with it is to be explained by reasons en- 
tirely independent of the principle involved, and of the 
measure in which that principle was grasped by the two 
great rivals. Hunter enjoyed a great authority and was 
widely known ; his example was followed, his practice was 
quoted by those who wrote in our language. Desault lived 
and made his great discovery at a time when his nation 
was entering upon a revolution that shook the world and 
isolated France by war for nearly twenty-five years; he 
made it at a time when men were occupied with mighty in- 
terests beside which the advances of science seemed as 
nothing; at a time when, to Lavoisier pleading for another 
fortnight of life that he might complete certain experiments, 
the answer was: “ The Republic has no need of such.” 
What wonder that at such a time and amid such surround- 
ings his discovery should have passed unheeded by those 
about him, and have remained unknown by those who were 
at war with his country ? It is our privilege, our duty, to 
recognize his work and to give him the credit that is his 
due. 
femoral aneurysm, quoted above, which he saw in consultation, and 
which, after a futile attempt at cure by compression, was abandoned 
to its fate. The lew York Medical Journal, 
A WEEKLY REVIEW OF MEDICINE. 
Published by 
0. Appleton & Co. 
Edited by 
Frank P. Foster, 
M. D. 
Tiie New York Medical Journal, now in the twentieth year of its* 
publication, is published every Saturday, each number containing twenty- 
eight large, double-colutnnea pages of reading-matter. By reason of the 
condensed form in which the matter is arranged, it contains more reading- 
matter than any other journal of its class in the United States. It is also 
more freely illustrated, and its illustrations are generally better executed, 
than is the case with other weekly journals. 
It has a large circulation in all parts of the country, and, since the pub- 
lishers invariably follow tho policy of declining to furnish the Journal to 
subscribers who fail to remit in due timo, its circulation is bona Jide. It is 
largely on this account that it is enabled to obtain a high class of contrib- 
uted articles, for authors know that through its columns they address the 
better part of the profession; a consideration which has not escaped the 
Jotice of advertisers, as shown by its increasing advertising patronage. 
The special departments of tho Journal are as follows: 
LECTURES.—The frequent publication of material of this sort is a prominent fea- 
ture, and pains are taken to choose such ns will prove valuable to the reader. 
OUIOINAL COMMUNICATIONS.—In accepting articles of that class, regard is 
had more particularly to the wants of tho general practitioner, and all the 
special branches of medicine uro duly represented. 
BOOK NOTICES.—Current publications are noticed in a spirit of fairness, and with 
the sole view of giving information to the render. 
CLINICAL REPORTS are also a regular feature of tho Journal, embracing clinical 
records from tho various hospitals and clinics, not only of New York, but of 
various other cities, together with clinical contributions from private practice. 
EDITORIAL ARTICLES are numerous and carefully written, and we are able to 
give timely consideration to passing events. 
MINOR PARAGRAPHS.—Under this heading are given short comments and 
notes on passing events. 
NEWS ITEMS contain the latest news of interest to the profession. 
OBI TUARY NOTES announce the deaths which occur in the ranks of the profes- 
sion, with a brief history of each individual when practicable. 
SOCIETY PROCEEDINGS are given promptly, and those of a great number of 
societies figure. At the same timo wo select for publication only such as we 
think profitable to our readers. 
REPORTS ON THE PROGRESS OF MEDICINE constitute a feature of the 
Journal which we have reason to think is highly valued by our readers. 
MISCELLANY includes matter of general interest, and space is also given for 
NEW INVENTIONS and LETTERS TO THE EDITOR. 
As n whole, we are warranted in saying that the New York Medical 
Journal is regarded with the highest favor by its readers and by its con- 
temporaries. 
!Subscription price, §5.00 per annum.