[Reprinted from The Medical News, September 7, 1895.] 
SUCCESSFUL LIGATION OF THE LEFT 
COMMON CAROTID ARTERY. 
By FRANK L. LAPSLEY, A.B., M.D., 
RESIDENT INTERNE, LOUISVILLE CITY HOSPITAL. 
On March 27th I was called to see M. E., aged thirty- 
three years, a bricklayer, and found him in a state of 
intoxication, with the surroundings strongly suggestive 
of his having attempted suicide. I learned that in at- 
tempting to shoot himself through the head his arm had 
been struck by someone, knocking the pistol downward, 
when it was discharged. The bullet, of 32-caliber, en- 
tered the mouth and passed out at the left angle, just 
between the superior and inferior maxillary bones. 
There was evidence of slight hemorrhage having oc- 
curred, but this had ceased when I reached the man. 
He was at once conveyed in the ambulance to the city 
hospital, where, with strict aseptic precautions, an ex- 
ploration of the wound was made, using my little finger 
as a probe. I found the course made by the bullet to 
be slightly upward and outward. The bullet was 
located against the ramus of the inferior maxillary bone 
and was extracted with a pair of artery-forceps. It was 
so battered out of shape I could not determine posi- 
tively, but supposed that it was removed in toto. 
Further examination showed that the bullet had 
struck the ramus near its lower anterior border. Three 
small spicules of bone were felt and removed. 
Slight hemorrhage followed this manipulation, but 
was easily controlled by packing with iodoform-gauze. 
The wound was thoroughly irrigated with a solution of 
mercuric chlorid I : 3000. 2 
At the end of forty-eight hours there was evidence of 
beginning suppuration, which continued freely, despite 
the daily irrigation with mercuric chlorid and packing 
with fresh gauze. The jaw and neck were so swollen 
as to prevent the man from opening his mouth further 
than to admit a small glass-tube, through which he took 
stimulants and nourishment. The administration of 
morphin and applications of heat were necessary to 
relieve the intense suffering. 
At midnight of April 10th, two weeks from the re- 
ception of the injury, the man suddenly had a profuse 
secondary hemorrhage. This was readily controlled 
by packing firmly in the angle of the mouth. This 
hemorrhage was, I think, due to the process of sup- 
puration extending into the walls of one of the facial 
branches. On the next day I deemed it advisable to estab- 
lish freer drainage, and accordingly made a counter- 
incision in the neck on the left side about two inches 
from the median line. This opening communicated 
with the mouth, and the entire tract was irrigated daily 
with mercuric-chlorid and hydrogen-dioxid solutions. 
The patient continued to suffer great pain in the jaw, 
the side of the face, and the ear. The swelling and 
inflammation of the neck and the side of the face sub- 
sided. 
On April 17th, just one week later and at the same 
hour of night, the man had another and more profuse 
hemorrhage than the first. I reached his bedside 
quickly and observed blood to be streaming from the 
wounds both in the mouth and neck. I at once com- 
pressed the carotid artery and the hemorrhage ceased, 
but the patient having lost two pints of blood was so ex- 
sanguinated that he fainted. He was resuscitated by 
stimulants and application of heat. 
I packed the wound in the mouth and applied a 
tight compress over the wound I had made in the neck. 
I realized that the case now demanded immediate sur- 3 
gical interference; so I summoned Drs. Grant, Dugan, 
and Vance, and when they saw the case a few hours 
later a false aneurism existed. 
It was agreed best and safest to ligate the common 
carotid artery, and the operation was undertaken by Dr. 
Grant and myself. The patient was accordingly pre- 
pared and anesthetized, taking the anesthetic badly. 
The point selected as the most favorable was that part 
of the vessel which is at the level of the cricoid cartilage. 
It is unnecessary to give a detailed account of the steps 
of the operation, but suffice it to say the vessel was 
reached with little difficulty and ligated with No. io 
braided Chinese silk, bearing in mind the relation 
thereto of other important structures. The incision was 
carried up over the angle of the jaw, where, after turn- 
ing out some clots, considerable necrosis of the bone 
was discovered. Another portion of the bullet was 
found lying against the anterior surface of the bone, 
showing that it had split and perforated the ramus. 
This was thoroughly scraped and irrigated, and allowed 
to remain open and granulate from the bottom. Two 
sutures were introduced at the lower angle of the wound 
and the usual antiseptic dressings applied. The man 
rallied from the shock nicely, and was at once put upon 
stimulants, reconstructives, and plenty of nourishing 
diet. His convalescence was gradual and permanent. 
The wound healed kindly, and he now suffers no incon- 
venience, except a slight stiffness of the jaws, which I 
think he will eventually overcome. 
The pulsation in the temporal artery is entirely ab- 
sent on the left side. The patient was discharged from 
the hospital on June 24th.