5th. No foreign body is left in the wound, thus favoring union by the first intention.

6th. There is no risk of pyæmia or phlebitis.

7th. It is applicable to all sizes and to all conditions of the arteries where the external coat is perfect.

8th. It is a mechanical appliance which has a uniform effect, and it requires but little skill or practice in its application.

These are advantages which can be claimed by no other method, and if the instrument sustains itself in the hands of others, as it promises to do, it will be found useful in many cases where neither of the present modes of closing arteries could be equally well applied.

I have had occasion to make the following severe trials of the artery constrictor. The instrument has the same effect upon the dead artery as upon the living, but it acts more perfectly. upon the living vessels.

EXPERIMENTS UPON DEAD ARTERIES.

Applied to the femoral or other large-sized artery of man (post mortem), it had the effect (represented in the accompanying cut) of perfectly closing the vessel, so that it resisted the flow of water forced into it by means of a Davison syringe. This experiment I have repeated frequently, and always with the same result.

3

EXPERIMENT UPON A LIVING DOG.

The constrictor applied to the abdominal aorta of a living dog, closed the vessel perfectly-no blood escaped from the constricted endwhich could be seen pulsating till the animal

died from the combined effects of chloroform and the operation.

EXPERIMENTS UPON LIVING SHEEP.

In the month of December the following operations were performed upon the carotid arteries of full-sized sheep:

The common carotid artery was constricted in its continuity as rapidly as possible, and the constricted portion removed at once. This operation was performed to see the immediate effect upon the vessel, and the rapidity with which the coagulum would

form. Upon examination of the specimen, a perfect invagination of the internal and middle coats, at the point of constriction, and a firm clot on either side of it, closing the vessel fectly.

OPERATION ON CAROTID ARTERY OF SHEEP, IN SECTION.

per

After the above operation the artery was, of course, exposed in such a way that it bled freely from both ends; the constrictor was applied to them with the effect of closing them perfectly, and the sheep was allowed to run in the yard while another sheep was operated upon; and then the animal was killed, and the artery examined. It was found closed by the invaginated internal and middle coats, and a firm clot covering them, as represented in cut.

OPERATION ON CAROTID ARTERY OF SHEEP, IN SECTION.

On another sheep the carotid artery was exposed and cut entirely across. The constrictor was then applied to both ends of the vessel, with the effect of perfectly closing the vessel. The animal was killed soon after, and the arteries were found occluded by a firm clot, as represented in the cut.

CAROTID ARTERY OF A HORSE CONSTRICTED IN ITS CONTINUITY.

On the 11th of November a large-sized horse, in good condition, was placed at my disposal by the kindness of Drs. A. Large and A. Liautard, of the New York Veterinary College, and the following operations were performed in the presence of these gentlemen, Dr. Robert F. Speir, Dr. Robinson, and a class of students. Dr. Liautard cut down upon and exposed the left carotid artery in a very skillful and careful manner. I applied the constrictor to the artery in its middle third, in its continuity; the constrictor being put upon the artery, and removed as soon as the screw could be turned to the required extent, which took only one minute and thirteen seconds.

Dr. Large examined the facial artery after the operation, and found that there was a diminution in its force, as much as could be expected considering the extent of the collateral circulation. through the vertebral artery. The wound was closed by Dr.

Liautard, and the horse was led to his stall. No untoward event occurred after the operation, and on the 25th the wound had entirely healed, and the animal was ready for the second operation, viz:

CONSTRICTION OF THE CAROTID ARTERY OF

A HORSE-THE ARTERY BEING CUT EN-
TIRELY THROUGH WITH THE KNIFE-NO

HÆMORRHAGE.

On the 25th of November the same horse was operated upon as follows: Dr. Liautard exposed the right common carotid for about two and a half inches in its middle third. I applied the constrictor at two points, about one inch and a half apart, and then, with the knife, divided the vessel between them. The artery immediately contracted at each end, the distal end being drawn up in the neck. The cardiac end retracted downward, but was at once projected into the wound again by the force of the heart's action, and it could be seen pulsating in keeping with the action of the heart, rising and falling one-half inch with every beat of the heart. Not one drop of blood escaped from the end of the artery. On the contrary, the cardiac extremity, which was seen beating in the wound, presented the yellowishwhite color of the inner coats which were exposed by the operation. The wound was kept open, and the artery exposed, that it might be observed by a class of veterinary students; and then Dr. Liautard brought the wound together with the sutures, and the horse was led to his stall, looking quite sleepy from the effects of the operation. There was no hæmorrhage from the wound or the artery; and in twenty-two hours the horse died from the effect of the operation, the other carotid. having been tied previously.

Dr. Liautard removed the arteries, and we examined them together.

The first specimen, from the left carotid

tied in its continuity, exhibited the effect of the constrictor upon an artery when applied in its continuity-viz., division of the internal and middle coats, with a continuous and uninjured external coat. The clots in this artery were small and easily washed out by a current of water. This operation was such as would be appropriate in the treatment of aneurism.

The second specimen-right carotid constricted in section-exhibited the effect of the constrictor upon the artery when applied to it in section, as would be appropriate in amputations. The divided artery was found separated about one and a half inches; both ends were closed and occupied by a firm clot, which, with the invaginated internal and middle coats, had effected a complete occlusion. There had been no hæmorrhage from either end of the artery.

Considering the large size of the carotid in the horse, I think this test may be fairly considered a very severe one. The appearance of the artery is well shown in the accompanying cut, p. 503.

I am not aware of any other means by which so large a vessel could be closed so rapidly and so perfectly. The advantage of leaving the wound free from foreign bodies was plainly indicated in the rapidity with which the wound healed after the first operation-a part of the wound closing by the first intention—a rare occurrence in the horse.

AMPUTATION AT THE HIP-CONSTRICTION OF THE
FEMORAL AND PROFUNDA ARTERIES.

On the evening of Saturday, October 8, 1870, a boy was run over by a street car, and taken to the Brooklyn City Hospital. Dr. Cochran, the surgeon then on duty, being sick, requested me to see the patient for him. I found the left limb terribly crushed; the knee-joint was disarticulated, and the soft parts of the thigh lacerated to such an extent as to allow the femur to project from the wound several inches, the leg being attached to the thigh by a band of skin and a few shreds of bruised tis

sue. The only chance for the boy seemed to be amputation at the hip, which I performed at once. As soon as the anterior flap was made, the femoral artery and the profunda artery were taken up, and the artery constrictor applied to them, the effect of which was to arrest hæmorrhage from these vessels entirely. They were left in this condition until the remainder of the operation the formation of the lower flap and the disarticulation of the head of the bone-was completed, and the wound washed and ready for coäptation. All this time the ends of the arteries constricted could be seen pulsating in the wound; those present of the resident staff of the hospital and myself were satisfied with the security of the vessel. However, considering the circumstances in this case, I was not willing to trust to the constrictor, feeling that it would be injudicious to do so in the absence of any of my colleagues, and especially as I knew of the objections of Dr. George Cochran, for whom I operated, to any method of closing arteries other than by the ligature. This, added to the fact that it was an accident case which might involve litigation, induced me to finally apply ligatures, and close the wound as usual in such cases. I removed a portion of the profunda artery which had been constricted. The femoral artery being short, I did not feel at liberty to remove a portion of that vessel.

AMPUTATION OF THE THIGH-CONSTRICTION OF THE FEMORAL ARRTEY.

On the 8th of December, C. W., aged fifty-four, was brought to the Brooklyn City Hospital with a compound comminuted fracture of the leg. Dr. D. E. Kissam, visiting surgeon then on duty, hoped to save the leg, and treated it with this end in view; but symptoms of gangrene appearing, it was decided to amputate at the thigh. On the 12th of December this operation was performed by Dr. Kissam amputating the thigh at its lower third, after the circular method. At the request of Dr. Kissam I closed the femoral artery with the constrictor, this vessel being the only artery exposed. The femoral vein, which bled more than usual, was also closed by the constrictor. The