BONE AND JOINT SURGERY xxvii
to tie the carotid artery, for it was thought that so much of the blood supply to the brain would be cut off that death would immediately result. Twitchell realizing, however, that the only possible salvation of his patient lay in securing the artery, compressed it with one hand against the vertebra, while with the other he dissected it free and with the aid of the patient's mother applied a ligature. Twitchell wrote very little, and for a long time Sir Astley Cooper was credited with this opera- tion, although, according to Twitchell's biographer, Dr. Albert Smith ("New Hampshire Journal of Medicine," 1850-51, vol. i), Twitchell per- formed the operation eight months previous to Cooper's first operation, which resulted in the death of the patient. Smith says of this opera- tion: " Thus in an obscure country town, alone, unaided either by counsel or competent assistance, inexperienced and without any preparation, his only help an agitated mother, did he perform with masterly skill and self- possession what was then one great, untried and unsettled operation of surgery."
William Gibson, a native of Maryland, the professor of surgery in the University of Maryland, and later, from 1818 to 1854, in the University of Pennsylvania, was the first to tie the common iliac artery. ("American Medical Recorder," 1820, iii.)
Philip Syng Physick first advised the use of animal ligatures (" Eclectic Repertory," Philadelphia, 1816, vol. vi), which he cut close and left buried in the wound in tying arteries. Physick made the ligatures of buckskin, rolling them under a marble slab. There is still considerable discussion as to the advisability of using absorbable ligatures, but there are those who believe that this is an important contribution to surgery. Among other important contributions Physick invented the tonsillitome and advocated rest in the treatment of hip-joint disease. About ten years later, Jameson ("Medical Recorder," Philadelphia, 1827, vol. xi), carried out a series of experimental ligations on animals which he felt showed convincingly the superiority of animal ligature material. He credits Physick with introducing this.
In connection with the ligation of arteries may be mentioned the treatment of aneurysm by digital compression. This was introduced by Jonathan Knight (" Boston Medical and Surgical Journal," 1845, vol. xxxviii), of New Haven, Connecticut, who succeeded in curing a popliteal aneurysm in this way. Jonathan Mason Warren, of Boston, also treated two inoperable aneurysms of the subclavian artery successfully by com- pression applied with weights directly over the aneurysmal tumor. ("Surgical Observations," Boston, 18G7.)
Bone and Joint Surgery. — Excisions of bones and joints had been practised in certain cases long before the settlement of America, but Horatio G. Jameson, a Baltimorean, in 1820 first excised the upper
