ARTERY, PATHOLOGICAL CONDITIONS OF. 



243 



appears as a patch, slightly elevated, of a red 

 or purple colour, being generally of a brighter 

 hue on the face or breast, and darker on those 

 parts usually kept covered. The colour of the 

 nasvus also seems to depend on the quality of 

 the blood with which it is altogether or prin- 

 cipally supplied, as sometimes tumours are met 

 with which might be termed venous aneurisms 

 of this description, consisting evidently of 

 veins indurated, knotted, and contorted on 

 each other, increasing gradually, and never pul- 

 satile; these frequently occur in different parts 

 of the body of the same individual, and are always 

 attended more or less with pain. The arterial 

 naevus is, however, most intimately connected 

 with the present subject. It sometimes pre- 

 sents an appearance as if irregularly granulated ; 

 more frequently is it smooth and velvety. The 

 deep stain possesses a sharp and circumscribed 

 edge, yet a net-work of minute vessels may be 

 seen like an areola around it, conveying blood 

 to nourish the tumour, and therefore forming 

 an important part of the diseased structure. 

 The tumour is increased in size and intensity of 

 colour by every thing that accelerates the circu- 

 lation by exercise, intemperance, paroxysms 

 of passion, and even by an elevation of tem- 

 perature, and hence the supposed marks of 

 currants and other fruits are said to grow red 

 and ripen at the proper season. Its feel is 

 doughy, and communicates a sensation as if it 

 contained a jelly. It sinks, and is diminished 

 by pressure on its surface, but immediately the 

 pressure is removed it recovers its former level. 

 It may be stationary for years, but the contrary 

 is generally observed ; its growth, however, is 

 always irregular, being more rapid at one period 

 than another. 3. The distinguishing charac- 

 teristic of the third form of nsevus is its pulsa- 

 tility. It beats synchronously with the heart 

 and arteries. When wounded, blood of a 

 bright red colour flows from it, often in such 

 abundance as to occasion syncope or even more 

 dangerous consequences. As it grows larger, 

 the skin gradually becomes thin ; it bursts and 

 bleeds ; masses of coagula lie upon its surface, 

 putrefying and occasioning the most unsightly 

 appearance and most offensive odour. This 

 is a condition that cannot endure long, the 

 patient soon becomes irritable and weak, and 

 falls a victim to that irregular, ill-formed hectic 

 which is seen in every disease accompanied by 

 extensive haemorrhages. It is manifest that the 

 distinctions between these latter forms of nasvi 

 are merely artificial ; the second can be made 

 to pulsate and to increase by heat or intem- 

 perance, the third can often be restrained by cold, 

 by abstinence, and other means that debilitate 

 the circulation. 



The external appearances, however, yield no 

 information as to the condition of the parts 

 within, or the nature of this newly-formed struc- 

 ture; and on this subject anatomical investiga- 

 tion affords but little satisfactory knowledge. 

 When a naevus is extirpated, it seems to consist 

 of a mass of cellular tissue, collapsed and 

 flaccid, which cannot be unravelled, and seems 

 to bear no proportion in size to that of the 



tumour before removal. If it be cut away 

 close to its denned edge, and without the ex- 

 tirpation of the zone of small vessels already 

 described, the bleeding is frightful, and in very 

 young children may be fatal, evidently shewing 

 that these vessels are not endowed with con- 

 tractility, and are a diseased and a new forma- 

 tion. If a naevus is injected, it only affords a 

 swollen and unshapely mass of whatever ma- 

 terial had been used, and throws no light what- 

 ever on the real pathology of the disease. Here, 

 then, in the absence of demonstration, theory 

 and conjecture are permitted, and all that is 

 known, or supposed to be known, is only the 

 fruit of speculation. 



Bell supposed the tumour to consist of a 

 congeries of cells, into each of which an artery 

 and vein opened; that these cells increased 

 both in number and in size with the growth of 

 the patient, until they became immense reser- 

 voirs of blood ; and, finally, that they became 

 so distended as to burst and destroy life, as any 

 other aneurism would, by a profuse discharge 

 of blood. But still this explanation is defec- 

 tive, as showing nothing of the nature of the 

 cells themselves, or why blood poured out into 

 them should not coagulate as it would in any 

 other cellular structure. It remained for Du- 

 puytren to offer an ingenious and extremely 

 probable hypothesis relative to these points, 

 and he conceived the aneurism by anastomosis 

 to be a " tissu erectile," analogous to that 

 naturally found in many parts of the body.* 



In the penis of man, and in the clitoris 

 and mamella of woman, there is a particular 

 structure, capable of receiving, retaining in a 

 fluid state, and afterwards returning a given 

 quantity of blood. These organs are provided 

 with strong fibrous sheaths, that prevent their 

 distension beyond a certain size, and are fur- 

 nished with a number of nerves that preside 

 over the circulation through them, and deter- 

 mine their conditions of erection and col- 

 lapse. The abnormal " tissu erectile" consists 

 of a cellulated structure, in itself of the same 

 or a similar structure, but not being invested 

 by a fibrous sheath or capsule, its growth is 

 unrestrained, and the size to which it may 

 attain has no limit; and as it has not a similar 

 distribution of nerves, there is nothing to occa- 

 sion either unwonted distension or collapse, and 

 it is left solely under the influence of those 

 causes that act upon the circulation. (See 



* The late Mr. Shekelton of Dublin injected one 

 of these tumours with wax from a large artery in 

 its vicinity, and corroded away the animal matter 

 by immersing it in a weak acid solution, by which 

 it was shewn to consist of a congeries of vessels 

 arranged in a retiform manner, diluted at some 

 points and contracted at others. An able and in- 

 teresting paper was read on this subject, and on 

 the tortuosity of arteries generally, to the medical 

 section of the British Association, which lately 

 met at Dublin. The great attainments of its author 

 (Mr. Adams) in pathological science lead us to 

 look, not without some degree of impatience, for 

 the lull publication of the paper, of which but an 

 imperfect report has appeared in the Dublin Medical 

 Journal for September 1835. ED. 



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