228 



ARTERY, PATHOLOGICAL CONDITIONS OF. 



mained upon the wheel, the artery, divided in 

 the subsequent amputation more than two 

 inches above the wound, did not pour out one 

 drop of blood. In others, still, the cellular 

 sheath of the artery has been seen injected 

 with blood in a state of coagulation, the pres- 

 sure of which on its orifice seemed to be 

 sufficient to prevent bleeding. 



We are told that the observation made by 

 Amussat,* that in gun-shot wounds where all 

 the parts were lacerated, the extremities of 

 even the larger vessels did not bleed, suggested 

 to him the application of the phenomenon 

 to practical surgery, and led to the practice 

 of the torsion of arteries. This operation con- 

 sists in laying bare a portion of the divided 

 artery, and carefully detaching it from the sur- 

 rounding cellular membrane until its own cel- 

 lular tunic is distinctly to be seen ; it is then 

 seized with a forceps, not unlike the common 

 artery- forceps of Bell, and twisted on its axis 

 until the extremity engaged between the blades 

 is completely detached by the torsion. This 

 forms something like a knot or knuckle at the 

 end of the vessel, which mechanically blocks 

 it up ; a coagulum is formed within, and the 

 remainder of the process is said nearly to re- 

 semble that which succeeds the application of 

 a ligature. Not having practised torsion on 

 a vessel of any considerable size in the human 

 subject, nor had an opportunity of examining 

 after death a case thus treated, I am unable to 

 comprehend, with sufficient precision, the exact 

 process that is established. In experimenting 

 on the femoral arteries of dogs, I have always 

 found that the immediate obstacle to the flow 

 of blood was a coagulum situated at the orifice, 

 and apparently entangled in the lacerated cel- 

 lular coat; but for the reasons already men- 

 tioned, little confidence can be placed in such 

 investigations. 



Hitherto we have been considering those 

 wounds of arteries, which, however important 

 in other respects, are not attended by hsemor- 

 rhage, and although ignorant of the operations of 

 nature in effecting this result, it is of the less con- 

 sequence, inasmuch as it is not likely we shall 

 attempt to imitate them, or entrust a large- 

 sized vessel to torsion alone. The wounds of 

 arteries, accompanied by loss of blood, present 

 themselves under very different circumstances; 

 there is always anxiety, agitation, and dismay on 

 the part of the sufferer, and it may be that 

 promptness and decision in the practitioner 

 shall be required to preserve life. In any of 

 these awful situations, coolness and self-pos- 

 session can alone ensure a freedom from em- 

 barrassment, and these qualities cannot be ex- 

 pected in any individual who has neglected to 

 make himself acquainted with the nature of 

 the mischief that has occurred, and the means 

 by which it may be remedied. 



The phenomena attendant on arterial hae- 

 morrhage occasioned by incised and punctured 

 wounds exhibit remarkable varieties, according 

 to the size, and of course to the structure of 

 the vessel ; to the circumstance of its having 



* Dictionaire de Chirurgic <le Rust, torn. ii. 



been fairly divided, or only notched, or punc- 

 tured ; to the wound being so large and patu- 

 lous as freely to permit the escape of all the 

 blood externally, or so small or oblique that 

 the fluid, though withdrawn from the circula- 

 tion, is still retained within the limb. There is 

 still another condition of wounded artery in 

 which the blood that escapes from it is poured 

 into an adjacent vein, and continues to circulate, 

 though not in its proper vessel. However, 

 these latter cases are usually considered and 

 described as forms of aneurism, and will, 

 therefore, not be noticed until there is an op- 

 portunity of comparing the different species of 

 that disease one with another. 



When a large artery is divided in an open 

 wound, it may happen that the patient dies 

 almost instantaneously, not from the absolute 

 quantity of blood lost, but from its being with- 

 drawn too suddenly from the circulation, just 

 as syncope is often produced by the rapid 

 abstraction of blood in the common operation 

 of phlebotomy. However, this is not uniformly 

 the case, and experience has proved that vessels 

 of such size and importance as the carotid and 

 femoral arteries may be divided, and yet suffi- 

 cient time allowed for the successful interposi- 

 tion of art. Mr. Guthrie states, that when the 

 femoral artery is cut across in the upper part of 

 the thigh, the patient does not always bleed 

 to death, although frequently lost; while if the 

 division takes place in the middle or lower half 

 of the thigh, the bleeding will probably cease 

 of itself. When, however, an artery of still 

 smaller size is divided, the powers of nature 

 are almost always competent to restrain the 

 haemorrhage, and consequently it is from an 

 examination of vessels of this class under such 

 circumstances that a knowledge can be ob- 

 tained of the nature and extent of these 

 powers. 



When a vessel of moderate size is divided, 

 the blood is poured forth in jerks from its 

 open mouth in a large and full stream ; soon, 

 however, this stream is seen to become dimi- 

 nished in size, and most probably it ceases to 

 flow per saltum. If the patient faints, the 

 bleeding perhaps ceases altogether, nor will it 

 be renewed unless accident or indiscretion gives 

 to the blood an impetus sufficient to overcome 

 the obstacle that opposes its exit, whatever that 

 may lie. When the artery is divided, its middle 

 coat retracts immediately that its natural state 

 of tension is removed, withdrawing with it the 

 lining membrane, but leaving the cellular, to 

 which it is but loosely attached, hanging out 

 beyond it. It contracts, too, in diameter, as is 

 evidenced by the diminished stream of blood. 

 The power by which this contraction and re- 

 traction are performed is a vital property inhe- 

 rent in the artery itself; it has been called 

 muscularity, and endless arguments have thus 

 been raised about a name, as if no tissue in the 

 body but muscle could be capable of contrac- 

 tion. But it operates in a manner very different 

 from the rapid and decided contraction of muscle ; 

 it is slow, gradual, and continued, and, there- 

 fore, is longer in bringing the large vessel into 

 a state favourable for the suppression of hsemor- 



