ARTERY, PATHOLOGICAL CONDITIONS OF. 



235 



likely that Mr. Turner's case of aneurism in 

 the fore-arm, in which he secured both rad.al 

 and ulnar arteries, was of a similar description 

 also. 2. Where by an irregular distribution 

 there exist two trunks in the limb, both con- 

 veying blood to the aneurismal tumour. Sir C. 

 Bell had a case of popliteal aneurism in the 

 Middlesex Hospital, in which, just below the 

 origin of the profunda, the femoral artery 

 divided into two branches of nearly equal size, 

 which ran parallel to each other until they 

 arrived at the spot where the artery perforates 

 the tendon of the triceps muscle, and there they 

 united again. Only one of these was tied, and 

 although the pulsation in the tumour ceased 

 for a moment, yet it soon returned, and never 

 disappeared until the patient's death, which 

 happened a few days afterwards, from erysipelas. 

 A preparation of a similar distribution is pre- 

 served in the Museum of the Royal College of 

 Surgeons in Dublin;* and it is quite clear that 

 where such exists in an aneurismatic limb, the 

 securing of one of the trunks could produce no 

 benefit. 



It has been already stated that one of the 

 effects of the ligature on an artery is the eventual 

 obliteration of the entire calibre of the vessel 

 between it and the nearest collateral branch at 

 each side, and, therefore, it might be supposed 

 that if it be tied immediately close beyond an 

 aneurismal sac in such wise that no branch 

 shall intervene between the cord and it, the 

 whole of the canal to the next branch, in- 

 cluding the spot where the rupture had taken 

 place, ought to become obliterated, and the 

 aneurism thus be cured. This is the principle 

 that led to the performance of the operation of 

 tying the artery at the distal side of the aneu- 

 rism. It was (I believe) originally proposed by 

 Delpech, and put in practice by Desault, but 

 the termination of the case gave little en- 

 couragement for future trials, and it fell into 

 disuse until of late years, when it has again been 

 tried in England, and still subsequently by 

 Mott, in New York, but not with a success to 

 justify its general adoption. There is but one 

 artery in the body (the common carotid) so 

 circumstanced as to answer the design of the 

 operation ; and even in this, if the smallest and 

 most trifling branch happened to intervene be- 

 tween the aneurism and the ligature, it must 

 defeat the principle of the operation altogether, 

 and perhaps tend to aggravate the disease. 



True aneurism. Two different pathological 

 conditions of an artery have been regarded as 

 constituting this disease; one in which the 

 entire circumference of the vessel is distended, 

 forming a tumour of an oval shape, pulsating 

 strongly during life, and not containing coagu- 

 lated blood : the other is where all the coats of 

 an artery at one particular spot are dilated in 

 such wise as to form a sac springing from the 

 side of the vessel, and containing blood with- 

 drawn from the circulation, and in a state of 

 coagulation. Perhaps it would be more cor- 

 rect to regard the former of these as a state of 



There is a similar preparation in the Museum 

 of St. Bartholomew's Hospital. ED. 



vessel predisposing to the formation of a false 

 aneurism, whilst the latter, presenting during life 

 the same phenomena, and curable on the same 

 principles that have been already laid down, 

 must be considered as offering truly a specimen 

 of the disease. 



When in consequence of arteritis, or from 

 any other cause, the elasticity of the arterial 

 structure becomes impaired or weakened, a 

 dilatation of the vessel at the spot so debilitated 

 ought to be the result ; and this probably takes 

 place in all arteries previous to the formation 

 of idiopathic aneurism. But the circumstances 

 that determine an artery to become dilated 

 rather than to ulcerate are very obscure, for 

 the same morbid appearances in the vessel are 

 observed to precede both. In the eleventh 

 number of the Dublin Journal of Medical 

 Science there is an account of two cases of 

 internal aneurism, one formed by ulceration of 

 the internal and middle coats of the artery, 

 which burst into the oesophagus ; the other, 

 evidently by dilatation, which destroyed the 

 patient by pressure on the trachea : and in 

 both the aorta exhibited the same appearances 

 of inflammation and steatomatous deposit be- 

 neath the lining membrane. The preparations 

 are preserved in the collection of the school in 

 Park-street, and as showing this pathological 

 fact are extremely satisfactory. Again, it is 

 not easy to say what dilatations should be con- 

 sidered aneurismal or not. The aorta, in a great 

 proportion of subjects above the age of forty, 

 is dilated ; yet such dilatation is not regarded 

 as an aneurism. Other arteries present a similar 

 appearance occasionally ; and a case occurred 

 not very long since in the Meath Hospital, in 

 which all the arteries of the inferior extremities 

 in an aged man were dilated to more than 

 twice their natural calibre. These vessels were 

 found after death filled with coagulated blood, 

 yet as the fluid seemed to circulate through 

 them during life, and the patient never ex- 

 perienced any inconvenience, it is difficult to 

 admit them as specimens of true aneurism. 

 On the other hand, nearly at the same time, a 

 man died in another hospital who for years 

 had a small aneurism of the femoral artery, 

 with every observable symptom of the disease 

 except that the growth of the tumour was un- 

 usually slow ; and on dissection this appeared 

 to have been a species of true aneurism, caused 

 by an equal dilatation of the entire circum- 

 ference of the vessel, and did not contain coa- 

 gulated blood. It would seem, then, impos- 

 sible to pronounce during life on the real 

 nature of an aneurismal tumour, nor is it always 

 easy to demonstrate it after death. 



In most instances of aneurism, particularly 

 those of long standing, the edges of the aperture 

 into the sac are smooth and even, and the lining 

 membrane seems to be prolonged into it. The 

 internal wall of the sac is so thickened, and all 

 the parts so matted together and confused by 

 depositions of lymph and fibrine, that the 

 appearances altogether become so deceptive as 

 almost to countenance the old opinion as to the 

 pathology of the disease. Professor Scarpa, 

 who principally opposed the doctrine of aneu- 



