73 



ARTERIES, DISEASES OF. 



ARTESIAN WELL. 



874 



In the treatment o such cases the ordinary remedies for inflammation 

 should be applied. Cooling applications should be made to the part, 

 and rest and an antiphlogistic regimen enjoined. 



The spreading form of arteritis occurs in middle age, in persona of 

 broken constitution. It is seldom confined to one vessel, but affects 

 the arteries of a whole limb. The tracks of the inflamed arteries are 

 painful to the touch, there is slight induration of the affected arteries, 

 the pulse is feeble, and has a peculiar thrilling stroke. The surround- 

 ing textures are not often involved in the disease. The pulse in the 

 affected arteries is feeble, has a thrilling stroke, and gradually dimi- 

 nishes till it finally ceases. The tissues surrounding the arteries are 

 seldom affected with the inflammation, and the skin is not altered, 

 except that it is pale. 



The effects on the arterial coats are the production of turgescence, 

 and a lose of the smoothness of the internal coat. There is a ten- 

 dency of the blood to coagulate and become adherent in. the inflamed 

 vessel, and ultimately the canal becomes blocked up. In proportion 

 as these changes are extensive, will be the general local mischief. The 

 temperature and sensation of the part are diminished, and gangrene, 

 unless the disease is arrested, seta in. 



The treatment consists in the employment of antiphlogistic measures. 

 Leeches may be applied to the part, and calomel and opium given 

 internally. The employment of stimulants, both internally and ex- 

 ternally, should be avoided. 



Chronic Arteriti* ia of more frequent occurrence than acute, and is a 

 state of the artery in which abnormal deposits are formed in the coats 

 of the artery, and which frequently lead to the more serious derange- 

 ments of the arteries. This disease is not to be detected by any 

 symptoms during life, but ia recognised after death by its effects on 

 the arteries. The artery may be affected in spots, or throughout its 

 whole extent. The internal coat of the artery is enlarged, and is less 

 smooth and serous on its surface. Between the internal and middle 

 coat there is a deposit of a soft, cheesy -looking, granular matter, either 

 in pi lints or patches. This deposit is usually called atlteromatous. 

 Under the microscope it is found to consist of fatty granules and 

 molecules, which are frequently associated with crystals of choleste- 

 rine. The middle coat of the artery is frequently altered in its 

 character, presenting a thin yellow opaque appearance. From this 

 cause the elasticity of the artery is much impaired, its cohesion is 

 diminished, it easily stretches, and is apt to tear. It is in this con- 

 dition that dilatation of the artery, or true aneurism, takes place. It 

 may also become the seat of vilceration, or it may tear at once, thus 

 leading directly or indirectly to dangerous haemorrhages. Although 

 these changes are supposed to take place as the result of inflammation, 

 there is no reason to believe that they may not go on quietly without 

 inflammation. It is not improbable that the changes which thus go 

 on in the artery are identical with those which produce fatty degene- 

 ration in the other tissues of the body. When this change takes place 

 in the small arteries of the brain, it not unf requently leads to an attack 

 of apoplexy, from the rupture of the vessel and the effusion of blood 

 upon the brain. 



Calrare>m# deposits between the inner and middle coats of the artery 

 may take place in the same way as the fatty deposits. In this manner 

 the artery becomes ossified. In this case the arteries become hard and 

 non-elastic, the internal coat is dry and shrivelled in appearance, and 

 atheromatous deposits are found mingled with the calcareous. 



The treatment of these forms of arterial disease, where they are 

 suspected to exist, should consist in removing all causes that can 

 contribute to hasten the changing condition of the arteries, and to 

 prevent that action which may facilitate the enlargement, or endanger 

 the bursting of the arteries. 



Vascular or Erectile Tumour. This is a form of disease of the arte- 

 rial tissue, sometimes called Aneurimi by Anattomosit. There are three 

 varieties : 1. The capillaries of the integument may become dilated so 

 M to produce a discoloured elevation of the skin, more or less de- 

 prened. These tumours bleed copiously on the slightest abrasion, or 

 from ulceration. It is commonly called Ncevus. 2. The veins and 

 arteries may be enlarged in the sub-cutaneous areolar tissue, pro- 

 ducing a dark livid tumour of the skin. Copious haemorrhage occurs 

 from any rupture of the skin, but this may be generally arrested by 

 pressure. Such tumours may occur under the mucous membrane, 

 and are exemplified in those forms of haemorrhoids which are situated 

 partly within and partly without the verge of the anus. 3. The true 

 erectile tumour, which is composed of dilated blood-vessels, which are 

 closely crowded together, and open into each other at many points. 

 " These openings may be of secondary formation ; the result of close 

 apposition in the dilated vessels. Or more probably they are primary ; 

 the structure consisting of a network of dilated capillaries ; the open- 

 ings of communication being the ordinary and original inosculations, 

 and what were intervascular spaces being now condensed into mere 

 fibrous bands. The whole constitutes a vascular network of great 

 capacity and activity of circulation, supplied, for reception of the 

 returned blood, with large and tortuous veins, whose lining membrane 

 is plainly continuous with that of the abnormal vascular cells. Also 

 in the neighbourhood are to be fovind the feeding arteries ; originally, 

 perhaps, twigs, now enlarged to trunks pulsating strongly, and obvi- 

 ously carrying on a plentiful and active supply." (Miller, ' Practice of 

 Surgery.') Such is the nature of those tumours which partake of the 



character of true erectile tissue. Like this tissue also, these tumours 

 become enlarged and diminished in size, according to the sluggishness 

 or activity of the blood circulating through them. They are compres- 

 sible, elastic, and of a reddish hue. They are usually subcutaneous, 

 but they are also submucous. The [most common situations are 

 beneath the integuments of the face, head, neck, back, and buttocks. 

 The tumour pulsates synchronously with the heart, and may be 

 considerably diminished in size by pressure, but resumes its usual 

 condition when the pressure is withdrawn. On auscultation, a beat 

 ia heard, dull and rough, sometimes accompanied by a vibratory thrill. 



Ulceration is likely to occur in these tumours, and lead either to 

 great hemorrhage or their cure. 



Erectile tumour may be treated in three different ways : 



1. The tumour may be removed. This is always better done by the 

 ligature than by the knife. 



2. The tumour may be starved by diminishing the arterial supply. 

 This is done, as in cases of true aneurism, by the application of a 

 ligature to the artery or arteries which supply the tumour with blood. 



3. The structure of the tumour may be changed. This may be 

 effected in various ways, as by pressure, the introduction of a needle, 

 the application of caustic potash, nitric acid, or other agent. A hot 

 needle may be run through, or a wire connected with the poles of a 

 galvanic battery may be passed through the tumour. All these plans 

 have been found to succeed with small erectile tumours. 



Vari.c of the Arteries. A tortuous and dilated condition of the 

 arteries frequently comes on in the smaller arteries, and produces 

 painful tumour. It may be removed in the same manner as varicose 

 veins. 



ARTERIOTOMY is the term applied to the opening of an artery 

 for the purpose of drawing blood, as phlebotomy is applied to the 

 same operation in a vein. When it is thought desirable to take blood 

 in large quantity and with much rapidity, it is better taken from an 

 artery than from a vein. This operation, however, is more difficult to 

 perform, and may be attended with ulterior consequences. Hence 

 phlebotomy or venaesection is always preferred, except under urgent 

 circumstances, as the means of drawing blood from the system. When 

 arteriotomy is performed for the sake of blood-letting, one of the 

 superficial anterior branches of the temporal artery is generally 

 selected. In this position the wound is easily healed afterwards by 

 pressure. The accidental wounding of an artery, as is sometimes the 

 case in bleeding from the veins at the bend of the arm, may lead to 

 false aneurism and the necessity of placing a ligature round the 

 wounded artery. Sometimes false aneurism follows arteriotomy in the 

 temporal artery, and in this case it becomes necessary to ligature 

 the arteries on each side of the wound. Sometimes on removing 

 the compress after arteriotomy, an ulcer is found to be formed. If 

 the ulceration spreads, the vessel may be opened and haemorrhage occur. 

 In this case also the artery must be tied. 



ARTESIAN WELL. A description of well in which the water is 

 obtained by means of a hole bored through an upper impermeable 

 stratum to an underlying stratum, of a permeable character charged 

 with water, and occupying a species of basin-shaped depression, in a 

 still lower impermeable stratum ; and also under such conditions of 

 hydrostatic pressure upon the waters contained in the permeable 

 stratum, as to cause them to flow over the surface of the ground at 

 the point of outlet. The name is derived from the fact that wells of 

 this description were first known, in north-western Europe, in the 

 province of the Artois in France, where this method of obtaining water 

 has been practised from a very early period. Properly speaking, an 

 Artesian well is one in which the water from the lower stratum rises 

 abort the surface of the superincumbent impermeable stratum ; but 

 by extension the phrase has been applied of late years to any well in 

 wliirh water is obtained by means of a boring through which the 

 waters of a lower stratum are enabled to rise sufficiently near to the 

 surface to allow of their being economically used. It will be seen 

 hereafter that in many instances borings, which were originally strictly 

 Artesian, have at a later period lost the characteristic property of 

 yielding waters flowing over the surface, so that in fact the logical 

 correctness of the name as applied to a particular well may very often 

 depend upon accidental conditions. 



In order to secure, originally, the condition that the waters of an 

 Artesian well should thus flow over the surface, it is necessary that the 

 outcrop of the permeable stratum, from which the supply is derived, 

 should be situated at a higher level than that of the edge of the over- 

 lapping impermeable stratum. In such cases, the water falling upon 

 the exposed edges of the former, passes under the latter, until it meets 

 with an inferior retentive stratum ; and then if it cannot find, or make 

 to itself an outlet, it will follow the surface of the impermeable, 

 upholding 1 ! stratum, in strict accordance with the laws which regulate 

 the flow of water above ground. If, under these circumstances, an 

 opening should be made through the overlying impermeable stratum, 

 the water will rise to a height corresponding with the level at which 

 it passed under the last-named impermeable stratum ; excepting in so 

 far as it may be affected by the friction it meets with in its traject, 

 or by the existence of any natural overflows, created by the inter- 

 ruption of the containing basin ; provided always that there should not 

 exist any disturbance of the lower retentive strata, of a nature to place 

 the water-bearing stratum in contact with a still lower one which 



