ANEURISM OF THE CAROTID. 



99 



thus the ligature is removed with its noose entire ; finally the portion 

 of the artery will be found converted into a small cord. 



The ligature should be round and small, or the coats will not be 

 divided ; inclusion, of cellular tissue or a nerve will also prevent this 

 division, 



Secondary hemorrhage may result from the application of an im- 

 proper ligature, or its premature removal, and also from the artery 

 being too much exposed, or in a diseased condition. 



ANEURISM OF THE AORTA. 



The arch of the aorta is especially liable to aneurism, producing 

 difficulty of breathing, pain in the chest, and palpitation of the 

 heart, difficulty of swallowing, and troublesome cough, owing to 

 its pressure upon the trachea, which is sometimes perforated ; it 

 should not be mistaken for an enlargement of the bronchial glands, 

 or collections of serum or pus. 



Aneurism of the abdominal aorta is usually situated just below 

 the diaphragm, producing pressure in the thoracic duct, caries of the 

 vertebra, dropsy, and by its rupture, death. 



Astley Cooper, James, and Murray have tied it without success ; 

 it should be treated only by medical means. 



ANEURISM OF THE CAROTID. 



This occurs most frequently in labouring people ; it is situated at 

 the angle of the jaw, near the bifurcation of the artery, and pro- 

 duces difficulty of swallowing and breathing ; it is to be carefully 

 distinguished from glandu- 

 lar enlargement. It was first Fig. 29. 

 tied by Sir Astley Cooper in 

 1805. The operation is thus 

 performed : the patient being 

 recumbent, with the head 

 thrown back, and slightly 

 turned to the opposite side, 

 an incision three inches in 

 length is made along the in- 

 ner border of the sterno- 

 mastoid muscle, through the 

 integuments, platysma and 

 superficial fascia, extending 

 from near the angle of the 

 jaw to the cricoid cartilage. 



The cross veins, descen- 

 dens noni nerve, and the 

 omo-hyoid muscle should be 

 carefully pushed aside, the sheath opened, and the aneurismal needle 



