1 I .MORAL AIITKHY. 



331 



without the intermedium of the second with 

 the popliteal artery, the latter forming by much 

 the more free channel of communication be- 

 tween the two vessels, whence the circulation 

 of the lower part of the limb may be pre- 

 served independent of the communication be- 

 tween the upper and lower parts of the femoral 

 artery, as has been exemplified in the case of 

 Sir A. Cooper given in the Medico-Chirur- 

 giral Transactions, vol. ii.; and, lastly, a com- 

 munication exists by which the blood may be 

 CDiivcved from the arteries of the trunk into 

 the popliteal artery and the arteries of the leg, 

 independent of the femoral and without trans- 

 nii-Mim through any part of its canal. 



Hence varieties may be expected in the con- 

 dition of the femoral artery in cases of inter- 

 ruption, according to the situation of the 

 interruption, and the influence of it or other 

 circumstances in determining the course which 

 the circulation is to take. 



When the artery is obstructed above the 

 origin of the profunda independent of aneu- 

 rism, the origin of that vessel being free from 

 disease, it would appear that the trunk of the 

 femoral does not undergo any alteration in its 

 <".i|>acity, at least from the origin of the pro- 

 funda downward : when an interval exists 

 between the point of interruption and the 

 origin of that vessel, the trunk may be di- 

 minished for so much, while again it may 

 continue unaltered ; thus in Sir A. Cooper's 

 case* already referred to, the vessel was found 

 reduced to about half its natural size between 

 the origins of the epigastric and circumflex 

 ilii arteries and that of the profunda, and from 

 the latter it preserved its ordinary size through 

 the remainder of its course : in Mr. Norman's 

 casef on the other hand, it was of its natural 

 size in the interval adverted to, but inasmuch 

 as the origin of the profunda was obstructed 

 in the latter case, it cannot be considered so 

 fair an instance of the influence of the simple 

 interruption at the part specified as the former, 

 in which the femoral artery remained pervious 

 after the cure of the aneurism. It is hence to 

 be inferred, 1. that interruption of the femoral 

 above the origin of the profunda or of the 

 external iliac artery is not necessarily followed 

 by obliteration of the former, unless it be of 

 so much of the femoral as might intervene 

 between the interruption and the origin of the 

 profunda, where the ligature has been applied 

 to the former: 2. that in such case the internal 

 iliac is thenceforward the principal source from 

 which the supply of blood to the lower extremity 

 is to be derived ; and that the profunda artery 

 through its inosculations with the branches of 

 the internal iliac, constitutes the chief channel 

 through which the transmission of the blood 

 to the trunk of the femoral and the limb takes 

 place : 3. that the external iliac artery con- 

 tributes, but in an inferior degree, to the sup- 

 ply of the limb, when the interruption is in 

 the femoral itself: 4. that the femoral artery 

 and its branches thenceforward are to be con- 



* Guy's Hospital Reports. 

 t Mcd.-Chir. Tians. vol. xx. 



lidered branches of th iliac arteries, rather of 

 the internal than of the external, the trunk of 

 the femoral itself being secondary to its own 

 branches, by which the blood is transmitted 

 into it from die iliacs. 



\\ hen the interruption of the femoral occurs 

 below the origin of the profunda, the oblitera- 

 tion of the trunk is no farther necessary than 

 between the interruption and the origin of the 

 profunda on the one hand, if no other branch 

 intervene, and that of the next considerable 

 branch upon the other. In such case the pro- 

 funda artery becomes the main channel of the 

 circulation through the lower extremity from its 

 origin downward, and the femoral with its 

 branches thenceforth are to be regarded as 

 branches of it. 



But when the interruption arises from aneu- 

 rism and the operation necessary for its cure, 

 obliteration of the femoral, to a greater or less 

 extent according to the case, for the most part 

 ensues : this appears to depend upon the in- 

 fluence, which the mode of cure of the disease 

 exerts upon the circulation through the vessel, 

 for the coagulation of the contents of the sac 

 being generally produced by the interruption 

 of the current of blood, the passage through 

 the sac becomes obstructed, and along with it 

 an extent of the artery upon both sides of the 

 seat of the aneurism greater or less according 

 to the disposition of the adjoining branches. 

 The extent to which the obliteration of the 

 artery has been found to proceed, has been 

 different in different cases, but the varieties 

 observed have been the following: 1. As re- 

 gards that part of the vessel which is above the 

 ligature, when the femoral artery has been 

 lied below the origin of the profunda for po- 

 pliteal aneurism, the vessel has been found, 

 when the ligature has been applied to the 

 lower part of the artery, either obliterated 

 from the ligature to the origin of the pro- 

 funda, as occurred in the first subject upon 

 whom Mr. Hunter* operated for popliteal aneu- 

 rism according to his method, or obliterated 

 upward only as far as the origin of those mus- 

 cular branches of the artery, which arise below 

 the profunda and anastomose with the articular 

 arteries. 2. When the ligature has been ap- 

 plied near to the origin of the profunda, as in 

 the operation of Scarpa, between it and the 

 origin of the branches alluded to, the artery 

 has been found obliterated from the point of 

 interruption to the origin of the profunda. 



The condition of the artery below the seat 

 of the ligature is equally subject to variety 

 according to circumstances, and is still more 

 deserving of attention than the former : it has 

 been found in one of three states, either ob- 

 literated throughout from the origin of the 

 profunda down to the extremity of the popli- 

 teal artery, as occurred in the case reported 

 by Sir A. Cooper in the Medico-Chirurcical 

 Transactions, vol. ii., or pervious throughout 

 from the point of application of the ligature 

 to the seat of the aneurism, where it was 



* Transactions of a Society for the improve- 

 ment of Medical and Chirurgical Knowledge, 

 vol. i. 



