242 



ARTERY, PATHOLOGICAL CONDITIONS OF. 



This disease must, in the great majority of 

 instances, be the result of accident, and its 

 probable situation has been already pointed out, 

 but it is also possible that it may appear as 

 an idiopathic affection without any previous 

 violence. Some years since a young female 

 applied at the Meath Hospital as an out- 

 patient, in whom aneurismal varices existed 

 between every artery and vein in the body that 

 lay in a state of approximation to each other. 

 In the neck, in several parts of the arms, the 

 thighs, &c. the peculiar thrill and sound were 

 remarkably distinct and plain. She did not 

 seem to experience much uneasiness, nor could 

 any probable exciting cause be assigned for 

 such a singular form of disease. She had pre- 

 viously suffered from syphilis and been sub- 

 jected to irregular mercurial treatment, but it 

 would be scarcely fair to assume as the cause 

 of a solitary specimen of disease in one indi- 

 vidual, influences that operate so very differ- 

 ently on others. 



Varicose aneurism. When a vein and artery 

 communicate with each other in a manner 

 similar to that already described, excepting that 

 an aneurismal sac formed of condensed cellular 

 tissue and containing some coagulated blood is 

 interposed between their orifices, the disease is 

 termed a varicose aneurism. As this disease is 

 generally the result of some accident in bleed- 

 ing, as it occupies the same situation at the 

 bend of the arm, and as the sac in that case never 

 attains to any considerable size, it is difficult 

 and frequently impossible to distinguish during 

 life between the two affections: nor is the 

 diagnosis of much importance, for as the patho- 

 logical changes in the artery and vein, and the 

 phenomena produced by them, are exactly the 

 same, so will be the rationale of the treatment. 



Some few years since, a patient was admitted 

 into the Charitable Infirmary with a popliteal 

 aneurism of the size of a child's head, and 

 with all the veins of the limb, particularly of 

 the thigh, enormously distended so as to appear 

 like ropes twisted and knotted under the in- 

 teguments. In every one of these veins the 

 peculiar thrill and sound of aneurismal varix 

 could be distinctly perceived. The account 

 he gave of himself was this : he had a pulsating 

 tumour in the ham for fourteen years previ- 

 ously, which gradually increased to its present 

 size, until the veins began to swell, when the 

 large tumour became stationary. He expe- 

 rienced but little inconvenience, and said he 

 was able to walk eleven or twelve miles a day. 

 ; He was frequently permitted to leave the hos- 

 \ pital, and exhibited himself to several profes- 

 ; sional men for money. As he refused to sub- 

 mit to any treatment, and indeed no operation 

 i held out a prospect of much benefit, he was 

 | soon discharged. This man (I believe) still 

 Hives, and as he resides in a distant part of the 

 \ country, perhaps the true pathological nature 

 Jof a case so very interesting may never be 

 f ascertained. Could it have been that this was 

 { originally a case of popliteal aneurism that had 

 burst into the popliteal vein ? The position of 

 this vein, and its very intimate connexion with 

 the artery, cause it to -appear to be a pan of the 



sac of every popliteal aneurism, and it is not 

 difficult to conceive that the tumour might have 

 given way in this particular situation, and a 

 communication been thus established between 

 the artery and vein through the medium of the 

 aneurismal sac. 



It may not be unimportant to observe, that 

 rare as these latter forms of disease are acknow- 

 ledged to be, they are still more so in reality 

 than is generally imagined. It often happens- 

 that a congeries of knotted and contorted veins 

 forms a tumour strongly resembling the aneu- 

 rismal varix in its external characters, and im- 

 parting similar sensations of thrill and sound. 

 If one of these happens to occupy a situation 

 favourable to the production of aneurismal varix,. 

 it might easily occasion a mistake, and perhaps it 

 would be very difficult to point out a satisfactory 

 diagnostic. I have seen two of these tumours 

 dissected, which during the lives of the patients 

 were supposed to have been aneurismal varices,. 

 in neither of which could the slightest commu- 

 nication with any neighbouring artery be dis- 

 covered. 



Aneurism by anastomosis. The d isease which 

 was so named by John Bell, and by him first 

 placed in the class of aneurismal tumours, has- 

 no title to such a position, unless that it forms 

 a reservoir of blood, and occasionally exhibits 

 the phenomenon of pulsation. But it mate- 

 rially differs in that the blood contained within 

 it is fluid, is not withdrawn from the circulation, 

 and therefore does not coagulate. The circum- 

 stances, however, of these tumours being in- 

 creased or diminished in size by those influ- 

 ences which excite or depress the activity of 

 the circulation, and of the leading trunks of 

 the vessels supplying them having, however 

 erroneously, been made the subjects of opera- 

 tion for their cure, serve to connect them in 

 some respects with the pathology of arteries, and 

 j ustify a passing notice of the subject here. This 

 kind of tumour has also been called the nsevus 

 maternus or mother mark, because it so often- 

 appears from birth or at a very early age, and 

 its shape, colour, size, or situation is explained 

 by the mother on the supposition of some sub- 

 stance having been thrown at her, or from other 

 causes of affright. It may, however, appear 

 for the first time in more advanced life, in the 

 form of a speck or pimple, which gradually 

 enlarges until it constitutes a disease of a most 

 important and sometimes dangerous nature. 



The external characters of aneurism by anas- 

 tomosis are somewhat varied, and have admitted 

 of its classification under three forms apparently 

 distinct from each other : 1. Where the mark 

 or stain is merely cutaneous, does not increase 

 in size, and is never pulsatile. These marks 

 may be of different colours, sometimes red, 

 sometimes of a brassy yellow, or perhaps brown ; 

 and as they occasion no inconvenience beyond 

 the unsightliness of their size and situation, 

 they can scarcely be considered as diseases. 

 Indeed, if the common mole be admitted un- 

 der this class of naevi, in many instances it 

 seems to constitute a beauty rather than a defect. 

 2. Where the disease is situated in both the 

 skin and sub-cutaneous cellular tissue. It 



