234 ARTERY, PATHOLOGICAL CONDITIONS OF. 



circumstances is also available here, for if a the object has been accomplished, have been 



wound of this species of vessel cannot heal proposed and tried, but success has not been 



whilst its calibre remains open, neither can an so great as to warrant their general adoption, 



aneurism be cured until the artery from which and the operation by ligature is still very 



it springs is completely obliterated at the spot generally preferred. It may be applied either 



where the aperture into the sac exists. The at the cardiac side of the tumour, when it acts 



complete closure of the vessel is to be accom- in the manner above stated, or between the 



plished by placing its opposite walls in contact aneurism and the capillary circulation, in which 



and under the influence of such pressure as case the principle of its operation is somewhat 



will occasion inflammation and the effusion of different. 



coagulating lymph, a pressure that can be In the former instance, when a ligature is 



applied either ab externo by means of com- applied to the trunk of an artery, the supply 



press and bandage, or from within, by placing of blood to the limb below it is interrupted for 



the blood in the sac in a condition that will a few moments; the aneurism loses its pulsa- 



admit of its perfect and complete coagulation. tion, and sinks and diminishes in size more or 



Pressure on the tumour, if it could be ex- less according as its contents had been fluid or 



actly applied and firmly maintained, ought to coagulated. Soon the blood begins to flow 



succeed, and, in truth, has often been success- through the collateral branches, and enters the 



ful, particularly when the disease is consequent aneurismal sac also, but it passes into it slowly 



on a wound ; but there are so many difficulties and without impetus, and no part of it is again 



to be surmounted and dangers to be encoun- forced back into the circulation. It coagulates 



i ^ 



tered in its use, that few entertain much confi- and comes to press upon and close the ruptured 

 dence in it, and perhaps it never would be vessel, which is soon obliterated by lymph, and 

 resorted to but from a dread of consecutive in process of time becomes degenerated into 

 haemorrhage after a ligature. A bandage, if little more than a ligamentous cord. A beau- 

 applied with sufficient firmness to operate with tiful illustration of this entire process was seen 

 rapidity, occasions such excruciating pain that in Mr. Crampton's case* of ligature of the corn- 

 it can scarcely be endured ; and if loosely, it is m on iliac artery. The patient had two aneu- 

 liable to slip ; and if even it does finally work a risms, one of very large size at the groin, the 

 cure, the progress of the case is so protracted other in the popliteal space of the same limb, 

 that many patients become wearied with the firmer, and of much smaller dimension. A liga- 

 trial. Again, the large trunks of arteries ture of catgut was placed round the common 

 throughout the extremities are generally accom- iliac, which either rotted or by some accident 

 panied by nerves and veins in such close became detached on the sixth day : the pulsa- 

 apposition with them, that a compress can tion returned in the larger tumour, which soon 

 scarcely be applied to one without interfering afterwards burst, and the patient perished. The 

 with the other ; and instances have occurred of sac of the popliteal aneurism being so much 

 dreadful mischief having been occasioned by smaller had time to become perfectly filled with 

 interruption of the venous circulation in such blood, which was there coagulated and firm, 

 cases, even in the course of one night. Finally, The ligature had accomplished all that was 

 pressure has very frequently caused the rupture necessary for it, and the cure would have 

 of the sac, and the aneurism, from being cir- been complete even although the ligature had 

 cumscribed, has suddenly become diffused ; loosened whilst the opposite was the fact with 

 and if there was no other source of apprehension reference to the larger tumour, 

 but the possibility of this latter occurrence, it Sometimes, soon after the ligature has been 

 should make a surgeon pause before he adopted applied, pulsation reappears in the tumour, 

 so hazardous a mode of treatment. This must always be considered as an untoward 

 Pressure from within is effected by re- circumstance, but does not necessarily involve 

 moving the impulse of the heart from the the failure of the operation; for it may take 

 blood within the sac for a sufficient time to place under two different conditions of the 

 permit of the sac becoming perfectly filled with parts. 1. In aneurisms of very long standing, 

 blood, and for that blood to become coagulated, in situations where there is a free and extensive 

 This object will be accomplished by interrupt- collateral circulation, probably increased by the 

 ing the flow of blood under the impulse of the pressure of the tumour. In these the pulsation 

 heart through the leading trunk of the vessel does not return for some time after the vessel 

 for a given time : in cases of small aneurisms has been tied, and is never so strong as before 

 forty-eight hours being sufficient, but the larger the operation. It may continue for several 

 and older requiring a longer period. A ligature days, but gradually diminishes in force, and at 

 placed around the vessel between the tumour last ceases. The progress of the case then 

 and the heart effects this purpose; but it does resembles that of the ordinary forms of the dis- 

 more than is requisite, for it divides its in- ease, except that in this the cure is much 

 ternal and middle coats, occasions the effusion more protracted. Apparently, such was Sir 

 of lymph and the obliteration of the artery A. Cooper's first successful case f of ligature of 

 there, and involves the risk of consecutive the common carotid artery, as also the case of 

 haemorrhage afterwards on its final separation, carotid aneurism published in the fifth volume 

 To avoid these inconveniences, the presse artere f the Dublin Hospital Reports.}: It is not un- 

 of Descharnps and a number of other con- 

 trivances for arresting the flow of blood through h 'KSTr J?"" 8 ' J 8 " 1 ? 0118 ' *<* . xvi - 



f.. c & t Medico-Chirurg. Transactions, vol. i. 



an artery, and admitting of easy removal after j p ag e 208. 



