ARTERY, PATHOLOGICAL CONDITIONS OF. 235 



likely that Mr. Turner's case of aneurism in vessel predisposing to the formation of a false 



the fore-arm, in which he secured both radial aneurism, whilst the latter, presenting during life 



and ulnar arteries, was of a similar description the same phenomena, and curable on the same 



also. 2. Where by an irregular distribution principles that have been already laid down, 



there exist two trunks in the limb, both con- must be considered as offering truly a specimen 



veying blood to the aneurismal tumour. Sir C. of the disease. 



Bell had a case of popliteal aneurism in the When in consequence of arteritis, or from 

 Middlesex Hospital, in which, just below the any other cause, the elasticity of the arterial 

 origin of the profunda, the femoral artery structure becomes impaired or weakened, a 

 divided into two branches of nearly equal size, dilatation of the vessel at the spot so debilitated 

 which ran parallel to each other until they ought to be the result ; and this probably takes 

 arrived at the spot where the artery perforates place in all arteries previous to the formation 

 the tendon of the triceps muscle, and there they of idiopathic aneurism. But the circumstances 

 united again. Only one of these was tied, and that determine an artery to become dilated 

 although the pulsation in the tumour ceased rather than to ulcerate are very obscure, for 

 for a moment, yet it soon returned, and never the same morbid appearances in the vessel are 

 disappeared until the patient's death, which observed to precede both. In the eleventh 

 happened a few days afterwards, from erysipelas, number of the Dublin Journal of Medical 

 A preparation of a similar distribution is pre- Science there is an account of two cases of 

 served in the Museum of the Royal College of internal aneurism, one formed by ulceration of 

 Surgeons in Dublin;* and it is quite clear that the internal and middle coats of the artery, 

 where such exists in an aneurismatic limb, the which burst into the oesophagus ; the other, 

 securing of one of the trunks could produce no evidently by dilatation, which destroyed the 

 benefit. patient by pressure on the trachea : and in 

 It has been already stated that one of the both the aorta exhibited the same appearances 

 effects of the ligature on an artery is the eventual of inflammation and steatomatous deposit be- 

 obliteration of the entire calibre of the vessel neath the lining membrane. The preparations 

 between it and the nearest collateral branch at are preserved in the collection of the school in 

 each side, and, therefore, it might be supposed Park-street, and as showing this pathological 

 that if it be tied immediately close beyond an fact are extremely satisfactory. Again, it is 

 aneurismal sac in such wise that no branch not easy to say what dilatations should be con- 

 shall intervene between the cord and it, the sidered aneurismal or not. The aorta, in a great 

 whole of the canal to the next branch, in- proportion of subjects above the age of forty, 

 eluding the spot where the rupture had taken is dilated ; yet such dilatation is not regarded 

 place, ought to become obliterated, and the as an aneurism. Other arteries present a similar 

 aneurism thus be cured. This is the principle appearance occasionally; and a case occurred 

 that led to the performance of the operation of not very long since in the Meath Hospital, in 

 tying the artery at the distal side of the aneu- which all the arteries of the inferior extremities 

 rism. It was (I believe) originally proposed by in an aged man were dilated to more than 

 Delpech, and put in practice by Desault, but twice their natural calibre. These vessels were 

 the termination of the case gave little en- found after death filled with coagulated blood, 

 couragernent for future trials, and it fell into yet as the fluid seemed to circulate througli 

 disuse until of late years, when it has again been them during life, and the patient never ex- 

 tried in England, and still subsequently by perienced any inconvenience, it is difficult to 

 Mott, in New York, but not with a success to admit them as specimens of true aneurism, 

 justify its general adoption. There is but one On the other hand, nearly at the same time, a 

 artery in the body (the common carotid) so man died in another hospital who for years 

 circumstanced as to answer the design of the had a small aneurism of the femoral artery, 

 operation ; and even in this, if the smallest and "with every observable symptom of the disease 

 most trifling branch happened to intervene be- except that the growth of the tumour was un- 

 tween the aneurism and the ligature, it must usually slow ; and on dissection this appeared 

 defeat the principle of the operation altogether, to have been a species of true aneurism, caused 

 and perhaps tend to aggravate the disease. by an equal dilatation of the entire circum- 

 True aneurism. Two different pathological ference of the vessel, and did not contain coa- 

 conditions of an artery have been regarded as gulated blood. It would seem, then, impos- 

 constituting this disease ; one in which the sible to pronounce during life on the real 

 entire circumference of the vessel is distended, nature of an aneurismal tumour, nor is it always 

 forming a tumour of an oval shape, pulsating easy to demonstrate it after death, 

 strongly during life, and not containing coagu- In most instances of aneurism, particularly 

 lated blood : the other is where all the coats of those of long standing, the edges of the aperture 

 an artery at one particular spot are dilated in into the sac are smooth and even, and the lining 

 such wise as to form a sac springing from the membrane seems to be prolonged into it. The 

 side of the vessel, and containing blood with- internal wall of the sac is so thickened, and all 

 drawn from the circulation, and in a state of the parts so matted together and confused by 

 coagulation. Perhaps it would be more cor- depositions of lymph and fibrine, that the 

 reel to regard the former of these as a state of appearances altogether become so deceptive as 



almost to countenance the old opinion as to the 



* There is a similar preparation in the Museum pathology of the disease. Professor Scarpa, 



of St. Bartholomew's Hospital. ED. who principally opposed the doctrine of aneu- 



