AORTA. 



the mammary and epigaftric arteries ; but chiefly by the 

 communications of the fuperior intercoftals and the mam- 

 mary arteries with the three large brandies entering the 

 aorta below the ftriflure ; and of the mammary and thoracic 

 arteries with the diaphragmatic and other intercoftals. See 

 Medico-Chir. Tranf. vol. v. 



If the aorta were obliterated, or ob'ftrufted in the abdo- 

 men, the blood would find adequate channels for its tranf- 

 miffion in the mammary and epigaftric, the fuperior and 

 inferior mefenteric, and the lumbar arteries. Mr. A. Cooper 

 informs us, that he has never met with any inftance of the 

 latter defcription in the human fubjeft. ( Surgical Eflays, 

 part i. p. 113.) But he has feveral times applied ligatures 

 to the aorta in dogs, and found that the blood was readily 

 carried by anaftomofing veflels to the pofterior extremities 

 of the animal. (See Medico-Chir. Tranf. vol. ii. p. 249, 

 Sec.) The incifion was in each experiment made on the 

 left fide of the fpine ; the aorta was drawn to the furface of 

 the flcin by an aneurifm needle, and being quite feparated 

 from other parts was tied. The animals were then kept 

 for a few weeks, and then killed. They were afterwards 

 injefted and diflefted, when it appeared that the lumbar 

 arteries were confiderably enlarged, fo as to be the chief 

 agents of the new circulation. 



In thofe difeafes caufing obftruftion of the thoracic aorta 

 a little beyond its arch, to which we have requefted the 

 reader's attention, no doubt the change was the refult of a 

 very gradual procefs, and confequently, the altered courfe 

 of the blood through the collateral channels would alfo be 

 ^ftabliihed, not all at once, but by degrees. The anafto- 

 mofing arteries would only enlarge, in proportion as the 

 obftruftion in the great artery increafed. But in the experi- 

 ment of tying the aorta in animals things were very differ- 

 ent ; for the ftoppage of the palTage of the blood through 

 the tied portion of that veffel was not only effefted inftan- 

 taneoufly, but alfo completely, fo that the whole office of 

 ■tranfmitting the blood to parts beyond the obftruftion fud- 

 denly devolved altogether to the anaftomofes, which had had 

 no time for any gradual and preparatory dilatation. Yet 

 notwithftanding this feeming difadvantage, we find that the 

 blood did pafs into the pofterior extremities. 



The aorta of the human fubjeft, however, has now been 

 tied in the human fubjcft by Mr. A. Cooper, and the fol- 

 lowing are a few of the particulars of the cafe. The pa- 

 tient, who was thirty-eight years of age, had on the left 

 fide an inguinal aneurifm, which had aftually burft, and 

 difcharged a quantity of blood fufficient to reduce the man 

 to a ttate of confiderable weaknefs. Another hemorrhage 

 would have carried him off. It was apprehended, that the 

 tumour extended too high up to admit of a ligature being 

 applied to the external ihac artery itfelf ; yet in the hope of 

 being able to difpenfe with fuch meafures as would be 

 neceflary to tie the aorta near its bifurcation, Mr. A.Cooper 

 refolved to try whether it were poffible to tie the aneurifmal 

 artery itfelf. He made, therefore, a fmall incifion into the 

 aneurifm, about two inches above Poupart's ligament ; but 

 he found only a chaos of broken coagula, and that the artery 

 entered the fac above and quitted it below without there 

 being any intervening portion of veffel. The operation was 

 confequently abandoned. " When I was about to withdraw 

 my fingei;," fays Mr. A. Cooper, " I direfted two of the 

 ftudents to comprefs with their hands the aorta upon the 

 fpine, and they fucceeded in flopping the puliation in the 

 artery of the right groin. As I withdrew my finger, I put 

 a doffil of lint by its fide, and clofcd the opening which I 

 J)ad made into the fac." Surgical Effays, part i. p. 118. 



The only other chance of prefervation was what might 

 Vol.. XXXIX. 



refult from tymg the aorta itfelf; and it was determined to 

 adopt the proceeding, bold and unprecedented as it wa-> in 

 refpea to the human fubjeft. A doubtful remedy is alwav^ 

 better than none. This ancient maxim in furgery feems to 

 gather ftrength in proportion to its duration, and is a fhort 

 but an effedual anfwer to every attempt which has been 

 made by the ignorant and mahcious to throw blame on the 

 diftinguiftied furgeon, whofe ardent defire to fave the life of 

 an individual was the main-fpring of his conduft. Mr. A. 

 Cooper, after enjoining the prudence of emptying the 

 bowels previoufly to any other fimilar operation, ftates, that 

 he made an incifion three inches long into the linea alba, giv. 

 ing It a flight curve to the left fide to avoid the umbilicus. 

 One inch and a half of the cut was above and the remainder 

 below the navel. He then made a fmall aperture into the 

 peritoneum, and introduced his finger into the abdomen. 

 This opening was enlarged with a probe-pointed biftoury to 

 nearly the fame extent as that of the external wound. Dur- 

 ing the progrefs of the operation, only one fmall convolution 

 of inteftine projefted beyond the wound. The operator next 

 pafted his finger between the inteftines down to the fpine, 

 where he felt the aorta beating with exceffive force. By 

 means of his finger-nail, he fcratched through the perito- 

 neum on the left fide of the aorta ; and next gently and gra- 

 dually pafling the finger between that vefi'el and the fpine, 

 again penetrated the peritoneum on the right fide of the 

 aorta. Guided by the fame finger, he now conveyed a 

 blunt aneurifmal needle, armed with a fingle hgature, behind 

 the veffel. After the ligature had been placed, much care 

 was requifite to exclude the inteftine from it in drawing it 

 into a noofe. The operation being finifhed, the wound was 

 clofed with a quill-future and adhefive plafter. 



During the operation the faeces paffed off involuntarily, 

 and the pulfe, both immediately and for an hour after the 

 operation, was 1 44 in a minute. An opiate was given, and 

 the involuntary difcharge of fasces foon ceafed. When the 

 right thigh was touched, the patient thought it was the foot, 

 fo that the fenfibility of that extremity was very imperfeft. 



The operation had been performed about nine in the even- 

 ing. At one o'clock the following morning, the lower 

 extremities, which had become cold foon after the operation, 

 were beginning to get warm again, but their fenfibility con- 

 tinued yet indiftinft. At eight o'clock, the right leg was 

 v.armer than the left, and tlie fenfibility was returning. At 

 noon, the temperature of the right limb was 94 ; that of 

 the left, or aneurifmal limb, 87^. At fix o'clock in the 

 evening, the temperature of the right was 96, that of the 

 left 873. At nine the fame evening, the pulfe was 104 and 

 feeble, with vomiting, reftleffnefs, and an involuntary dif- 

 charge of fsces. At eleven, the pulfe was 100 and feeble, 

 and the vomiting llill continued. At eight the next morn- 

 ing, the aneurifmal limb appeared livid and felt cold, more 

 particularly around the aneurifm ; but the right leg remained 

 warm. At eleven the pulfe was 1 20, and the patient 

 feemed to be finking. In faft, he died eighteen minutes 

 after one in the afternoon, having furvived the operation 

 forty hours. On diffeftion, no appearance of peritoneal 

 inflammation was found, except at the edges of the wound. 

 The omentum and inteftines were free from any unnatural 

 colour. The ligature which had not included any portion of 

 bowels was placed round the aorta about three-quarters of 

 an inch above its bifurcation, and about an inch below the 

 part where the duodenum lies acrofs it. In the aorta a 

 coagulum more than an inch in extent was found to have 

 fealed the veffel above the ligature. Below the bifurcation, 

 other fimilar coagula were found in the right and left iliac 

 arteries. By the fall to which the p.itient had afcribed the 

 U u tumour. 



