An account of a case of aneurismal dilatation of the popliteal artery, treated with pressure / by James Paget.
- James Paget
- Date:
- [1850]
Licence: Public Domain Mark
Credit: An account of a case of aneurismal dilatation of the popliteal artery, treated with pressure / by James Paget. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![The compressing pad was placed at different times over nearly every part of the length of the femoral artery. When one place gp-ew tender, another was chosen ; and, on an average, about two hours was the longest time during which the pressure could be borne. At the end of this time, the pressed tissues became extremely painful; only slight and short relief could be obtained by a little relaxation of the tourniquet; and it was very soon necessary to apply another, and take off all pressure Irom the painful place. The situation on which pressure could be longest endured was directly below Poupart’s ligament; yet even here, pain was so constantly pi'oduced by continuing tbe pressure for more than two hours, that during the weeks he was under this treatment he assured me that he only once slept for more than two hours at a time. During the first mouth, indeed, he i-arely slept for more than an hour, without being awakened by the pain of the pressure. He was thus considerably reduced in strength and flesh ; but he suffered no other sign of illness. He remained always in bed, and lived with great moderation. From the 2nd of Febniary, when the pressiue was commenced, to tbe 16tli of the same month, the size of the aneurism ai swelling gradually de- creased. In this time it became about one-third less than it had been, and no other change was observed in it. After this time it retained its size for ten or twelve days: no progress was made, though the pressure and all the other particulars of the treatment were steadily pursued. Again, after this pause, the swelling diminished, gradually con- tracting for several days : and thus it decreased to about half the size it had resented when the treatment was egun. About the 10th of March the progress of improvement was again checked, we could not tell why, and for ten or fourteen days no change was dis cemible. At this time it was particu- larly noticed, that if the pressm’e in the femoral artery were slightly relaxed, so that the swelling might, for a few heats, pulsate freely, then, on again compress- ing the artery more firmly, the swelling would gradually, but considerably di minish, as if by contracting. This fact, together with the decreasing firmness and tension of the swelling, and otlier con- siderations to be presently mentioned, all tended to suggest that the swelling was formed of only the dilated arterial walls, with little or no clot within them. On the 2lst of March, the diuiinution of the tumor again commenced, and this time continued, till, by the 18th of April, it was reduced to the size of a hazel nut, and felt as a dilatation of the artery, measuring about an inch in length and half an inch in diameter. It had still a full pulsation, and was still devoid of the firmness and solidity characteristic of a sac filled with lami- nated clot. When now, after eleven weeks con- finement, no further diminution of the swelling appeared, the patient, thorough- ly tired of so long and tedious a treat- ment, wished to move about. The plan of applying pressure was therefore changed to the employment of the tourniquet during tlie night only ; and, instead of it during th^ 'lay, a large firm linen ])ad was placed over the dilated portion u- the artery, and held with pressm’e on it by means of elastic straps round tlie knee. These sufficed to check any tendency to increase ; and by the 21st of May, a slight improve- ment was perceptible ; the swelling feeling ratlier smaller and ])ulsating less forcibly. The same mode of pressure was con- tinued for nearly six weeks, the elastic straps and pad being worn in the day, and the tourniquet at night, and the artery being, probably, almost always pervious: still no change whatever en- sued in the aneurism. The patient had I'egained his general health and strength; but in the last week of June he suffered with severe tooth-ache and inflammation of the gums, and with this he became so ill, that he was obliged to lie in bed. On the 28th of June, after wearing the tourniquet all night, he found, in the morning, that the swelling in the ham had ceased to pulsate. No pulsa- tion either could be felt in the anterior and 2)osterior tibial arteries. Till this time, no change bad been observed for nearly two months; but the closure of the aneurism now appeared com- plete. On the 1st of July, I could feel no pulse at the ham; and there was only a small tumor, very ill defined, and such as one might have overlooked. I was doubtful about any pulsation of the arteries of the leg or foot. The patient was better as to his general health tlian he had been for the previous week, but](https://iiif.wellcomecollection.org/image/b22424659_0004.jp2/full/800%2C/0/default.jpg)
