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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![und containing no clots such as are almost constantly found in saccular anemdsms,—i. e., partial or lateral dila tations of the arterial walls. The results of the treatment of this case, by pressure on the trunk of the artery above the aneurism, may next deserve comment. Considering that the patient was instructed in sm’gery, and well imderstood the plan on which the treatment was to be conducted, that he had himself chosen this plan of treat- ment, and submitted to it without in- terruption, and that it was attended with no local iniury, or other inconve- nience fi’om pressure ill applied, few cases could be found in which the plan was more fairly employed. Yet eleven weeks of confinement to bed, of painful re- straint, and of weariness from interrupted sleep, included an amount of suflfering which I could not recommend any pa- tient to undergo, in preference to the ope- ration of ligature oi the femoral artery. In recording this case, however, it is far from my purpose to detract from the reputation which the application of pressure, for the cure of aneurism, has lately gained. The chai’acters of the siu-geons in Dublin, by whom chiefly this method has been promoted, are too eminent to allow me to doubt that its success is often admirable alike for safety and for speed. I am disposed to think that the slowness of recovery,' in the case here related, may have been due to the peculiarity in the forin of the aneurismal dilatation; In all the instances of popliteal aneu- rism cured by pfe'ssure< to which I have been able to refer, it appears ptobttble that the cure was efiected triaihly of solely by the coagulation of the blood in, the sac; Here that event did not take place tlntil after many weeks; knd the recovery, accomplishfed mainly; and in the first instance^ by the contraction of the dilated walls; could not be other- wise than slo#. The postponement of coagillation in the dilated part of the artery may be; aS already stated, most probably assigned to the uniformity of the dilatation; and in all Sufch cases wd might anticipate, from tho rarity of clot- formation in tubular aneurisms of the aorta, that pressure; if employed, would need to be maintained for a lopg time, arid that, even when the natural diameter of the artery is nearly regained, it would be apt to be again dilated, unless, at last, obliteration by clots should occur. But, might not the same events follow the aj)plication of the ligature? May we not suspect that tlie instances in which, after aj)parent cure, popliteal aneurisms have reajipeared, have been cases of aneurismal dilatation, or tubular aneurism, in which the temporary re- coveiy has been accomplished by con- traction of the sac, without coagulation of the blood ? I think that these ques- tions may deserve consideration, and ' the collection of more facte than can yet be produced in illustration of them. I think we may occasionally expect that some differences may be found in the results of the ti'eatment of aneurisms, according to their form, and especially according to whether they be saccular or tubular,—i. e., lateral or ])eripheral dilatations of the diseased portion of the artery. Differences of the results of treatment have, indeed, often been no ticed; but, so far as I know, they have not been generally explained, or, in any measure, referred to the differences of | the forms of aneurism. j The last fact in the history of this j case to which I would direct attention, is the sudden and unexpected cessation of the pulsation in the sac, two months after the discontinuance of constant | or effective pressure. I offer no ex- | plauation of the occurrence; but it has i its parallel in one case recorded by Dr. Porter,* and in another by Mr. Cusack.f ; In Dr. Porter’s case, a physician had a j popliteal aneurism for nine months. ' The swelling was soft and compressible, j and pressure in the groin caused ; tlie pulsation to cease, and the sac to collapse and appear empty. Pressure was applied on the femoral artery for twenty days, and then the])atientreftised to submit to it longer. There was now ( a decided hardness in the seat of the disease; but the pidsation appeai’ed to be nearly as gfeat as before Four weeks after the pressure was left off, the patient found that the pulsation had ceased, and the cure appeared complete six months afterwards. In Mr. Cusack’s : case, pulsation ceased in a brachial aneurism very soon after the patient ; left the hospital, in which pressure had been used, as it wris supposed, witlioiit advantage. * Dublin Medical Quarterly Journal, May, 184€. t Miller’s Principles of Surgery, p. 586. Kd. 1850.](https://iiif.wellcomecollection.org/image/b22424659_0006.jp2/full/800%2C/0/default.jpg)
