A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period ... forming a catalogue of surgical literature arranged according to subjects / by Samuel Cooper.
- Samuel Cooper
- Date:
- 1838
Licence: Public Domain Mark
Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period ... forming a catalogue of surgical literature arranged according to subjects / by Samuel Cooper. Source: Wellcome Collection.
15/794 (page 9)
![Addenda.] ANEURISM. progress of this improvement, and find that the ’ operation was first proposed by Brasdor nearly half a century ago, so that the projection of the plan unquestionably belongs to him. Bichat next gave directions for its performance in his edition of Desault, and here the error of Allan Burns probably originated, which has been since repeated by so many. Deschamps was the first who per- formed the operation in a case of femoral aneurism ; then Sir A. Cooper repeated it on the external iliac ; then Mr. Home’s case occurred : all of which were unsuccessful. Mr. Wardrop’s first trial of it for a carotid aneurism was made in 1825, by tying the vessel on the anti-cardial side of the sac, with complete success. Mr. Wardrop’s second trial was not so fortunate, and, as will be perceived, it is questioned whether the artery was tied at all. Mr. Lambert next operated (as will be seen in this article) without success ; and Dr. Bushe’s and Dr. Evans’s cases were the only successful instances I can find, so that the former of these is the second; and the latter the third, in which Brasclor’s method has succeeded. Dr. Mott’s case is therefore the fourth successful instance on record, and certainly the only one in which it has been attempted in America. So much light has been elicited on this dark subject by the cases alluded to, that there can be little doubt that the operation on the distal side of the aneurism will now rescue from the grave many valuable lives, which would therwise be lost to the world, and abandoned as beyond the resources of our art.— Tieese.] Subsequently to the period when the article Aneurism was corrected, Mr. Liston, in a case of subclavian aneurism, situated very close to the outer edge of the right scalenus anticus, took up the right subclavian and right carotid at their origins ; by which measure it was hoped, that the innominata would become completely plugged up with coagulated blood, and the former vessels have a better chance of being permanently closed, than if a ligature had been applied to the much larger vessel, the innominata itself. The sug- gestion was made by Mr. Quain. In fact, pre- viously to the patient’s death from hemorrhage, on the tenth day after the operation, the innominata became perfectly blocked up with solid blood ; the ligature had come away from the carotid, and was found lying loose in the wound, with the two orifices of the artery above and below separated by an interval of more than an inch, and perma- nently closed. The ligature on the subclavian had not separated, but the root of that vessel, on the side towards the heart, was closed; and the hemor- rhage had taken place from an ulcerated opening in the portion of the artery on the distal side of the ligature. My friends, Sir Astley Cooper, Mr. Vincent, and some other surgeons of great experience, have noticed that, when secondary he- morrhage occurs, after operations for aneurism, it is most frequently produced by ulceration of the vessel on the distal side of the ligature. The following passage I find in the American edition of this work : — [In cases of aneurism of the thigh, it is not always practicable to decide -with absolute cer- tainty whether the disease is situated in the femoral artery, or in the profunda ; and even when it ob- viously originates with the former, the latter is often deeply involved, particularly when the dis- pasp ba<? hppn nf Inner stnndincr. Manv unsuc- cessful cases have been reported ; and I know of one which has failed in the hands of a distinguished surgeon, the aneurismal tumour still remaining, although the femoral artery was tied above the tumour. In this case the disease is, no doubt, seated in the profunda. Many surgical writers and teachers have incul- cated the doctrine, that, when the aneurism is situated in the thigh, the ligature must always be applied below the bifurcation, lest the circulation of the limb should suffer. A distinguished sur- geon of Philadelphia preferred opening the sac of a femoral aneurism, and applying his liga- ture below the profunda, rather than venture to tie the artery higher up. The operation failed, however, and the tumour still remains. That such fears are wholly groundless, may be confidently asserted from analogy, furnished as we are with the knowledge that the innominata, the common iliac, and even the aorta itself, may be obliterated, and yet the anastomosing vessels continue the cir- culation. But Dr. Whitridge, an accomplished surgeon of Charleston, S. C., has afforded a de- monstration in a case of aneurism in the thigh from a gun-shot wound, in which he tied the femoral artery just below Poupart’s ligament, and of course above the point at which the profunda goes off. This case has been completely successful, and the patient recovered without any sensible interruption in the circulation, and without any untoward symptoms. The cases in which the femoral artery divides high up, which Professor Godman has shown are by no means unfrequent, may account for the oc- casional failures of this operation, and should not be lost sight of by the judicious surgeon. As a general rule, however, applicable to all other cases, when the aneurism is situated immediately below the bifurcation, and in the vicinity of the profunda, it is safer, and also better surgery, to apply the ligature above. The action of the pro- funda may endanger the success of the operation, and the most profound surgeon may sometimes mistake the seat of the disease. — lieese.'] Besides the examples of ligature of the internal iliac, referred to in the present work, I find an- other, in which this operation was successfully performed, for the cure of a gluteal aneurism, by Professor White the younger, of Berkshire Med. Institution, in the United States. This case, which is alluded to by Dr. Ileese, is published in the second number of the American Journ. of Medical Science. According to Dr. Reese, Professor Bushe tied the common iliac, in a child less than two months old, for a congenital aneurism of one of the labia. The child recovered from the operation, but pe- rished a few weeks afterwards from abscesses of the knee-joint. With regard to axillary aneurisms, it appears that Professor Gibson (to whom I am under great obligations for several favours) cured a case of this description, occasioned by the reduction of an old luxation of the humerus, by tying the subclavian artery. (American Journ. vol. ii. p. 136.) The particulars of Mr. Perry’s example of varicose aneurism in the thigh are published in vol. xx. of the Med. Chir. Trans. When I saw the patient with Mr. Perry, in the St. Mary-le- bone Infirmary, I expressed my belief, that the svmntnms lnrlmatprl n miYirminirntinn liptwppn ttio](https://iiif.wellcomecollection.org/image/b29339674_0015.jp2/full/800%2C/0/default.jpg)
