A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    166/878 (page 142)
    a knowledge of the morbid changes to which arteries are liable is, that with defective elasticity there is a tendency to rupture of tunics and the development of aneurism in one or other of its forms. Those aneurisms which are the result of wounds, must be excepted from this observation, and so also must that particular kind which is known as aneurism by anastomosis. The last-named disease will be specially considered in the chapter which follows this one, and the various operations for aneurism most commonly in use, will be carefully described in future pages; but the disease requires some separate notice at my present progress. A knowledge of inflammation and its various effects will lead to a just appreciation of such conditions in the veins, and so much is said elsewhere regarding injuries of these vessels, that I shall not dwell upon such subjects here. I must refer to other parts of the volume for some observations upon the admission of air into the veins, and for the consideration of that dilated condition to which the term varicose veins has been applied. The sections on the Head and Neck, and on the lower extremity, will supply the chief information which I deem worthy of place in this volume upon these subjects. The symptoms of aneurism are generally so distinct, that there is seldom any difficulty in detecting the disease. A tumour, in the course of a large artery, pulsating synchronously with that vessel, diminishing in size, when the blood is prevented from passing into it, by pressure either upon it or upon the vessel nearer the heart, and accompanied by a peculiar sound, usually now-a-days termed “ bruit de soufflet,” which is recognised by applying the ear directly over the swelling, or through the medium of the stethoscope, can scarcely be mistaken for any other disease. But some of these symptoms are occasionally indistinct, and others not altogether to be relied upon: thus tumour or swelling may depend on other affections, and pulsatory motion may be very indistinct, from the presence of fibrin, or it may be communicated by a contiguous artery. The “ bruit ” above referred to, is not esteemed by Mr. Porter and other recent authorities, as altogether infallible, and I have myself examined instances when it did not serve to clear up existing doubts. I have seen a most expe- rienced and judicious surgeon cut through the parietes of the abdomen, with the intention of tying the external iliac artery, for a supposed aneurismal tumour, situated immediately above Poupart s ligament, which, however, in the progress of the operation, turned out to be a malignant affection of the lymphatic glands; and have known the same excellent practitioner, for a tumour which baffled the diagnostic skill of many seniors around him, place a ligature on the main artery, under the supposition that the disease was aneurism, when it was ultimately proved that lie was correct. The late Mr. Liston opened an abscess in the neck, as he supposed, which was thereupon dis- covered to be an aneurism; and Mr. Syme, in “ The Edinburgh Monthly Journal of Medical Science,” has recorded an instance in which he placed a ligature on the common carotid, for a supposed