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Show or AXEURISM 1x rm: ARM. or annuals." m we ARM. The true and the false aneurism is not to be distinguished by the greater or lesser pulsation of either, or by the conic pressibility of the one being greater than the other. The true aneurism forms at that part of the artery where and that the bleeding was unusually profuse, and difficult to stop. Soon after the operation, a small tumour forms on the 50 the coats are most exposed to the impetus of the blood, as in the arch of the aorta, where the common carotid branches, and where the artery passes the great joints, as in the groin,or behind the knee. In the two latter places, the aneurism from disease of the coats is peculiarly apt to form; not that the coats of the arteries are more diseased here, but that the gene- ral arterial system being diseased by the bending of the limbs, the artery at these flexures becomes directly exposed to the course of the blood. IVhile I do not deny but that the arteries in the extremi.a "tJJUW "WU-t ties, like the aorta, sometimes suitor the nature of an aneuu rismal tumour by mere distension or enlargement, yet more generally that which we call a true aneurism appears, on dissection, to be of the nature of a diffused aneurism; viz. the artery has given way entirely on one side, and What forms the walls of the tumour, is merely the condensed cellular membrane. Further, the surrounding cellular membrane and the fascia so embrace the bleeding orifice of the artery, that, strictly speaking, there is no such thing as a difi‘used 'aneurism. The condensed membrane and fascia forming a sac more or less regulates. OF THE \VOI'ND OI" THE ARTERY, IN BLEEDING IN THE ARM, AND OF THE OPERATION I‘OR ANEL‘HISM. 'I'nn blood flowing per salttnn, has often made the face of the youngsurgeon pale with aft'right, but without reason; for the blood w ill sometimes flow from the Vein in jets, owing to the general fulness of the arm, or the pulsation of the arterv immediately under the vein. . The patient. who applies to you with an anenrismal tumour, will, perhaps, say that he thought the lancet went very deep" Ancurism by: Anastamosis-Sce tumours {)1 part; at first soft, regular, and with an evident pulsation. In this first stage we may compress it, when the blood probably will return into the wounded vessel; or it may also pass into the deeper recesses, by the insterstices of the muscles. At all events, this receding of the blood I have seen. In a few weeks, or we had better say when the tumour is increased, the character of the disease is considerably changed. A tumour, not very prominent or regular, occupies the whole bend of the arm having an obscure deep pulsation when we put the whole hand upon it. The arm is bent in consequence of the binding of the fascia, and the fingers are crooked. Now a firm coagulum is formed in the sac, and the fascia is stufl‘ed and distended to the utmost, and we are no longer capable of compressing and emptying it by gentle means. Bolder and more cruel attempts (and such I have seen made from ignorance and obstinacy, twin brothers) only dilfuse the blood wider,by bursting up the cellular membrane, and the deep , connexions of the fascia. In the end, by the continued pulsation of the artery, the blood poured out is so beaten together and impacted, that the pulsation of the tumour is scarcely perceptible. The complaint which brings the patient to the surgeon, is not the tumour and pulsation ; it is the lameness, the coldness, numbness, and diffused pain of the arm, proceeding from the compression of the artery, in consequence of the aneurismal tumour, and the distension of the fascia. Though I know no instance of it, there is a possibility of a spontaneous cure. For when the tumour has distended to the last degree, if the accumulated coagnluni should press so strong!y on the artery as to interrupt the pulse which was free in the beginning of the disease -, the collateral branches may become enlarged, and the current of blood may altogether leave the trunk of the artery. This is precisely the effect which is to be accomplished by the surgical operation. And. I .3 H,_ 45* ‘5‘ us. l it \Mfl3C h - - Mum |
