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Show rorLIrmn ANEURISM. i'OPLITEAL ANEURISM. the ligatures may be expected to come away: they ought , For the advantages of the present method, we are indebted to Mr. Hunter. Mr. Home persevered in the views of Mr. Hunter, and established the operation. It is performed with some variety in the manner of securing the artery, by Mr. Lynn, Mr. Abernethy, and Mr. Cowper. As long as the tumour behind the joint is small, and the geo 5'1 neither to be tugged with violence, nor cut shortt‘. THE OPERATION FOR POPLITEAL ANEURISM. IN the course of the artery through the limbs, that part which is behind the knee joint is the most exposed to disease ; or rather, we should say, to the most frequent consequence of This disease is call- neral swelling and tumefaction of the knee, leg, and foot, mode‘ rate, it may be proper to delay the operation : for during this delay, the collateral branches are enlarging. But when the tu~ ed the popliteal aneurism ; and is a. frequent occasion of ope- mour in the joint is large and firm, the ham-strings distended, ration. This is called a true aneurism ; but I believe that it is often- and the general swelling increasing, delay produces the danger the diseased state of the coats, aneurism. er a bursting of the proper coats of the artery, than a dilata~ ' ~r mum of suppuration in the ham after the operation. The tourniquet is put about the limb, but not screwed so tion. The artery generaily gives way suddenly, with acute pain and lameness, in consequence of sudden exertions; or after a long walk ; or in carrying a heavy burden. But though as to obstruct the artery. The instruments necessary, are a scalpel, a blunt hook, a probe, and a flat silver needle. the proper coats have given way, the common coat, the cellu- I. ._ MI‘ _.-3.__\_.._...,\:.me'-.--s-T.A .~ lar membrane, and the uniform compression of the surrounding parts, and the binding of the fascia, will often prevent any ran pid increase of the aneurism. Yet sometimes, in the course of rmce or THE INCISION. every few days, there is total lameness, great swelling around the joint, and ozdema of the leg and foot. In most cases the swelling is uniform, the proper aneurismal tumour little prominent; the pulsation is, however, distinct, THE incision is made in the tract of the outer edge of the sarr torius muscle, beginning about three hand-breadths from the Arvr-L ,. until the mdema spreads very much around the joint. \Ve do not operate inthe place of the tumour, but in the tine-part ..,.. .l,'A‘~1* .1". - .. \t ‘4" ' 4.15 UV of the thigh, where the artery lies more superficial. The operation in the ham was given up, from the many bad conse~ quences of deep incisions to get at the artery among parts al- ready diseased; the eonsequences of which, were extensive sores and abscess by the side of the aneurismal tumour, ulcera~ . "#1." r->-::-> "-‘f‘V‘ rat-JP» '1 55 superior spinous process of the os ilium, and being carried down about five inches ; but the length of the incision must vary with the depth of the integuments. II. Ilaving cut. through the fat, and exposed the fibres of the sartorius muscle, you turn aside the outer edge of this muscle, and now you find a strong fascia under it. This fascia covers tion of the artery, and repeated hzemorrhagy; and, in some cases, the triceps was cut across in pursuing the bleeding ori. the artery. iiee of the artery. engravings of the arteries, it will be better to cut on the outer edge of the sartorius muscle, and to fold the muscle aside, with * The operation as descrilscd in the Expose de la I‘raetiqur ‘1'"???th par. X, Biehat was very ill j'ici'fornied, and ought l conceive to intilienec us :11 no degree ‘ N. B. If the artery is to be tied at the point 10, plate IX. the integiunents of the inner edge of the incision ; but if it is to be tied higher, it is better to make the incision upon the hi" |