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Show 58 or Trme run EXTERNAL ILI.\C ARIERY. Ql" TYING THE EXTERNAL ILIAL‘ ARTIIRY. go down, and there is pricking pain shooting to the toes, with mg also bent, it receives the full impulse of the blood, and the coats of the artery being already diseased they are here more subject to be further injured by the motions of the thigh. A small pulsating tumour is perceived a little below the a dark colour of the skin, I conceive that there is danger of the vesicat‘ions which precede gangrene, arising on the toes. This gangrene, I have seen proceed in its course uniformly for several days, and cease upon the bursting of the tumour, and the discharge of the blood of the aneurism, and a great quantity of offensive matter from behind the joint, and from had stifled and suppressed the free action of the collateral vesv _ sels, and the return of the blood by the veins, so as to produce gangrene in the extreme parts. mour might divert the stream of blood from it, allow the Should such a case presentto me, I should have no hesitation in puncturing the tumour of c.‘ ,. "aw-Iv 'QJJUW "Mil ' ll .liull. mum". the aneurism. To puncture it in this stage, after inllammw tion in the sac, I should imagine would be attended with no haanorrhagy, but only with the evacuation of such grumous blood to coagulate, and make a cure as in the natural process of obliteration of an aneurism. I find that this has been attempted in France, with very little success. There is no space betwixt the tumour and the ligament of the thigh ; for indeed blood as flows with the matter when it bursts spontaneously. that ligament often circumscribes the tumour above, and con- A" A ,4". u .__-. pq§:‘d'€‘§\e'f .A.‘_:~L. At all events it should be so punctured that the opening might. be closed again in such a way as to avoid accelerating the wide extending suppuratiou which sometimes follows the dis. solution of the blood in the sac. When gangrene has taken place, (from whatever cause, and ,.. .a.«.‘--;-. --., r - here as in others) the system must be supported. The coun~ tenance and pulse will sulliciently indicate the necessity ol'this. 'fig P17... ..,<‘~‘- ag- .'.-~ < - By successive stages, it bursts up the connexions of fascia, and from the perpendicular lamina of the fascia restraining the blood, the tumour is often divided into parts, in the last formed of which the pulsation is strongest, while from the coagulation of the blood in the others they are firmer, and have less pulsation. I have thought that tying the femoral artery below the tu- under the bellies of the gastrocnemii. The tension, as I con- ceive, occasioned by the inflammation and swelling of the sac, 7," groin. d0 , struction of the bones, both from the matter and from their lying pressed to the bed by the weight of the limb, will endanger the patient's life. In this state we must still guard the general health, and wait for an opportunity of amputatin". ) . 7 (l 131W 3b lllL l‘..\TER.\ Al. ILIAC ARTERY IN THE FEJIORAI AXEUILISM. "I III? natural or spontaneous ansurisni I have alread v obserw rd takes place ., . most . con . unonl ' ' w ' ‘ ‘ ' '- V ' Milli ~... 1"th . . . -. bouil w lw it. tl nu, 3' The": "IL- dihl) h Pbflng & bendi ngot the limb, the artery b9- sequently the femoral artery cannot be tied there. Mr. Aberncthy has proposed, and has three times perform< ed an operation for the cure of this aneurism. In the first in; stance the artery ulcerated 0n the fifth day after the operation, and small quantities of blood was occasionally discharged from it till the eighth, when the patient died. The case is related in the third part of his Surgical and Physiological Ob~ servations, page 155. The second is narrated in the first part of his Surgical Observations; and the third patient I have just seen, thirty hours after the operation. The tumour is lessened very much, the limb warm and perspiring. I regret that I cannot give the result. There is a case pending in the Birmingham hospital also. Mr. Abernethy operates in this manner : pressing the fascia of the external oblique muscle, he feels the beating artery; or if that is obscure, he ascertains the precise place of the artery by the relations of the superior and inferior spincus process of the ilium, and the crest of the os pubis. He then makes an incision, about three inches in length, through the integuments 0f the abdomen, in the direction of the external 2-»- mm}? b Mflllm |