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Show Gt) or'AnnnmsMAL VARIX. or ANEURISMAL VARIX. iliac artery, beginning just above Poupart's ligament. His second incision goes through the aponeurosis of the external oblique muscle ; he then insinuates his finger between the in~ ternal oblique and transversalis muscles and the peritoneumJ and divides them upwards to the extent of an inch and a half. The knife is now laid aside, and the peritoneum is pushed up from the vessels of the thigh and psoas muscle. The artery is‘next felt for, and now separated from the vein, the artery. He passes a double ligature under the artery, and he is particularly careful to have it of so great a thickness that tery, and of the vein to the fascia, whilst the puncture made Cutting brought low, and both ligatures are tied, and then the artery is ,i. we r ,g ,4.» .v:+:w€~.‘<‘-:T- - _ ., blood in this case will naturally flow profusely, and be dith- cult to stop, the surgeon probably applies his compress very tight. This produces a firm adhesion of the fascia to the ars the needle from the ligature, the one portion of the ligature is pushed as high upon the artery as possible; the other is "WU-l formed betwixt the humeral artery and the median basilic vein ; in consequence of which, the blood being carried into the vein with the same force which impels the blood in the artery, it dilates the veins. This communication is formed by the lancet, transfixing the vein and fascia, and puncturing the artery. As the on the inside, and the anterior crural nerve, on the outside of it cannot cut the artery in drawing it very firmly. ‘ asuw 6,1 cut in the middle, and the parts brought together. Mr. Abernethy is particularly anxious to avoid the vein, and not to include it in the ligature, as he rightly conceives, when the force of the arteries of the limb is so much diminished as it must be by the lancet remains open betwixt the artery and vein. The symptoms and character of the aneurismal varix, are these: there arises over the artery, a few weeks after the acc1-: dent, a flat swelling of the vein, with the mark of the lancet in the middle of it. On placing the finger upon this tumour, a faint pulsation or vibratory motion is felt. There is a noise, or at least a peculiar feeling, which conveys that idea, ‘ between thrilling and whizzing.' The tumour extends from the median basilic to the other veins; but it is chiefly of the median basilic, medan cephalic, basilic and cephalic veins, What seems to have destroyed Mr. Abernethy's second pa- est in the median branches ; but both the distension and the tient, was the putrefaction of the blood in the aneurism, after the ligature. had come away, and the circulation of the leg was thrilling sensation are, on applying the finger, felt some way completely restored. If therefore he found that in the pre- sent case the blood of the aneurism were to open a communi- cation with the wound, certain that by this communication with the air, it would putrify, and become a source of mortal irritation to the system, he will then open the tumour, and wash the blood from it entirely. I confess that my fears are still for the ulcwa tion of the and extending up the arm. The tumour is, of course, great- up the arm. . The tumour increases by hard labour and exercise. It IS largest when the arm hangs; and both the enlargement of the veins and the thrilling sensation almost entirely subside upon holding the arm over the head. The veins do not subside upon putting a ligature 0n the arm below the commune cation. The motion of the blood is not only felt, but some- times seen distinctly ; and, if the ear be brought near the part, artery. OF ANIZURISMAL VARIX. it is heard. It gives a hissing noise, as if there was a blast of air sent through a small hole. The humeral artery is enlarged, and its pulsation becomes unusually evident. THIS is a peculiar kind of aneurism, and happ ens only after bleeding in the median basilic vein. It is a communication mm .1? b Mrvrm after the operation for aneurism, an obstruction to the return of he blood by the vain would probably produce gangrene. The pulse at the wrist is weaker and smaller than in the other arm. Lastly, on pressing the median-basilie vein with the point of the finger, so as to stop |
