Surgical treatment of cervical, thoracic and abdominal aneurism / by Charles Beylard Nancrede.

  • Nancrede, Charles B. (Charles Beylard), 1847-1921.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Surgical treatment of cervical, thoracic and abdominal aneurism / by Charles Beylard Nancrede. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    bard, has suggested that after ligation interference with the vaso- motor and blood supply to the sac from constriction of the vaso-vatorum, may account for some of the failures, because of nutritive alterations in the sac-wall. How does distal arrest of the circulation act ? The effect of the direct momentum of the blood is diminished, but in a less efficient manner than by proximal arrest ; distal arrest does not directly lead to the formation of white thrombi,1 but may do so secondarily by creating eddies and still bays by the mechanical effects of soft coagula ; moreover, the contact of thrombus and wall is more apt to be disturbed. Unless the sacculation is unusu- ally favorably located, distal ligation for innominate and aortic aneurism will usually only temporarily arrest the disease, but cannot produce what I have laid down as a genuine cure. Are there no other means but proximal or distal arrest of circulation whereby the same mechanico-pathological conditions can be secured ? Certainly ; if in any way the direct momentum of the blood current can be mechanically broken up into minor currents, eddies and relatively quiet embayed collections of blood will result which, if the other chief requisite be present, i. e., change of the sac wall, will give rise to white clot formation ; these thrombi, if maintained in contact with the altered sac wall, can now go on to organization. This mechanical action on the blood current seems to me the far most reasonable explanation of the good effect produced by the introduction of catgut, coiled wire and electrolytic needles into the aneurism, which can only determine at first the formation of red thrombi. When no further changes occur after such therapeutic efforts, either no perceptible effect is produced, possibly rupture of the sac is hastened, or only tem- porary benefit results until the soft clot disappears. The absence of sufficiently extensive alteration of the lining of the sac explains why these methods, including acupuncture, so commonly fail, and why Macewen’s “ needling ” has been followed by the sur- prising measure of success which has been reported. This is because the latter plan is a combination of interference with, and 1 This is no doubt partly due to interference with the free access of blood plaques.