On naevi materni and dilatations of the vessels of the integument / by Holmes Coote.

  • Coote, Holmes, 1817-1872.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: On naevi materni and dilatations of the vessels of the integument / by Holmes Coote. 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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    creased slowly up to the present time. Some time ago the right facial artery had been tied by another surgeon, and during the operation profuse haemor- rhage took place from a vessel towards the side of the tumor. No perceptible diminution in the swelling ensued,—a result which will not surprise any ac- customed to view, in an injected sub- ject, the free anastomosis of tire coro- nary arteries of the right and left side of the face. Air. Lawrence extirpated the whole pulsatory mass with the knife Jan. 11th, 1847. There ensued very little more haemorrhage than would have taken place after extirpating a cancer of the lip. The ends of the co- ronary arteries and of one smaller vessel were tied, and the patient recovered without an unfavourable symptom. Mr. Lawrence kindly gave me the tu- mor to examine, and I injected it with mercury. It was composed of arteiies in the natural state of the diameter of a large pin, dilated for about an inch of then- course into great sinuses or canals, the cavity of which equalled that of the radial artery in the adult. They freely communicated one with another, and were lodged in the natural structure of the lip, to which they were attached by loose areolar tissue. Upon the divided surface there were the cut orifices of eight arteries, some of them of consider- able size. The walls of these dilated arteries were thin, but I failed in de- tecting anything remarkable by micro- scopical examination. Here, then, is an instance of aneurism by anastomosis. It is a pulsating swelling connected with a few arteiies of some considerable size. It is obvious that there exists a wide difference between this disease and the mevus of infants, as commonly seen, which consists in a pulseless red vascular spot, seated in or under the integument, and composed of dilatations of the capillaries which constitute the skin. Therefore, aneurism by anastomosis consists in a dilatation of several arte- ries for a certain part of then- course. Ncevus maternus is composed of a congeries of capillaries. The two diseases are essentially dis- tinct, and require different modes of treatment. There remains a third variety of vas- cular tumor, of which there have been of late in the hospital some good exam- ples. The first case of this kind which fell before my observation was in the year 1845. A delicate young man, set. 20, an undergraduate at Oxford, consulted Mr. Lawrence for an oblong, pulseless, blue- coloured, vascular tumor, of four years’ duration, situated in front of the abdo- men, over the inferior ribs of the right side. It was firm, having been fre- quently cauterised. The blood, when squeezed out by pressure, did not readily flow in again. The patient attributed the disease to the rubbing of the braces; indeed, his attention was first directed to the part by the irritation which he experienced in walking. The whole mass, including some diseased integument, was extir- pated by the knife : one small cutaneous artery only was tied, but the bleeding was inconsiderable. The tumor, upon examination, was found to consist of a number of tortuous and dilated vessels, which I concluded, from the thinness of their walls, the collapsed state of the cut extremities, which were healthy, the want of pulsation during life, and the general varicose appearance of the part, to be veins. They contained a thin watery yellowish-red fluid, which, under the microscope, was seen to contain blood-discs in small quantity, altered in shape, and jagged at their edges; gra- nules, probably tlie remains of decom- posed blood-discs; epithelium, and fatty matter. The wound healed without a bad symptom, and the gentleman left town in a fortnight. Now in a vascular tumor removed recently in the hospital by Mr. Law- rence, which closely resembled, in its general characters, the vascular swellling just described, I was interested in ob- serving several of those hard concre- tions known by the name of phlebo- lithes. Phlebolithes, or vein-stones, are confined to the venous system, and their presence in such a tumor may be taken as very conclusive evidence as to the character of the vessels affected. It is the opinion of the best pathologists that vein-stones form in consequence of a limited sub-inflammatory process, which determines a coagulation of the blood in distinct layers; the coagula, for the most part spherical in shape, continue for a length of time subject to an interchange of action and reaction with the passing current of venous blood, and there is deposited in them