On rupture of the popliteal artery and popliteal aneurism / by Alfred Poland.

  • Poland, Alfred, 1822-1872.
Date:
[1860?]
Catalogue details

Licence: Public Domain Mark

Credit: On rupture of the popliteal artery and popliteal aneurism / by Alfred Poland. Source: Wellcome Collection.

    22/118 (page 22)
    confinement, pain, and exhaustion caused by waiting till nature bad nearly completed tbe division of tbe living from tbe dead portion. Case 6.—Ruptured popliteal artery; gangrene ; spontaneous amputation ; recovery?. Eichard Cook, aet. 50, a mason, whilst sitting on a square block of stone on the 23d of February, was struck by another, which drove the popliteal space or ham against the edge of the block on which he sat, giving him great pain, and otherwise greatly bruising the leg, although no bones were fractured, nor was the skin torn. The limb, on his admission half an hour afterwards into the Westminster Hospital, was much larger than the other, and of a dark, reddish-blue colour, evidently from the bruise or extravasation of blood, which appeared to he still issuing from the vessel or vessels as the limb continued to increase in size, until it at last became greatly swollen. The pulsation of neither the anterior nor the posterior tibial artery could be distinguished through the swelling the next morning. The bowels were opened, and a cold spirit lotion was applied to the calf and around the leg, and tbe swelling somewhat subsided, the limb becoming quite a blue-black, which, with the tenseness of the parts, distinctly indicated the effusion of a large quantity of blood. It was soon obvious that greater mischief had occurred than had been expected; and on the 2d of March, as vesications, filled with a bloody fluid, were formed on the outside of the leg over the fibula, and the whole limb was manifestly about to pass into a state of gangrene, if it had not already done so, I prepared everything for tying the popliteal or other arteries if found necessary, and made a long and deep incision on the outer and hack part of the leg, through the integuments and muscles, posterior to the fibula, and removed a considerable quantity of coagulated blood from between the muscles, and from a large cavity which extended upwards into the ham without causing further haemorrhage, and in no part of which cavity could an artery be felt. The patient’s countenance and body had assumed a jaundiced hue ; the pulse was very quick; the tongue foul; the countenance sunken ; the skin hot; the head wandering. Poultices of linseed meal and stale beer were applied, with gentle stimulating applications. Brandy and wine in proper quantities were ordered every hour or two, with sufficient doses of muriate of morphia at night to allay irritation and induce sleep. The incision, together with these remedies, gave great relief; and on the 7th, the man seemed to have been saved from a state of the most imminent danger. On the 8th the pulse was 112, the tongue clean, the skin of a whiter colour, the bowels opened by injections. Eight ounces of brandy were given in the twenty-four hours ; wine, with sago, arrowroot, jelly, oranges, and anything he chose to ask for. The greatest cleanliness was observed, and the chloride of lime used in profusion all around him. The mortification of the limb was complete; a line of separation formed about four inches below the knee in front, and extended behind towards the ham. On the 26th, the dead parts having almost entirely separated from the bones all round, those w'hich remained were ’ Guthrie in his “ Lectures on some of the more important points in surgery.”— ‘Lancet,’ 1850-1, vol. i, p. 618-19.