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.

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    right side, which bad already produced some oedema of the right foot. His account of it was, that he had discovered a swelling in the ham three weeks before admission ; that it had rapidly increased in size, and become very painful, especially at night. There was so much general irritability and arterial action, that it was thought advisable to delay operative measures for a few days. However, the pain in the ham increased, as also the size and circumference of the limb ; and it w^as resolved to operate forthwith, but no persuasion could move him to submit. Several days passed on, the pain increased, the size of the limb also, as wmll as the oedema, and he then himself proposed operative measures. Ligature of the femoral was per¬ formed, and two other large arterial trunks, seen in the course of the operation, like¬ wise ligatured. The patient’s suffering was lessened from the moment of the operation; the pain in the tumour was dissipated, and in forty-three hours his general condition and countenance improved; but one thing created uneasiness, and that was the large quantity of blood effused at the ham and at the upper part of the calf. On the eighth day there w'as heat and redness, and on the eleventh fluctuation was evident; this was explored ; a dark, thin, red, bloody fluid escaped, containing pus. Two incisions were made, to allow of escape of fluid, but not much evacuated. Gangrene set in. Heath on forty-third day after operation. No facilities afforded in examining limb. The parts were so broken down by gangrene that nothing could be made of them. Case 12.—Ruptured artery ; ligature of femoral on sixth week; gangrene. Death thirty-nine days after operation} Thomas C—, set. 56, tailor; pale; unhealthy; admitted into the Liverpool Royal Infirmary, under Mr. Stubbs. About five weeks before admission, while drunk, met with a severe fall. For some time previous to this occurrence he had experienced slight stiffness in the left leg, w'hich subsequently increased, and was soon attended with pain. After the accident he soon perceived a swelling behind the knee, which became hot and hard, and caused pain on walking; it had gradually increased in size. On admission, there w^as a swelling in the left calf, giving the sensation of diffused fluid; a tumour of considerable size occupied the inner side of knee, and extended into popliteal space, and gave distinct but feeble pulsation over whole surface; a slight bellow's-sound heard. The veins crossing it were large. Pressure on femoral arrested the pulsation. On the outer side of the ham there was a fluctuating spot under the integument, which was somewhat discoloured, into which an exploring needle had been passed previous to admission, and some blood evacuated. Ligature of the femoral performed on the eighth day. Favorable progression until tenth day, when gangrene attacked fourth and fifth toes. The ligature came away on seventeenth day, and an incision was made into the ham, and a large quan. tity of coagulated blood removed, and with relief. Gangrene continued to pro¬ gress, and amputation unable to be performed on account of patient’s condition. Death resulted on thirty-ninth day.