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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    On examining the popliteal vessels, they were found both torn through, but no external communication with the torn ends. Scarcely any blood had been lost; the ends had not retracted, but the orifices of the artery were contracted and filled with a small quantity of coagulum; a web of membrane was enveloping the extremity of the vessel. The vein was also torn, and its extremities appeared puckered, and also covered with cellular membrane. Quicksilver dropped into the vessel did not escape. In this case two causes prevented haemorrhage—the cellular sheath enveloping the divided extremities of the vessel, and the contraction of the muscular coat. (See Prep. 1509, Guy’s Museum.) A similar case was admitted into Guy’s, under Mr. B. B. Cooper. A man, aet. 32, was struck by a plate of iron weighing 4 cwt., and at red heat, on the outer part of the thigh, just above the knee, jambing him against the wall with fearful weight. There was a large vertical wound over the outer part of the knee, the vastus externus torn through, as also the capsule of the knee-joint; the femur fractured in its lower fifth, and protruding through a wound in the popliteal space. There had been but little haemorrhage. Amputation was performed two hours after the accident. The popliteal vein and artery were completely torn through ; both ends of the artery were filled with a large coagulum. (See Prep. 1515®^.) We have thus somewhat digressed from our subject^ but the foregoing remarks were introduced, in the first place, to show that it requires much force to rupture a popliteal artery; and secondly, that when ruptured completely across, there may be little or no haemorrhage after the first immediate gush. These points will have to be borne in mind in investigating the class of cases for our consideration; the essential difference being the absence of lesion of surface and the want of a vent for the immediate escape of blood, so that in the majority of these cases tension takes place, and rapid gangrene ensues. Of complete rupture of the popliteal artery without any, or but slight, external lesions, we have collected nine cases from the British journals; and of these, it is singular, three came under our especial notice and treatment at Guy^s Hospital. Eight were males, and one female; 3 of the age of 30, one aged 32, one aged 36, one aged 46, and 2 aged 50; and all due to violence and injury. 1. The more precise nature of the causes of the injuries in these cases were— a. Those acting from without inwards. In Case 2 it was maintained by the man that he was kicked in the popliteal space by a horse, and it was thought so probable by the surgeon, that, acting upon this and having decided the case to be one of ruptured artery, he cut