Case of aneurism of the upper part of the axillary artery : attended by certain peculiarities and unsuccessfully treated by ligature of the subclavian artery / by R.J. Mackenzie.

  • Mackenzie, R. J. (Richard James), 1821-1854.
Date:
[1852]
Catalogue details

Licence: Public Domain Mark

Credit: Case of aneurism of the upper part of the axillary artery : attended by certain peculiarities and unsuccessfully treated by ligature of the subclavian artery / by R.J. Mackenzie. Source: Wellcome Collection.

    3/18 (page 3)
    a pital under Mr Syme’s care, an abscess had been opened in the popliteal space ; and on introducing the finger into the opening, the artery was felt distinctly beating on the finger placed between the vessels and the bone. Unhealthy ulceration of the parts ensued, on account of which the patient was removed from the hospital, and three weeks intervened between the opening of the abscess and the occurrence of the hemorrhage. The occurrence of hemorrhage from a large arterial trunk, which has become involved in the open ulceration or sloughing of sur¬ rounding tissues, is not very rare. A good many cases are re¬ corded, where the same event has occurred at a shorter or longer interval after the opening of an abscess, which has not appeared to have been followed by well-marked ulceration of the tissues. But the opening of an artery into the cavity of an unopened abscess, so as to give rise to the formation of a false aneurism, appears either to be a lesion of very unusual occurrence, or one which, if less rare, has been too much overlooked by surgical writers. The three cases recorded by M. Robert, by Mr Liston, and by MrQuain,are all which I have been able to find in which these precise conditions existed. A case, however, is related by Dr Edward Dewes, physician to the Coventry and Warwickshire Hospital,1 which appears to be of a similar character. The case is published as one “ of false diffused aneurism of the abdominal aorta, caused by caries of the vertebrae.” The existence of an abscess in this case is not mentioned ; but I presume, from the nature of the disease, and from the fact of seve¬ ral pieces of exfoliated bone being found lying loose among the coagula, that suppuration must have preceded the opening of the artery. The precise cause of the breach in the arterial coats, how¬ ever, is not quite clear. A case is mentioned by Mr Miller,2 (which is cited as “ especially conclusive” on this point) u in which the aorta, where in contact with an unopened abscess, was found ulceratively eroded from without, the inner coat alone remaining, attenuated, yet entire.” Whilst, however, the cases which I have quoted seem to prove the occasional formation of this variety of aneurism, the possibility of its occurrence does not appear to be generally admitted as a pathological fact. The subject is not mentioned in most of the later works on systematic surgery ; the fact of the occasional com¬ munication of the canal of an arterial trunk with the cyst of an abscess is indeed not admitted by some of the highest surgical authorities of the present day. This, I think, is probably to be explained by two circumstances 1st, The rare occurrence of this form of aneurism; and, 2d, The difficulty of proving the order in which the pathological changes in the cyst and in the coats of the artery have occurred; the difficulty, in other words, of proving that the cyst was not originally that of an ordinary aneurism, in 1 London Journal of Medicine, January 1852, p. 35.