A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery / collected from the most authentic and oiginal sources of information ; comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymoloy and signification of the principal terms. The whole illustrated by numerous interesting cases ... / By Samuel Cooper.

  • Cooper, Samuel, 1780-1848.
Date:
1813
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: exhibiting the present state of the principles and practice of surgery / collected from the most authentic and oiginal sources of information ; comprehending also an account of the instruments, remedies and applications employed in surgery, and the etymoloy and signification of the principal terms. The whole illustrated by numerous interesting cases ... / By Samuel Cooper. Source: Wellcome Collection.

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    squamous, degeneration of the internal coat of the artery is. more frequently the cause ot its bursting, than violent exer- tions of the whole body, blows, or an in- creased impulse of the heart. This kind of diseased change is very common in the curvature, and thoracic and abdominal trunks, ot the aorta. In the incipient state of such disease, the internal coat of the artery loses, for a certain space, its beautiful smoothness, and becomes irre- gular and wrinkled. It afterwards ap- pears interspersed with yellow spots, which are converted into grains, or earthy scales, or into steatomatous, and cheese- like concretions, which render the inter- nal coat of the artery brittle and so slight- ly united to the adjoining muscular coat, that, upon being merely scratched with the knife, or point of the nail, pieces are readily detached from if, and, on being cut, it gives a crackling sound, similar to the breaking of an egg-shell. This ossi- fication cannot be said to be proper to old age, since it is sometimes met with in subjects not much advanced in life. The whole of the side of the artery, in that part which is occupied by the morbid af- fection, is, for the most part, hard and rigid, sometimes soft and fungous, and, in most cases, the canal of the artery is preternaturally constricted. In the high- est degree of this morbid disorganization, true ulcerations are found on the inside of the artery, with hard and fringed edges, fissures, and lacerations of the in- ternal and fibrous coats of the artery. Whenever an aneurismal sac of an im- moderate size beats violently, and, for a long while against a bone, as the sternum, ribs, clavicle, and vertebras, the bones are in the end invariably corroded, so that the aneurismal sac elevates the integu- ments of the thorax, or back, and pul- sates immediately under the skin. Scar- pa, with the best modern writers, attri- butes the effect to absorption, in conse- quence of the pressure. Having presented the reader with an abridged account of the most important remarks, made by Scarpa, in support of the doctrine he defends, we now annex his conclusions. 1. That this disease is invariably formed by the rupture of the proper coats of the artery. 2. That the aneurismal sac, is never formed by a dila- tation of the proper coats of the artery, but, undoubtedly, by the cellular sheath, which the artery receives in common with the parts contiguous to it; over which cellular sheath the pleura is placed in the thorax, and the peritoneum in the abdo- men, 8. That if the aorta, immediately above the heart, appears sometimes in- creased beyond its natural diameter, this is not common to all the rest of the arte- ry, and when the aorta, in the vicinity of the heart, yields to a dilatation greater than natural, this dilatation does not con- stitute, properly speaking, the essence of the aneurism. 4. That there are none of those marks regarded by medical men as characteristic of aneurism from dilatation, which may not be met with in aneurism from rupture, including even the circum- scribed figure of the tumour. 5. That the distinction of aneurism into true and spurious, adopted in the schools, is only the production of a false theory* since observation shews, that there is only one form of this disease, or that caused by a rupture of the proper coats of the artery, and an effusion of arterial blood into the cellular sheath, which surrounds the rup- tured artery. (See Treatise on Aneurism, by A. Scarpa, translated by J. H. Wish art, Tdinb. 1808.) Even the believers in the doctrine of dilatation, will, 1 think, now agree with Sabatier, that, in what they call true aneurisms, the internal coats of the ar- tery, that is to say, the cutieular and muscular coats, are mostly ruptured, while that which is called cellular, or elastic, is dila ted, so as to form the pouch, in which the blood is contained. This, he says, is particularly apt to be the case, when these sw ellings are the consequence of some exertion or violent shock. The generality of modern surgical authors, by whom the true aneurism, attended with a real dilatation of all the coats of the artery, is implicitly believed, univer- sally admit, that, when such a tumour has acquired a large size, the inner coats ot the vessel, which are imagined to be dilated, may give way and be ruptured. The blood, forcibly impelled into the vessel, or tumour, is described as pro- ducing a laceration of the resisting coats, becoming effused within the cellular coat, which is very elastic, occasioning a se- paration of this tunic from the others, and collecting within it in a more or less considerable quantity. “ I have found this proved,” says Sabatier, “ in nearly all the aneurisms which I have seen dis- sected, as well as in those, which I have examined myself, but, particularly, in a subject, whose carotids I was about to inject. In endeavouring to expose these vessels, I found a large quantity of blood extravasated in the adjoining cellular substance. As they appeared to me to be larger than ordinary, my curiosity was excited, and I traced them to the aorta, which was extremely dilated, as was likewise the pericardium. The deep livid colour of this latter membrane shewed, that there was an accumulation ot blood in its cavity. In fact, a large quantity was found there, and the por- tion of the aorta, included within this membrane, was much enlarged. I soon