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.

    115/1024 (page 103)
    winch it may happen. But, the occur- rence is excessively rare, and can hardly be called a radical cure, as the cicatrix is always found in a state ready to burst and break, if the arm is, by any accident, violently stretched or struck, where the wound was situated. Whenever the ulcerated, lacerated, or ■wounded artery, is accurately compressed against a hard body, like the bones, it ceases to pour blood into the surround- ing cellular sheath, because its sides, being kept in firm contact, for a certain extent, above and below the breach of continuity, become united by the adhe- sive inflammation, and converted into a solid, ligamentous, cylinder. Molinelli, Guattani, and White, have given exam- ples and plates, illustrative of this fact. When aneurisms get well spontaneously, the same fact is observed after death, as Valsalva, Ford, &c. have demonstrated. I have myself seen in St. Bartholomew’s Hospital, an instance, in which a. man had had a spontaneous^cure of an aneu- rism in the left axilla, but afterwards died of hemorrhage from another one under the right clavicle; the artery on the left side was found completely im- pervious. My friend, Mr. Albert, had under his care, in the York Hospital, Chelsea, a dragoon, who recovered spon- taneously of a very large aneurism of the external iliac artery : the tumour slough- ed, discharged about two quarts of coa- gulated blood, and then granulated and healed up. Paoli relates a similar ter- mination of a popliteal aneurism. Moini- chen and Guattani, relate other exam- ples. Hunter found the femoral artery quite impervious, and obliterated, at the place where a ligature had been applied fifteen months before. Boyer noticed the same fact in a subject, eight years after the operation. Petit relates a spon- taneous cure of an aneurism at the bifur- cation of the right carotid, and the sub- ject having afterwards died of apoplexy, the vessel on dissection, was found closed up and obliterated from the bifurcation, as far as the right subclavian artery. Desault had an opportunity of opening a patient, in whom a spontaneous cure of a popliteal aneurism was just beginning; he found a very hard, bloody thrombus, which extended for three finger-breadths, within the tube of the artery, above the sac, and was so firm, as to resist injec- tion, and make it pass into the collateral branches. Both the spontaneous and surgical cures of aneurisms, have two stages ; in the first, the entrance of the blood into the aneurismal sac is interrupted; in the second, the parietes of the artery ap- proach each other, and, becoming agglu- tinated, the vessel is converted into a solid cylinder. This doctrine is corro- borated by the tumour first losing its pulsation, and then gradually diminish- ing and disappearing. Dr. Thomson, as well as Scarpa, has long expressed his opinion, that the spontaneous radical cure of aneurisms, may sometimes arise from the pressure of the aneurismal sac on the trunk of the injured artery, just above the communication between the vessel and the cavity of the aneurism. Morand proved that a violent blow may lead to the obliteration of an artery, and Dr. Jones has demonstrated, that arteries always become impervious, after having a tight ligature put round them, even though such ligature be removed the mo- ment after its application. When an aneurism is affected deeply by gangrene, a dense, compact, bloody, coagulum is formed within the vessel, shutting up its canal, and interrupting completely the course of the blood. Hence the sphacelation which follows, and the bursting of the integuments, and of the aneurismal sac, are never accom- panied by a fatal hemorrhage, and the patient is cured of the gangrene and the aneurism, if he has strength sufficient to re- sist the destructive action of the sphacelus on the constitution. When a patient dies of hemorrhage, after the mortification of an aneurism, it is because only a portion of the integuments and sac has sloughed, without the root of the aneurism, and, especially, the arterial trunk, being in this way affected. In order that compression may make the opposite sides di’ an artery unite, and thus produce a radical cure of an aneu- rism, Scarpa says, the degree of pressure must be such as to place these opposite sides in firm and complete contact, and such as to excite the adhesive inflamma- tion in the coats of the artery, which must also possess a state of vitality, pre- sently to be noticed. The point of com- pression must also fall above the lacera- tion, or wound of the artery; for, when it operates belowq it hastens the enlarge- ment of the tumour; and Scarpa adds, that, in practice, bandages, which are expulsive and compressive, are more use- ful for making pressure, than any tour- niquets or instruments, many of which are contrived to operate, without retard- ing the return of blood through the veins. For pressure to succeed, the coats of the vessel must possess, at the place where it is made, such a degree of vitalir -ty, as to be capable of feeling the stimu- lus, and of inflaming. When the arterial coats, round the root of the aneurism, are diseased, as above described, they are insusceptible of the adhesive inflamma- tion, although compressed together in the most scientific manner, and, eye a