Clinical reports of the surgical practice of the Glasgow Royal Infirmary / by John MacFarlane.

  • MacFarlane, John, 1796-1869.
Date:
1832
Catalogue details

Licence: Public Domain Mark

Credit: Clinical reports of the surgical practice of the Glasgow Royal Infirmary / by John MacFarlane. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    the leg increased, and was combined with a feeling of numb- ness about the foot and ankle. The tumour, which pulsated distinctly, and coidd be emptied by pressure, was ill defined, and situated between the origins of the gastrocnemius externus. The leg was swollen, oedematous, and deformed about the centre of the tibia, where he had sustained a compound frac- ture fifteen years ago. His general health was good, and the pulse seventy-six. On the 9th, the femoral artery was exposed at the inner edge of the sartorius, and tied with a single ligature. The external incision required to be larger than usual, on account of the great quantity of adipose substance, both under the integuments, and between the sartorius muscle and the sheath of the femoral vessels. During the first twenty-four hours, the temperature of the left leg and foot was nearly two degrees higher than the op- posite one. The limb was free from pain, swelling, and tension; and the superficial veins were prominent and well filled. Little or no febrile excitement took place: the wound adhered, ex- cept where the ligature passed out: the tumour became firm and incompressible, but diminished slowly. On the 2Sth, at seven a. m., when attempting to get out of bed, a sudden gush of arterial blood took place from the wound, by the side of the ligature. It flowed, per saltum, to the amount of about eight ounces, and was arrested by pressure. A tourniquet was applied a little above the wound, and retained for a few days; whilst rest in the recumbent position was strictly enjoined. The ligature did not separate till the 4th of August, being the twenty-sixth day from the operation. There was no return of hemorrhage: the wound gradually closed, and he was dismissed cured in the beginning of September. The aneurism was in this case to be attributed to external injury, the blow having probably lacerated the internal and middle coats of the artery; by which means the external yielded to the impetus of the circulation, and a sac was formed. The hemorrhage, whicli evidently proceeded from the femoral artery, showed that this vessel was not completely closed; and there was, therefore, a risk of its recurring as