Treatment of aneurism : advantages of completely arresting the current through the sac / by E.P. Mapother. Notes on the rapid pressure treatment of aneurism / by W. Murray.

  • Mapother, E. D. (Edward Dillon), 1835-1908.
Date:
[1867]
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Licence: Public Domain Mark

Credit: Treatment of aneurism : advantages of completely arresting the current through the sac / by E.P. Mapother. Notes on the rapid pressure treatment of aneurism / by W. Murray. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    NOTES ON THE RAPID PRESSURE TREATMENT OF ANEURISM * By W. MURRAY, M.D., M.R.C.P.Lond., Newcastle-on-Tyne. The object of this paper is to prove, first, that aneurisms of the largest size can be treated successfully by a process which is so rapid in its oper- ation as to occupy less than an hour; and, second, that the cure takes place in these cases by coagulation of blood in the sac of the aneurism, and not, as has been hitherto believed, by the deposition of fibrine. What is the nature of this treatment? The patient is put fully under the influence of chloroform, that we may be enabled to apply a very powerful pressing instrument on tender or sensitive parts, such as the site of the abdominal aorta. The full administration of chloroform is further necessary to relax the muscular system, which is an important condition of success, as the slightest movement of the pressing instrument by the muscu- lar action of the parts pressed on, is fatal to this process of cure. I would draw special attention to the next part of the treatment, as success is de- pendent upon the care with which this is carried out. It is the complete arrest of all movement of the blood in the ajteurismal sac. By the old method of cure, fibrine was supposed to coagulate and be deposited from the very slow, scanty, and feeble current of blood, which found its way through the sac of the aneurism while incomplete pressure was main- tained. Such a current, however feeble and slow, would be absolutely fatal to the rapid treatment. Complete arrest, therefore, of a current of blood, which shall be retained in a motionless state, is the secret of success. In fact, you must do by pressure exactly what is done by the ligature when it is applied to the artery above the aneurism; and you may do even more than is done by the ligature; for Dr. O’Ferrall of Dublin has insisted upon the application of distal as well as proximal pressure; and Dr. Mapother has carried out his suggestion with com- plete success. Aneurisms requiring pressure on the abdominal aorta are perhaps least dependent on distal pressure, as the collateral circulation to the lower parts of the body is here so limited as to render a current into the distal orifice of the a.neurism improbable. In order to obtain this complete arrest of blood in the sac of the aneurism, the most careful and energetic watching of the pressing instrument is necessary. You must have so deep an interest in the treatment that you will sit for a whole hour or more, enduring the most trying strain on your muscular and nervous sys- tems, before you can hope to obtain a cure. Your eye and hand must be continually testing the condition of the aneurismal swelling; and the faintest indication of pulsation there must be considered fatal to the pro- cess of cure, and at once remedied; in fact, the tourniquet must be so placed as not to permit a single rush of blood into the aneurism. No- thing short of this will bring about a cure in a short space of time. We must now consider the duration of the treatment. At Newcastle, a case of aneurism of the abdominal aorta underwent the process of cure in three-quarters of an hour; and, in another case at Sunderland, under Dr. Heath’s care, consolidation was distinctly observed to occur within twenty minutes. In the Newcastle case, unsuccessful efforts had been made for four hours; and, at the end of that time, the aneurism re- * Read in the Surgical Section before the Annual Meeting of the British Medical Association in Dublin, August 1867.