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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    mained unchanged. As neither increase of solidity, diminished pulsa- tion, nor decrease in size, could be detected, I determined to make a final effort. The patient being fully under the influence of chloroform, I re-applied the tourniquet, and held it finnly and securely over the aorta so as to obliterate every trace of pulsation. By a prolonged effort, three-fourths of an hour passed without a single slip of the instrument. It was then removed, and the aneurismdiad ceased to pulsate. A slight movement was perceptible for some time afterwards; this being an im- pulse communicated from the pulsation of the aorta above it. In Dr. Heath’s case, the pressure had been kept up irregularly for about ten hours, when the patient fainted under the chloroform. The pressure was then removed, and the pulsation and other characters of the aneurism were found to be as bad as ever. The patient was then urged to bear a final attempt without chloroform. This he did; and, to our amazement, when, at the end of twenty minutes, he declared he could bear the pressure no'longer, we found the aneurism had become solid and had ceased to beat. Here, then, are two cases in which the actual process of cure was brought about in less than an hour. How is this effected ? We affirm by coagulation of blood in the sac of the aneurism. We believe this, because of the short time occupied in bringing about a sudden and de- cided change in the disease. It seems to me impossible that fibrine can be so rapidly deposited from the blood in such quantities as to fill up the cavity of a large aneurism, and to change a pulsating, thrilling, and expanding sac, into a motionless solid mass. This opinion is sup- ported by another important fact—the large soft mass which is produced by the filling of the aneurism with solid matter disappears in a few hours. In each of the above cases, all trace of the aneurismal tumour was gone before we could obtain a plaster cast of the part. Rapidity of disappearance, then, as well as rapidity of production, is in favour of the existence of coagulation of the blood. In it we have contraction of a clot of blood inside the aneurism, by which the watery parts of the blood are squeezed out and absorbed, such as occurs in a clot of blood outside the body. In conclusion, we may observe that the solution of fibrine in liquor sanguinis is, like all complicated natural phenomena, to be regarded as resulting from the adjustment of certain conditions to the forces by which it is maintained. When we disturb the conditions, the phenomenon ceases, to be replaced by another equally remarkable—coagulation. In fact, by substituting the conditions of coagulation for those of the solution of fibrine we cure aneurism. The day may come when even a simpler plan than pressure will effect this change; but, at present, it must be admitted that a great advance has been made in limiting the time and altering the process by which this disease may be cured. Discussion on the Papers of Dr. Mapother and Dr. Alurray. Mr. Collis: I should apologise for speaking so soon after having just spoken. Dr. Mapother was kind enough to let me see his first case, which had for me a peculiar interest ; with the same clamp of Signoroni, which effected a cure in it, I had the good fortune to effect a cure in a most interesting case. It is on record in the Dublin Quarterly Journal, so I need only indicate it. It was a case of aneurism of the common femoral artery, close to Poupart’s ligament, leaving scarcely the breadth of a finger for compression. Digital pressure was tried for two or three days without any effect on the tumour, and with the disadvan- tageous effect of producing a tendency to slough in the integuments.