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.

  • Edward Mapother
Date:
[1867]
Catalogue details

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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    up the idea after the remarkable facts which have been brought forward to day, but I think that in some cases it must be absolutely esssential to employ compression on two places, so as to cut off the possibility of the aneurism being fed by the second vessel. Dr. MaP(3THER: Both my cases were previously treated for a few days by the instrumental and digital compression, which failed. In one of the cases, after thirty-six hours, the first clot gave way, having been probably formed by the plugging of the first vessel, and not by the filling of the sac with coagulum. Both of my cases required between three and four weeks of care and rest; and, after that, absorption rapidly went on. Dr. Murray: I must express the great gratification I feel at finding the views which my cases have suggested to my own mind, so ably sul)» stantiated by Dr. Mapother and the various gentlemen associated with us to-day. These cases of aneurism suggest an almost infinite field of thought, speculation, and theorising, into which it is impossible for me to go. 1 rise, therefore, simply to insist on the points laid down in my papers, and to answer the questions which have been put. I insist, first, on the administration of chloroform in all these cases to destroy consciousness and to relax muscles. Absolute unconsciousness is neces- sary. In the next place, you must have the artery not only commanded so as to prevent visible pulsation, but you must have every single jet of blood that could possibly pass into the aneurismal sac stopped. If a single drachm of blood enter after the proper moment, the operation of coagulation will be interfered with. I absolutely insist on that point as to the immobility of the blood in the sac. It is impossible for me to go into the proofs that the cure takes place by the coagulation itself, and not by the deposition of fibrine; but the questions which have been put to me may be answered in this way. In the first case, the aneurism had only been pressed for two hours on a previous occasion, and that treatment was given up at that time chiefly because we feared to persevere much longer with chloroform. Gaining confidence from that, I tried four hours pressing on the aorta, as well as I could, preventing any great amount of blood from entering the sac. At the end of that time I was convinced that I could not command the aorta, and that I might go on for ever pressing the abdominal aorta without arresting the current of blood to it. It was then that I found I had not got at the pro- cess by which the artery was to be compressed. I determined to make another effort. This I did, and the aneurism was cured. In the other case, the artery was pressed for ten hours, and the man fainted. On his recovering, the aneurism seemed to be expanding; there was throb- bing in the sac as before, and not the slightest evidence of consolidntion. The patient seemed as bad as ever, and in danger of being left without being cured. But on applying the tourniquet, after about twenty minutes, not a particle of blood could enter the aneurismal sac, the aneurism ceased to beat, and was cured by the coagulation of the blood. With regard to the time necessary for rest, these two cases are inter- esting, as showing what a remarkably short time was necessary. In the first case, the patient was walking along the street with the aorta com- pletely blocked up at the end of six days. lie went out without my sanction, and walked a quarter of a mile home, althougli he felt rather tight about the waist, and his legs were a little numb, and when he reached home he had a slight pain in his back; and from that time he got on perfectly well, and was afterwards able to earn his bread by working as a paviour, as he did before the aneurism. In the next case, the man was making baskets in about four days after pressure, and since then he has followed his trade of a basket-maker.
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