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]
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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    i‘te1&R&I^%^EDicAi. Journal, Oct. 5, 1867.] I z: J l(r% 1,2. AMM TREATMI^'T^; AA' 'URISM; ADVANTAGES OF COMPLETfieP^RRESTING THE CURRENT THROUGH THE SAC* By E. D. MAPOTHER, M.D., Surgeon to St. Vincent’s Hospital; Professor of Anatomy and Physiology, Royal College of Surgeons, Dublin, The treatment of external aneurisms by compression, one of the greatest of modern surgical improvements, was established by Dublin surgeons. They advocated such a degree of compression as v/ould send the blood gently flowing through the sac; layer after layer of coagula being ex- pected to form, as happens, it was asserted, when aneurisms cure spon- taneously. Arrest of current, and clotting of the blood in the sac, were deprecated; but it seems to me that the following cases show that these events are, on the contrary, most desirable. Case i.—^J. D., aged 25, healthy, was admitted into St. Vincent’s Hos- pital January 14th, 1865, for right ilio-femoral aneurism, which had be- gun without injury five months before. Digital and partial instrumental pressure having failed, I tried to stop the common iliac with an elastic compressor, the patient being kept under chloroform for twelve hours. No clot formed. An anthracoid slough formed at the point of pressure. Five days afterwards, another attempt was made, after the following preparatory steps. The abdomen was made lank by emptying the bowels and bladder; the limb was raised, bandaged and fixed to aid venous return, and to render increased'flow of blood for muscular action unnecessary; and the sac was compressed by an elastic roller, so as to contract the space to be filled by the clot as much as possible. At Dr. O’Ferrall’s suggestion, the superficial femoral was stopped, so as to keep the sac full. Signoroni’s clamp was then fixed over the common iliac artery for four and a half hours, when the tumour was found solid and pulseless, the common and external iliacs being still pervious. Absorp- tion and complete cure followed. Case ii.—^J. B., aged 35, healthy, was admitted into St. Vin- cent’s Hospital, May 1866, for left popliteal aneurism, which fol- lowed a strain a fortnight before, while getting down from his cab. The sac was as large as a turkey-egg, and towards the biceps appeared diffuse. Digital and elastic instrumental pressure fading, stoppage as complete as could be achieved in a very restless patient was kept up for five hours, when the sac was found pulseless. Thirty-six hours after- wards, pulsation recommenced. After three other attempts, unsuc- cessful because chloroform was refused, the femoral at Scarpa’s triangle was compressed, and the flow of blood out of the sac was impeded by tight bandaging and elevation of the leg, distal pressure on the popliteal not being possible. The patient was kept apathetic, not insensible, with chloroform, for nine and a half hours, when the sac was found hard and * Read in the Surgical Section before the Annual Meeting of the British Medical Association in Dublin, August 1867.