An account of a case of aneurismal dilatation of the popliteal artery, treated with pressure / by James Paget.

  • Paget, James, Sir, 1814-1899.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: An account of a case of aneurismal dilatation of the popliteal artery, treated with pressure / by James Paget. 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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    AI^ ACCOUNT OF A CASE OF ANEDEISMAL DILATATION OF THE POPLITEAL AKTEKY, TREATED WITH PRESSURE. By JAMES PAGET, Esq. ASSISTANT-SURGEON TO ST. BARTHOLOMEW’S HOSPITAL. Read on Thursday, December 6, 1850. April 1850.—B. C., a gentleman who had been educated as a surgeon, 27 years old, very tall and thin, had en- joyed good health till October, 1845, when some heavy deals feU upon liim. They knocked him down and fell across his legs; and he remained about a minute under them, before, with Die exertion of gi-eat force, he could extri- cate himseH. He was laid up for a week, and then resumed his usual occupation; but he had pain about his knees and legs, and especially in the left knee, and in the muscles of the calf of his left leg, whenever he walked ; after over- exertion tlie pain became so severe that he could hardly stand. He treated these pains as rheumatism ; but, about three years after the accident, he found the veins of the left leg becoming varicose: the pain still continuing as It had been in the knee and calf. For this state of the veins he applied bandages to the limb, with some diminution of pain in walking, but with no other advantage. It was just before Christmas, 1849, that he found a pulsating tumor in the ham, which felt somewhat larger thah a wal- nut, and continued increasing till I first I saw him, on the 9th of Januaryj 1850; I found in the left ham a tumor of 1 oval form, having its long axis parallel ’ with that of the limb, and measuring itwo and a half inches by two. It ] pulsated very forcibly, and equally on 1 all parts of its circumference, and, with j pulsation^ felt as if it tlitilled. A loud I bellows sound was audible with the ear 1 placed over the tumor, or over the I artery aboYe it. The pulse in the left c dorsal artery of the foot was rather ffeebler than that in the right; but I ould detect no difference in time be- tween them. The skin over the swelling was tense; but its tissue, like that of all the adjacent parts, appeared completely healthy. There was, indeed, no other appearance of disease, either local or general. The treatmeht of the case could not be commenced till the 31st of January, when first pressure was applied to the femoral artery, with two tourniquets made according to the description of Dr. Carte. These were placed on dif- ferent portions of the length of the artery, and were alternately tightened and relaxed; but so much pain was produced, that the patient removed them after nine hours, and the pltin was not resumed till the 2nd of Februeiry. From this day to the 10th of April, pressure was made on some part of the artery, and steadily maim tained. During the whole seventy-five days, the blood only once fldwed through the artery, the patient having fallen asleep, and the tourniquet having slipped and remained loose for four hours. The - pressure, as already stated, was made, in the first instance, with tourni- quets constructed according to the plan of Dr. Carte, deriving their force frotn the tension of elastic caoutchouc bands. But although they Were never tightened more than enough to stop, er reduce to a minimum, the pulsation in the tumor, yet they caused SUch pain, that after the fourth Week, tile pattetil would dnly use the Italian tourniquem Tliese, made with large pads tb fit the outer and back part of the thigh, completely sufficed for the pressure, could be more easily applied, rested more secitfely, and produced less pain than the other instruments, however used.