Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/243/
231 
ARTERY, PATHOLOGICAL CONDITIONS OF. 
the neighbourhood are neither distended nor 
ruptured, and the blood within it passes through 
the general circulation, and of course does not 
coagulate. It is difficult to class this disease 
with aneurism in any form, yet is it termed the 
aneurism by anastomosis. 
No part of the natural history of any disease 
can be more interesting than that which has 
reference to its causes, whether predisposing 
and remote, or immediately exciting. Cer¬ 
tainly, when an aneurism has been formed, a 
knowledge of the circumstances that occa¬ 
sioned it will not be very useful in contributing 
to its removal, although it may often assist in 
forming a prognosis as to the result of an 
operation : yet if it can be made available in 
the prevention of the disease, it must prove of 
no inconsiderable value. It is admitted that 
aneurism frequently appears suddenly as the 
result of a blow, a strain, or some violent exer¬ 
tion, the patient being conscious of something 
having torn or given way within him. With 
still greater frequency it occurs without any 
such consciousness on the part of the sufferer, 
and persons have borne this formidable disease 
about them for months, and even for years, 
not only without being themselves aware of its 
existence, but, if situated internally, without 
its being recognized by their professional at¬ 
tendants ;* and it often happens that a patient 
complains of the crookening of the fingers or 
the numbness of the foot, unmindful of the 
tumour under the clavicle or in the popliteal 
space. Without denying that an artery, in a 
perfectly healthy condition, can become the 
seat of aneurism, because there are too many 
facts apparently in support of such an opinion, 
it may be remarked that if such was generally 
or even frequently the case, the disease ought to 
be much more common amongst the labouring 
poor, and also that it should prevail amongst 
some particular trades. These considerations 
lead to a belief, that previous to the occurrence 
of spontaneous aneurism, the artery has under¬ 
gone some change predisposing to it, although 
it may not be so easy to point out the nature 
of that change, or the causes that lead to its 
production. 
It is observed that aneurism is of far less 
frequent occurrence in woman than in man ; 
a comparison between the numbers of internal 
cases proving this fact in a remarkable manner, 
and in cases of external aneurism still more so. 
It is very rare to meet with a popliteal aneu¬ 
rism in a female. Certainly, the more labo¬ 
rious habits and constant exposure to accident 
in the one sex may in some respects serve to 
account for this circumstance, but to those 
who know that in many places women are 
obliged to undergo at least as much hardship 
and fatigue, the explanation will be far from 
satisfactory. Again, it has been stated that 
certain pursuits of life predispose to aneurism, 
inasmuch as it prevails amongst coachmen and 
postilions, but there never has been even a 
plausible reason offered to explain this greater 
* A very curious case of this description is related 
in the Dublin Hospital Reports, vol. v. p. 167. 
liability of particular callings. It cannot be 
the bent positions of the limbs of such per¬ 
sons, because many other classes, studious 
persons for instance, maintain similar postures 
for a longer time and with greater frequency, 
yet is not aneurism common amongst them. 
Neither will the sudden stretching of the limb 
by pressing the foot against the stirrup or foot¬ 
board in managing the horses throw7 any light 
upon the subject, for it is found by experiment 
that no force will rupture a healthy artery short 
of what would also tear asunder the ligaments 
of the adjacent joints. Allowing, therefore, 
the accuracy and truth of these observations, 
their explanation is still to be sought for. 
Some have supposed that old age, and the 
deposit of earthy material which is formed in 
the arteries at that period, are predisposing 
causes of aneurism ; yet, if this was the case, 
the disease should be very prevalent indeed 
among those advanced in life, whereas it is 
in reality almost as rare as in infancy or early 
youth. Of fifteen cases of large aneurism 
operated on, only two had exceeded the age 
of forty years, the average of all being but 
thirty-one and a half ; and if a larger number 
of cases (inclusive of the internal forms of the 
disease) were collected and compared, it would 
probably be shewn to be considerably less. 
With respect to the earthy deposit alluded to, 
it is found between the fibrous and internal 
coats closely adhering to the latter, from which 
it can scarcely be separated : it is disposed in 
thin laminae or plates of different sizes, the 
largest being seldom greater than a spangle, 
and these earthy spots are distinct and separate, 
not running into or connected with each other, 
and never encircling the vessel with an un¬ 
interrupted bony ring. They are supposed to 
render an artery friable and brittle, and there¬ 
fore to predispose to aneurism, and have been 
considered by some to be the products of 
arterial inflammation. Unfortunately the origin 
and progress of this earthy degeneration have 
not yet been satisfactorily traced. Scarpa* 
seems to regard it as arising from the same 
cause that produces the steatomatous deposit, 
and states that it cannot be said to be proper 
to old age, as it is sometimes met with in 
patients who are not much advanced in life. I 
have seen these earthy depositions in the aorta 
of a female not twenty-five years of age, which 
was also highly inflamed and covered with 
spots of soft steatomatous deposit, but still 
that is far from proof of its being the product 
of active inflammation, or of its rendering the 
artery weak or disposed to aneurism. 
Of any number of subjects above the age 
of sixty brought into a dissecting-room, three- 
fourths will be found with this earthy dege¬ 
neration in some of the arteries, yet the in¬ 
frequency of aneurism amongst old patients 
has been already remarked. Again, this de¬ 
posit has been seen in the sac of a true aneu¬ 
rism, a circumstance that would shew it did 
not greatly interfere with the distensibility of 
the arterial tunics or render them more friable, 
* On Aneurism, page 90.
        

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