Bauhaus-Universität Weimar

The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Todd, Robert Bentley
advanced. Hence it is, that the bleeding 
occurs some two or three days earlier than the 
period at which the ligature naturally separates 
and comes from the wound. 
When the bleeding has commenced, it is a 
case of haemorrhage from an open wound, and 
must be managed on similar principles, that is, 
pressure to a sufficient extent must be applied 
directly on the orifice of the vessel. I have 
never seen a second ligature applied on the 
mouth of the vessel, either in consequence of 
the difficulty of finding the artery in a wound 
swollen and matted up with lymph and gra¬ 
nulations, or from an apprehension of the ex¬ 
istence of such a diseased condition of its coats 
as would cause it again to break down under 
the cord. But I have frequently witnessed 
the effective operation of direct pressure, par¬ 
ticularly in three cases, which occurred within 
the last few months, two of which were 
patients in the Meath Hospital, and all of 
whom recovered. In the application of this 
pressure, however, much caution is required. 
It should not be greater than is absolutely 
necessary to command the haemorrhage; it 
ought to be maintained by means of some me¬ 
chanical contrivance, and be independent of all 
bandages which are liable to stretch, to loosen, 
or to slip, and it should be removed the very 
moment this can be done with safety. If the 
bleeding has been perfectly restrained during 
three or four days, it is probable it never will 
return. The sequelae of secondary haemor¬ 
rhage ought always to have been regarded as 
more important and more perilous than the 
bleeding itself. I have invariably found the 
wound to become the seat of unhealthy sup¬ 
puration : very frequently abscesses form in 
different parts of the limb, and occasionally 
gangrene supervenes. It is sometimes diffi¬ 
cult to connect any of these occurrences with 
a lesion of any structure within the limb ; but 
too frequently the mischief can be evidently 
traced to the pressure being directed on the 
vein, and being either too forcible or too long 
Having thus, however imperfectly, sketched 
the pathology of the arterial system in con¬ 
nexion with the use of the ligature, it will be 
necessary to revert to other forms of disease, 
which have hitherto been postponed, in order 
to permit the introduction of the subject of 
secondary haemorrhage, and that the practical 
arrangement of aneurism and its consequences, 
both fortunate and otherwise, might be as un- 
L interrupted as possible. 
Aneurismal varix.—In the year 1761, Dr. 
William Hunter* directed the attention of the 
profession to a disease that had not been before 
observed, one not indeed very formidable in 
its consequences, but exceedingly curious as to 
its exciting cause and subsequent progress. 
: When an artery and vein lying in close con- 
- tact are transfixed by a cutting instrument in 
such a manner that the aperture in one shall 
exactly correspond with that of the other ; and 
* Medical Observations and Inquiries, vol. i. 
and ii. 
vol. r. 
when subsequent inflammation has so glued 
and fastened these apertures together, that, 
whilst a mutual transmission of blood between 
the vessels is freely permitted, not a drop will 
be allowed to escape in any other direction, 
a disease is formed, to which the discoverer 
gave the name of aneurismal varix. All and 
each of these several conditions are absolutely 
indispensable, and there are so many chances 
of their not being fulfilled in a case of 
wounded artery, that the infrequency of the 
disease may be easily explained. It does, 
however, occasionally occur, and for obvious 
reasons will most generally be found in the 
arm as a consequence of phlebotomy. 
Soon after the infliction of the injury that 
has been the cause of the disease, a small 
tumefaction is observed in the vein; its ap¬ 
pearance is irregular and knotted, but it is soft, 
yielding, and disappears on pressure. On 
laying the finger on it, a peculiar thrilling sen¬ 
sation is perceptible, and on applying the ear, 
a whizzing noise is heard, very much re¬ 
sembling that occasioned by a fly inclosed in 
a small paper bag. These phenomena dis¬ 
appear on either current of blood being in¬ 
terrupted by pressure on the artery above or 
on the vein below : at the same time that the 
tumour subsides a little, (though it soon regains 
its original size) and the peculiar noise is no 
longer heard. If the disease is allowed to 
advance uninterruptedly, the calibre of the 
artery above the point of communication be¬ 
comes enlarged, but it is diminished below : the 
vein also enlarges chiefly in the direction of 
the current of its blood, rarely in the opposite, 
and then but very slowly. Another interesting 
circumstance is, that the peculiar thrill is 
heard and felt all over the dilated portion of 
the vein, at a distance from, as well as in the 
immediate neighbourhood of, the point of 
communication between the two vessels. It 
seldom produces any inconvenience that can¬ 
not be remedied by the use of a moderately 
tight bandage, and if thus managed in time 
never requires a severer treatment. 
From the circumstance of pressure, either 
on the artery or vein, diminishing the size of 
the tumour and removing the thrilling sen¬ 
sation it imparted, it may be fairly inferred 
that both these phenomena are produced by 
the meeting of the two currents of blood, and 
their mutual resistance to the escape of either 
from its proper vessel. And further, it is ob¬ 
vious that if the disease should by any chance 
prove troublesome or alarming to the patient, 
its growth might be checked and its progress 
altogether stopped by permanently obliterating 
the canal of either the artery above or the vein 
below : but no operation that a surgeon would 
be justified in undertaking can remove the 
tumour, inasmuch as the blood still will con¬ 
tinue to flow into and through the enlarged 
vein. The dangers of secondary haemorrhage 
after an artery is tied, or of venous inflam¬ 
mation if the other vessel is tampered with, 
ought to inculcate the greatest caution, and it 
may be easily understood why in such cases 
Dr. Hunter thought it advisable not to interfere. 


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