VII. A Cafe of Aneurifin of the Crural Artery; communicated in a Letter to Dr. Simmons, by Mr. Thompfon Forfter, Surgeon on the Staff of the Army, and Surgeon to Guy's Hofpital.

TO DR. SIMMONS.

Dear Sir,

rjpO the two cafes of Aneurifm which you | have done me-, "the honour to infert in

the fifth volume of Medical Fads and Obfer-

vations, I am defirous of adding the following, as I flatter myfelf it will tend dill further to

elucidate the peculiar utility and advantages of the operation in queftion.

Believe me, Dear Sir,

Your's, &c. Ntv. 3, 1794. THOMPSON FORSTER.

CASE.

[ "5 ]

CASE.

Lswrence M'Carthy, a labouring man, aged thirty-feven years, was admitted, as my patient, into Guy's Hofpital, on the 30th of July 1794, for the cure of an nneurifm of the crural artery. About nine months before his admiffion, he

had perceived a fmall tumor on his right thigh,' near that part where the crural artery dips under the triceps mufcle; as it occafioned no incon-

venience, nor prevented his working, he took but little notice of it; it came fpontaneoufly, without any external violence, and remained

ftationary for near fix months before it became

painful: when the tumor had acquired the fize of an egg, a pulfation was perceptible in it, but not before.

At this period of the difeafe he was advifed to foment the part, and to make ufe of lini-

ments : this he continued to do for fome

time; but finding no relief from thefe reme-

dies, he applied to a furgeon, who recom-

mended the ufe of a bandage, which he made ufe of for near three months, but without any abatement of the pain ; and the tumor in the

mean time had increafed to a Very confiderable I 2 fize,

[ 116 ]

fize, and the limb in general had acquired fomething more than its natural bulk. The patient, naturally hypochondriacal, be-

came anxious, irritable, and deje&ed; com-

plaining of great pain in the limb, and parti- cularly in the tumor, which was in fome mea- fure eafed by preffure. In this ftate he came

into the hofpital; and his general habit having been lowered by bleeding, purgatives, and a fuitable regimen previoufly to the operation, I

performed it on Monday, the nth of Auguft, by making an incifion'in the courfe of the lower

edge of the fartorius mufcle, and about an

inch below where the profunda is ufually given off. Having laid bare the artery, * I pafTed a

ligature under it with an eyed probe, and ap- plying the flick, furrounded by adhefive plafter, &c. as defcribed in the former cafes -f, the ar-

* With a view of conveying to the reader a more precifs idea of the operation, I have made a fketch of the parts con- cerned in it,, from a fubjeft differed for the purpofe. See

the annexed engraving (plate x, fig. 2.) in which a refers

to Poupart's ligament; b to the crural artery, with a li?

gature pafTed under it at the part where it was tied; c to

the profunda; and d to the fartorius mufcle. It feems

hardly neceflfary to remind the reader that the objeft of this fketch being merely to point out the feat of the operation,

"

the parts are delineated in their natural ftate.

+ Vide Vol. V. p. 6, '

. tery

[ "7 3 -

tery was thus furrounded, and by thefe means

equally comprefTed; the pulfation below of

courfe ceafed : but, for fear of a fudden Hae-

morrhage, I pafled a fecond ligature about half an inch above the former, laying it loofe, that an affiftant might inftantly tie it in cafe of fuch an accident.

Auguft 21 ft. The firft ligature, with the

ilick, came away with eafe.

Auguft 22d. The fecond ligature came away with equal eafe. An account of the ftat-e of the pulfe at the

wrift, and of the temperature of both limbs, at

the ham, and at the foot, was taken e very day with

great accuracy by Mr. G. Babington, according to the annexed Table until Auguft the*27th, when the temperature of each was found .to be

equal. The fize of the tumor gradually deereafed,

2nd'the patient, having the perfect ufe of his

limb, was di(miffed, cured, O&ober io, 1794. ?*

/

The preceding cafe differs materially from die two former, not only in the circumftance of

the' tumor in this having been fituated in the

* Seepage r.19. I 3 upper

[ "8 3

upper part of the thigh, To that the artery could

not be fecured lower than about an inch below

where the profunda is ufually given off, but likewife in the very great pain the patient en- dured both night and day for three weeks before the operation. The tumor was as confiderable, but the enlargement of the limb below it was

much lefs than in the former cafes. After the

operation, the fymptoms were much flighter than in the other cafes, probably owing to the low ftate I thought it proper to reduce the patient to for the purpofe; and the ligature came away on the tenth day after the operation without the leaft trouble. But the circumftance in which it

differed the moft effentially from the other two, was, that the tumor was completely abforbed in

feveh weeks, and the patient had then acquired a perfeft ufe of the limb, while, .in the former

cafes, the patients did indeed acquire the ule of '

their limbs, but the tumors, though leffened

and free from pulfation, (till remained.

TABLE.

[ ll9 J

TABLE.

Day ?fthe Month.

pulfe at

wrift

tern.j tem. . of [right arm. !iam.

right foot.

left | left ham.' | foot.

Time of day when the obf. were made.

Atiguft ii

13

M

*5

16

17

18

128

109 112

104 116

96 112

97 112

96 112

110

100

124 114 116

68'-'

682 70 68

71 68

72

6gt 722 72 73 7 V 74 7? 72 68

7*2 67 70

98<* 97 99 98 100

98 99 97 97 9s 98 98 97 93 97 94

101

100

99

94 0

91 91 92 95 91 96 91 93 93z 95 92 94 91 92 90 9eh 93 95

97 91 94 9? 95 91 96 94 94 94 94 95 94

96 '

?9 93 88

95 9T& 96 88

95 90 94 89 94

io? P. M. 8|r A.M. 105 P. M.

8? A.M. 104 P. M. Rt a. m. 8.t P. M. 8? A.M. 8 P. M. 8 A. M. 8 P. M. 8 A. M. 8 P. M. 8 A.M..

9 P. M. 8 A. M.

8.V P. M. 8'? A.M. Si P. M.

94 93 9- 91 97 97

96, 94 95 94

Firft ligature and llickcame away with eafe, there, bein"- a perfeft foiuLion of continuity. 100 j 66 ?| 970 I. S?.| 93 ? | 86 ?

| 8 A.M. 100 I 69 j 98 J 92 j 95 j 94 I 8 P. M.

22 Second ligature was removed.

23

24

25

26

27

100

108 100

104. 96 104 104 106 100

106 100

95

690 69 67* 7?h 69 69 664

%2 64 66

64 63i

96? 9s 96 98 97 99 98 95 96 98 96 96

86

94 91 94 89 95 93 92 9? 92 91 9?

84 95 90 93 87 95 92 91 86

90 91 90

8^ A.M. 9 P. M.

9 A. M.

l}2 P- M. 10 A.M. 8 P. M. 8;V A. M. 8" P.M. 8 A. M. 8.V P. M. 8^ A.M. 8 P. M.

VJII. An