SURGERY.
Coagulation of the Blood in Arteries for the Cure of Aneurisms.—
By Dr. Pravas of Lyons. The plan which Dr. Pravas proposes con-
sists in coagulating the blood in the arterial vessels by the injection of
a few drops of a concentrated solution of perchloride of iron. This is
done with either a gold or platinum trocar, very finely pointed, intro-
duced obliquely through the walls of the vessel with a rotatory sort of
motion. The instrument being furnished with a syringe, and the piston
worked by a screw, so that the injection would not be thrown in jerks,
and the quantity of liquid used measured accurately. Besides, the cir-
culation in the vessel must be temporarily stopped, and some other pre-
cautions taken, which will be mentioned directly, after an account of the
experiments performed.
1st. The carotid of a sheep having been exposed, the current of blood
was interrupted by the finger and thumb, at two points distant one inch
and a half or two inches; about a spoonful of blood was thus enclosed.
A puncture was made very obliquely in the walls of the vessel, and three
or four drops of the perchloride of iron injected. For this purpose two
turns of the screw were made, each turn ejecting about two drops of the
fluid. Immediately after the injection of the salt, an increase in the
density of the blood could be felt, and a clot forming rapidly. In four
minutes the vessel could be left to itself, leaving off all compression ; in
fact, the clot did not change its position, and it could be felt in the same
place for eight days subsequently.
2nd. A similar experiment performed on a horse gave the same result.
The portion of the artery in which the circulation had been suspended
was about three inches long, and could contain five teaspoonfuls of blood.
Eight or ten drops of the solution were injected, Dr. Pravas having
observed that it took nearly two drops of the solution to coagulate a tea-
spoonful of blood. In four minutes in the horse, as well as in the sheep,
the clot was fully formed; it was firm and resisting, and was not dis-
placed by the impulse of the blood for a quarter of an hour, at the end
of which time that portion of the vessel subjected to the experiment was
cut out and split; the inner surface was rough, and showed granulations
and longitudinal striae along the whole length occupied by the clot.
3rd. In another horse, a similar experiment was performed, with ex-
actly similar immediate results, except that this animal was preserved
for eight days, leaving the vessel exposed, so as to watch the progressive
changes. It was observed that the induration of the carotid extended
above and below the formative clot. At the end of eight days the horse
was killed, and on examining the interior of the artery, three distinct
clots were seen, which caused its obliteration for about eight inches and
a half in extent. The middle clot corresponded to where the injection
was introduced, and had a darker-colored and granular appearance, about
an inch and a quarter long.
Resume: After the injection of the perchloride of iron, four minutes
and a half were sufficient to cause a clot in the carotids of these animals
so consistent and adherent as not to be displaced by the impulse of the
column of blood from the heart.
The above experiments have been witnessed by M. Lalleinand, and
M. Le Coq, directeur de 1’Ecole de Lyon. Dr. Pravas is still pursuing
his researches, and has made these first results public, so as to draw the
attention of experimentalists and practitioners to this plan of obliterating
arteries. So far, his observations have been purely experimental, and
instituted in such a way as to prove directly the mode of action of the
coagulating agent he employs. As to its application for the cure of
aneurism in the human subject, the proceeding ought to be thus modi-
fied : it is into the aneurismal sac that the solution ought to be injected,
having previously arrested the circulation below the sac—that is, be-
tween it and the capillaries. The quantity injected should be in propor-
tion to the size of the sac, and the compression below should last four or
five minutes. This, in Dr. Pravas’s opinion will be sufficient to form
an extensive clot, capable of plugging the artery and producing the
same effect as ligature.—Dublin Med. Press, from Presse Med. Beige.
On the Manufacture of Sponge Tents. By Dr. Digby.—[The fol-
lowing directions are given :J “A piece of tolerably fine sponge, pre-
viously well dried, should be soaked in Mistura Acacia?, and rolled up
into a cylindrical form, somewhat in the shape of a small segar, taper-
ing to a point at one end. The other, or thick end, must be rolled
round a middling-sized awl, partly for the purpose of a leaving a cen-
tral perforation into which the end of the instrument which carries it
is to be inserted, and partly to fix it, while a piece of stout cord is wound
tightly and closely around it from the thick end up to the point. By
this means, the sponge is powerfully compressed into the cylindrical
form above mentioned, and if well-dried, becomes as hard as a piece of
wood, and retains its compressed state perfectly when the cord is re-
moved. Any little projections or roughnesses may be trimmed off
with a sharp knife; and, lastly, the tent is to be dipped several times
in melted tallow, rendered harder by the admixture of a little white
wax, until it has become thickly coated. A piece of string or tape is
fastened to the lower or thicker end, to assist in removing it from the
os uteri when expanded. The heat of the part soon melts the unctu-
ous covering, and thus enables the tent to slide up in its own grease as it
gradually melts, when otherwise it might have been difficult to intro-
duce it. The secretions of the part slowly pervade the sponge, and
dissolve the hardened gum with which it has been soaked, and the sponge
gradually expands as it returns to its full size.
11 Twelve hours is usually a sufficient period to affect this in ; and the
degree of dilatation produced will guide us to the introduction of a
larger tent on the removal of the first.’’—Med. Times.