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Farther, when we see the veins below the ligature instantly swell up and become gorged, when from extreme tightness it is somewhat relaxed, the arteries meantime continuing unaffected, this is an obvious indication that the blood passes from the arteries into the veins, and not from the veins into the arteries, and that there is either an anastomosis of the two orders of vessels, or porosities in the flesh and solid parts generally that are permeable to the blood It is farther an indication that the veins have frequent communications with one another, because they all become turgid together, whilst under the medium ligature applied above the elbow; and if any single small vein be pricked with a lancet, they all speedily shrink, and disburthening themselves into this they subside almost simultaneously.
These facts furnish us with indications as to the seat and method of amputation. Experience has proved that in senile gangrene of the lower extremity the most reliable and satisfactory results are obtained by amputating in the region of the knee, care being taken to perform the operation so as to leave the prepatellar anastomosis intact by retaining the patella in the anterior flap.
No question but her name is puissant who aventried the dear corse of our Agenbuyer, Healer and Herd, our mighty mother and mother most venerable and Bernardus saith aptly that She hath an omnipotentiam deiparae supplicem, that is to wit, an almightiness of petition because she is the second Eve and she won us, saith Augustine too, whereas that other, our grandam, which we are linked up with by successive anastomosis of navelcords sold us all, seed, breed and generation, for a penny pippin.
Accordingly, he asked himself where else in the growing plant something like separation and reunion could be seen. This he found in the branching and reuniting of the veins in the leaves, known as anastomosis.
For in continuance of the vertical principle of the plant, the pistil and carpel represent the male aspect in the process of spiritual anastomosis, and the mobile, wind- or insect-borne pollen, in continuing the spiral principle, represents the female part.
Intestinal anastomosis, whereby two portions of a severed or resected bowel can be intimately joined, excluding from fecal circulation the portion of bowel which has become obstructed, was originally suggested by Maisonneuve, and was studied experimentally by von Hacken. Billroth resorted to it, and Senn modified it by substituting decalcified bone-plates for sutures.
Finally, we are now in a condition to suspect wherefore it is that no one has yet said anything to the purpose upon the anastomosis of the veins and arteries, either as to where or how it is effected, or for what purpose. I now enter upon the investigation of the subject.
When the femoral below the origin of its deep branch or the popliteal artery is obstructed, the veins remaining pervious, the anastomosis through the profunda is sufficient to maintain the vascular supply, and gangrene does not necessarily follow. The rupture of a popliteal aneurysm, however, by compressing the vein and the articular branches, usually determines gangrene.
Attempts have been made to improve the peripheral circulation by establishing an anastomosis between the main artery of a limb and its companion vein, so that arterial blood may reach the peripheral capillaries reversal of the circulation but the clinical results have proved disappointing. Treatment.
Varicose veins sometimes become so enlarged and distorted as to simulate the appearance of one varicose tumor. Adams describes a curious case of congenital dilatation of the arteries and veins in the right lower limb, accompanied by an anastomosis with the interior of the os calcis. The affected thigh exceeded the other in size by one-third, all the veins being immensely swelled and distorted.
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