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It was first practiced by Sir Astley Cooper in 1817, and has since been performed several times with a uniformly fatal result, although Monteiro's patient survived until the tenth day, and there is a record in which ligature of the abdominal aorta did not cause death until the eleventh day.
In tertiary lesions there is greater difficulty in demonstrating the spirochæte, but small numbers have been found in the peripheral parts of gummata and in the thickened patches in syphilitic disease of the aorta. Noguchi and Moore have discovered the spirochæte in the brain in a number of cases of general paralysis of the insane.
The stimulus must regularly begin in the auricle, must be perfectly transmitted through the bundle of His to the ventricles, the ventricles must normally contract with the normal and regular force, the valves must close normally and at the proper time, the blood pressure in the aorta must be normally constant to insure the perfect transmission of the blood to the peripheral arteries and to insure the normal circulation through the coronary arteries, and the arterioles must be normally elastic.
Carson did not suffer immediately from his injury, but he found in time that a grave internal disturbance had been caused by his fall. In the spring of 1868, he accompanied a party of Ute Indians to Washington. He was then failing fast and consulted a number of leading physicians and surgeons. His disease was aneurism of the aorta which progressed fast.
Consider, farther, the use of the several valves, which are all so arranged that the blood, once received into the ventricles of the heart, shall never regurgitate; once forced into the pulmonary artery and aorta, shall not flow back upon the ventricles.
Looking him over, it was apparent that my second shaft had hit him in the base of the heart, emerged through the breast and only stopped in its flight by striking the foreleg. The first arrow had gone completely through the back part of the chest, severed the aorta, and flown past him. There it lay, sticking deep into the ground twenty yards beyond the spot where he stood when shot.
All the coats of the vessel are stretched and form the sac of the aneurysm, and the affected portion is not only dilated but is also increased in length. This form is chiefly met with in the arch of the aorta, but may occur in any of the main arterial trunks.
9. =Of the Aorta and Pulmonary Artery.= Fatal. 10. =Of the Diaphragm.= Generally fatal, owing to the severe injury of the other abdominal organs. If the diaphragm be ruptured, hernia of the organs may result. 11. =Of the Abdomen.= Of the walls, may be dangerous from division of the epigastric artery; ventral hernia may follow, internal hæmorrhage, etc.
The autopsy revealed the surprising fact that there was no blade in his thorax at all; it had been gradually consumed by the muriatic acid which Entrefort had prescribed for that very purpose, and the perforations in the aorta had closed up gradually with the wasting of the blade and had been perfectly healed for a long time. All his vital organs were sound.
It would therefore appear that the function of the valves in the veins is the same as that of the three sigmoid valves which we find at the commencement of the aorta and pulmonary artery, viz., to prevent all reflux of the blood that is passing over them.
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