XIV. On the coagulation by heat of the fluid blood in an aneurismal tumour
Authors: Home Everard 
Published: December 2006

In a case of aneurism in the external iliac artery, in Chelsea Hospital, for the cure of which I tied the femoral artery below the sac, on the 16th September 1825; upon finding that this operation neither diminished the pulsation, nor arrested the increase of the size of the tumour, I was led to introduce a needle, to which is given the name of acu punctorium, into the centre of the tumour where the pulsation was most violent, and the fluid state of the blood most distinctly felt: the needle was passed through a small orifice in a bar of steel three inches long, the skin of the thigh was guarded by cork, and the needle was heated through the medium of the steel by a spirit lamp. In a few minutes the patient felt heat and pain in the centre of the tumour, but not very severe, so that the application was continued for fifteen minutes, during which the pulsation in the tumour was diminished; on withdrawing the needle the orifice was marked by a single drop of coloured serum. In half an hour intense pain was felt in the thigh; but this was not only removed in ten minutes by 20 drops of laudanum, but the thigh and leg became more easy than they had been for the previous twelve hours, and the throbbing in the sac was reduced to an undulation. as reduced to an undulation. This application of heat was not resorted to till the 28th day after taking up the femoral artery, in which time the swelling had increased in size very considerably. The man was 43 years of age, had served 18 years in the 14th dragoon guards, and was a hard drinker. For two days the tumour was easy, and the pulsation had become less under the punctured part than higher up towards the belly. The tumour not diminishing, the operation was repeated on the 34th day from tying the artery; the needle and bar of steel double the size of those before used, and the application continued 35 minutes. The internal heat was greater than before, and the pulsation in the tumour much diminished. The needle was with difficulty withdrawn, a coagulum as hard as sealingwax the size of a pin's head being firmly attached to the middle of the needle. The pain the operation produced subsided in ten minutes ; the internal heat continued 24 hours, and the tumour had now a solid feel: he was quite easy for two days, but on the third the pain and pulsation returned, also the inward pain in a still greater degree than while the needle was immersed, and the tumour was extremely tense. Under these circumstances, on the 44th day after tying the femoral artery, I repeated the application of the acu punctorium with a needle and steel double the size of those last employed: the heat felt internally was very great, but the pain was not much increased: after it had been immersed 20 minutes the pulsation all at once stopped, and the needle was immediately withdrawn; the pain in ten minutes went off, and the patient was quite easy. From this time there was no pulsation in the tumour, which to the feel appeared solid, and therefore I considered the progress of the aneurism arrested; this was in some measure proved by the pulsation remaining violent in the external iliac artery down to the part pressed upon by the sac, but no further.