. American practice of surgery ; a complete system of the science and art of surgery . n this fact, together withthe induration due to the throm-bus, is readily determined. Whenthe force has been very violent,or prolonged for some time, theartery may be flattened andempty, as if crushed in the jawsof powerful forceps. Cloquetdescribes a specimen of this sort(Figs. 70 and 71), the injury be-ing associated with a fracture ofthe humerus. On each side ofthe narrowed portion, the vesselwas distended for a short distance by coagulated blood. Ordinarily the clot,as in thrombosis from other causes, ex
. American practice of surgery ; a complete system of the science and art of surgery . n this fact, together withthe induration due to the throm-bus, is readily determined. Whenthe force has been very violent,or prolonged for some time, theartery may be flattened andempty, as if crushed in the jawsof powerful forceps. Cloquetdescribes a specimen of this sort(Figs. 70 and 71), the injury be-ing associated with a fracture ofthe humerus. On each side ofthe narrowed portion, the vesselwas distended for a short distance by coagulated blood. Ordinarily the clot,as in thrombosis from other causes, extends centralward in a conical form asfar as the first collateral branch. Peripherally, the length of the thrombusvaries. It may fill the main branch and invade the smaller arteries or itmay terminate like the central portion near a large collateral. Upon itsextent and upon the activity of the collateral circulation depends the integrityof the limb. If the injury is confined to the artery alone and the vesselsare healthy and the collaterals abundant, no harm need follow; indeed, it. Fig. 70. Fig. 71. Figs. 70 and 71.—Contusion of the Brachial Arteryfrom Fracture of the Humerus. (From Cloquet, inRevue de Chirurgie, 1898, page 298.) In Fig. 70, which gives a view of the artery as seenfrom the outside, note the distention of the vessel oneach side of the contused area. In Fig. 71, which givesa view of the vessel after it has been laid open, the divis-ion of the inner coats at the distended spots is shown. THE PERICARDIUM, HEART, AND BLOOD-VESSELS. 213 is lii^;lily probable that in most cases of this sort the diagnosis is never sus-pected. If the clot forms slowly, ample opportunity is afforded for the develop-ment of iin adequate collateral circulation, which becomes progressiveh^ more(efficient the more the lumen is closed; thus i)ulsation may never be absent fromthe i)c>ripheral vessels, even though the artery at the contused point becomesimpervious, l^ut if the vessels are
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