Veneseetion—removal of from 27 to 30 ounces—followed by great relief from paroxysmal dyspncea and from pain, lasting nine months in one case. One copious venesection recommended. Davi son (Lancet, May 19, '94).
Tracheotomy may be useful when dyspncea is due to bilateral abductor paralysis, but not when it is due to compression at the bifurcation, which is almost always the case.
Where external rupture of an aneu rism is feared hemlock or lead plaster may be used as a support. (Ashhurst.) Laceration of the media frequently occurs in the ascending portion of the arch previous to the occurrence of com pensatory thickening. (Osler.) Tuffnell's treatment of restricted diet and rest in bed has given satisfactory results.
If the milder methods do not succeed needling should be tried, aided by distal compression, when feasible, during the use of the needles; if this fail, distal ligation should be resorted to. (Nan crede.) In treatment of aneurism of aortic arch following conclusions reached: 1. The remedy lies within the domain of surgery. 2. There are but two such methods at the present time to be con sidered: (a) obstruction of the right subelavian and common carotid arteries; (b) introduction of wire or needles into the sac, with or without galvanism. 3. Either one or both of the operations should be applied in all cases after a thorough saturation with the iodides. 4. Ligation is attended by less danger, less mortality, greater and more permanent and universal benefit. B. Merrill Ricketts (Jour. Amer. Med. Assoc., Aug. 13, '9S).
Discussion on treatment of aneurism of the aorta. Golubinin. of Moscow, had employed in S cases the method of treating aortic aneurisms by injection of gelatinized serum recommended by Lan cereaux and Paulesco. The number of injections varied according to the case from 2 to 15. Of the 8 patients, 4 died in a short time and the other 4 were lost sight of; in 3 of the cases belonging to the latter group the injections produced no effect. In the remaining 1 they were followed by slight improvement in the subjective symptoms without modifica tion of the objective signs. Golubinin had come to the conclusion that the method did not fulfill the expectations that had been founded on it. In the treatment of aortic aneurism. Huchard says it is a mistake to allow one's self to be hypnotized by the changes to be brought about in the content of the sac, —that is to say, in the blood,—and to take no account of the containing structure. The methcd of gelatinized
injections, which is useful, although in sufficient, is open to this criticism. To complete its action, especially in persons with large heart and increased arterial tension,—they are almost always at the same time subjects of Bright's disease,— medicaments should be chosen which di minish arterial tension, such as potas sium iodide, trinitrin, nitrite of amyl, and especially tetranitrate of erythrol, or tetranitrol, which Huchard has now used for a considerable time and which, as compared with trinitrin, has the ad vantage of a more durable action. More over, an essential point is to supervise the diet not in regard to quantity, as in Valsal•a's method, but in regard to quality. Meat, which holds too large a place in our food, contains toxins, which have an excessively powerful vasocon strictor action. The best treatment of aortic aneurism is still absolute milk diet regularly adhered to. (Section of Therap., Inter. Congress of Med., 1900; Brit. Med. Jour., Oct. 13, 1900).
Remark on treatment of aneurism of the aorta by the insertion of a perma nent wire and galvanism based on a re port of 5 cases. A black varnish or lacquer makes the best insulation for the needle. The disposition of the wire in the lumen of the sac is an important factor in the amount and the effective ness of the fibrin whipped out. A small quantity of wire possessing a good spring should be selected. Cure of the aneurism demands as complete contraction as pos sible of the sac-wall upon the clot formed at or soon after the operation. The wire should be of such amount and material as not to interfere seriously with this contraction. The corrosion of the wire by the electric current makes a rough surface very conducive to the rapid whipping out of fibrin. Within certain limits, the wire most easily corroded is to be preferred. The sac should never receive both poles, and the negative elec trode should never be in the sac. Sepsis is an omnipresent danger. Another danger is that of the development and rupture of a secondary sac due to the rapid filling up of the main sac by coag ulum, and the shunting of the blood stream against a portion not receiving 2. special strain before. Thirty-nine per cent. of successful results reported in the 23 cases, including the author's 5, found in literature. G. L. Hunner (Johns Hop kins Hosp. Bull., Nov., 1900).