Injections of gelatin in aneurism. Case of aortic aneurism in which the size of the tumor was much reduced after 10 injections (1 ounces each) of gelatin solution. The following formula is sug gested:— 13. White gelatin, 15 grains. Salt, 7 grains.
Hot water, 26 ounces.
This mixture is sterilized and allowed to cool. When required for use it is warmed to fluidity and injected under the skin with antiseptic precautions. The injections may be given every few days, or even every day. After the in jections the patients should remain abso lutely quiet in bed. Frankel (Dent. med. Presse, June 9, '99).
Nine eases treated with gelatin sug gest the following conclusions: 1. In no case did cure of the aneurism result, and only in one was there considerable im provement. 2. In seven cases there was an appreciable lessening of the pressure symptoms. 3. The coagulability of the blood is greatly increased. 4. The injec tions often cause a good deal of pain. 5. The injections are sometimes followed by rigor and fever. 6. The treatment affords amelioration, and is deserving of further trial. Futcher (Jour. Amer. Med. Assoc., Jan. 27, 1900).
Treatment of aneurisms with gelatin in several recent cases. Complete cure of a large aneurism by total obliteration of the sac is obtained only after a variable number of injections of gelatin, accord ing to the case, but approximately from 25 to 30 at the least. Lancereaux and Paulesco (Gaz. des Hop., July 17, 1000).
Three cases of thoracic aneurism treated by gelatin injections. They were under observation in the Hudson Street Hospital. None of them was successful. The cases were not under observation long enough to give data for a final con clusion, but the result seems sufficient to indicate that gelatin injections not only do no good, but cause severe pain locally and often considerable constitu tional reaction. Lancereaux's method was to take 1 to 1 drachms of gelatin and make a solution of it in 200 cubic centimetres of normal salt solution. This was kept for several days at a tempera ture of 3S° C. If no cloudiness developed nor any other sign of micro-organismal growth the liquid was injected sub cutaneously, usually into the patient's thigh. After about a week another in
jection was made and the treatment con tinued at regular intervals. Special di rections were given by Lancereaux not to palpate the aneurism during the course of the treatment. At first, a 2 per-cent. solution of gelatin was used; later, however, he used a 1-per-cent. so lution. Attention is called to the fact that, if Lancereaux's directions were followed, the patient would be given twenty injections covering a period of five months. During all this time the patient should rest in bed. Rest is suffi cient of itself to relieve greatly the sub jective symptoms of aneurism, and often does away with certain of the physical signs and even lessens the size of the aneurism. Lewis A. Conner (Med. News, Aug. 11, 1900).
The injections are often followed by fever and pain. The possibility of ex tensive coagulation and of embolism has not been demonstrated. The injections may cause increase of vascular pressure and involve rupture of a large-sized aneurism whose walls are thin. The clinical observations so far made do not warrant an exact estimate of the value of the gelatin treatment. Henri Grenet and G. Piquard (Archives GOnerales de Med., June, 1001).
It has also been affirmed that the gelatin method is painful and liable to cause fever, but if the solution be gently injected into the subcutaneous tissue of the thigh, it is absolutely painless, and if proper antiseptic precautions are ob served there is no fever. The authors insist upon these details, as showing that the ill success attributable to this method of treatment depend entirely on a faulty technique. Lancereaux and Paulesco (Bull. Acad. de Mod., Paris, July 16, 1901).
Subcutaneous Injections.—Lang,enbeck recommends subcutaneous injections of ergotine, which act in two ways: by slow ing the action of the heart, thus favoring the deposit of fibrin, and causing con traction of the unstriped muscular fibre entering into the composition of the middle coat of the artery, thus raising the blood-pressure.