The cavity heals without trouble. roth (Wiener klin. Woch., No. 50, '93).
Three cases successfully treated by ligation of the femoral artery after COM pression and flexion had been tried with out success. Leutaigne (Dublin Jour. of Med. Sci., July, '94).
Case of double popliteal aneurism treated by compression; three months later both sacs consolidated. Iodide of potassium, administered from the start, still continued. Golding-Bird (Brit. Med. Jour., Jan. 12, '95).
Case of popliteal aneurism cured by forced flexion of the knee. Treatment begun by half-flexion, which is much less painful. Alessandro (Riforma Medica, p. 5, '95).
Hypodermic injections of ergotin in aneurism recommended. the following mixture being employed:— Ergotin (Bonjean), 40 grains. Spiritus vini rectifleati. SO minims. Glyeerini, SO minims.
M. et ft. sol. Inject 3 centigrammes under the skin over the tumor. Lang enbeek (Phila. Med. Jour., Feb. 14, 1903).
Traumatic Aneurism.
Traumatic aneurism is not due, like other aneurisms, to an anterior patho logical condition of the artery-wall, but to a direct injury to the vessel, resulting in an arterial htematoma.
Traumatic aneurism may be caused by a shot or stab wound of an artery, by which the blood is extravasated into the neighboring cellular tissue, until it is arrested. There are three varieties of traumatic aneurism. The true traumatic aneurism is the form in which the artery, generally a large one, has received a punctured wound, which has healed and the cicatrix afterward yields. In this case the external coat of the artery and its sheath form a true sac.
A circumscribed traumatic aneurism is a variety wherein condensation of the surrounding cellular tissue has formed an adventitious sac for the blood. Cir cumscribed traumatic aneurism is usu ally due to punctured wounds of small arteries.
A diffused traumatic aneurism may be caused in three ways: (1) by healing of the cutaneous wound before the arterial wound heals; (2) by a subcutaneous in jury to the artery without a skin wound; (3) later on, due to a bruise caused by a projectile or instrument, the bruised spot yielding when the remainder of the in jury was healed.
A diffused traumatic aneurism should not be considered an aneurism; it is, in reality, but a collection of arterial blood in the tissues, not in communication with the exterior, like an ordinary wounded artery.
Protrusion of the inner coats of an artery through a wound of the outer coat is called a hernial aneurism. It is ex ceedingly uncommon.
Diagnosis, — That a traumatic aneu rism may cause an abscess should be borne in mind; on the other hand, an uncomplicated traumatic aneurism may resemble an abscess. A positive diag nosis may be arrived at by the history of the case, and by withdrawing some of the contents with an asepticized hypo dermic needle. Pus will be found if an abscess is present, and fluid blood if an aneurism.
Treatment. — The treatment of trau matic aneurism varies according to its location. It should be treated like a primary wound of an artery.
Where possible, as on a limb, an Es march bandage should be applied, the injured artery exposed by incision, com pletely divided. Both ends of the vessel are then tied. Every effort should be made to obtain primary union.
When the aneurism is located in a region where Esmarch's bandage cannot be used, as on the neck, the tumor should be exposed, and an opening made just large enough to introduce one finger, which, guided by the current of warm arterial blood, should be carried to the artery leading to the aneurism.
Six cases in which aneurism of the arch of the aorta and of the base of the neck by the simultaneous ligation of the right carotid and subclavian arteries. But one death occurred: due to hemiplegia. In this ease the arteries on the left side were not permeable, and so could not furnish blood to the brain. Thrombosis occurred. Ligation of the right carotid should never be performed when the left carotid and its branches DO longer pulsate.