COMPRESSION.—Compression was used over two hundred years ago for cases of traumatic aneurism. but the first sur geon to propose this method was Ileister. In 1772 Guattani, an Italian. compressed the entire limb and the sac in cases of popliteal aneurism. Cases thus treated usually, however, ended fatally, from transformation of the circumscribed an eurism into a diffuse aneurism, inflam mation and suppuration of the sac, and gangrene of the leg. The mortality was 50 per cent.
3 ohn Hunter, in 1735, introduced into the treatment of aneurism the gov erning principle that the current of the blood through the sac should not be completely suppressed, but only dimin ished, thus allowing the elasticity of the sac to act. In this way the effect of the overpressure from the heart's action is removed.
The fact that the sac in diffused and traumatic aneurism is not contractile explains why this treatment is without success in aneurisms of this variety.
Advantages of compression over liga tion:— 1. It is not so dangerous; if neces sary, it can be discontinued and then renewed, whereas, in ligation, the danger may be great for many days following the operation.
2. In cases treated by compression only the sac consolidates, just as in spontaneous cure. The arteries, up to the point of compression, are not con solidated, as in ligation.
3. Compression is more successful than ligation, and does not present danger of complications, such as secondary haem orrhage, sloughing of the sac, phlebitis, gangrene, or pymmia.
4. Ligation has been followed by a second aneurism or by suppuration in the sac. Though these complications may occur after compression, they are not likely to do so, and consequently compression is more likely to be perma nent than ligation.
Compression may be applied with the fingers or by means of various instru ments, bags of shot, Esmarch's elastic bandage, flexion of the joints, etc.
Jonathan Knight, of New haven, Conn., first employed the finger as a means of compression in 1348, and in the same year Willard Parker and James R. Wood, of New York City, each suc cessfully treated an aneurism in this manner.
Digital pressure over the vessel, just above the aneurism, is applied by a succession of assistants relaying one an other. The procedure is rendered much less irksome for the operator by placing a weight upon the pressing fingers, the muscular strain being thus, in a meas ure, relieved.
It is necessary to keep up the press ure from one to several days, until the pulsation has ceased. The average time required is three days. The pressure should then be gradually diminished, in order to prevent disintegration of the clot before it is firmly contracted.
1.n proximal compression of the artery it is only necessary to stop the pulsation of the sac, it being unnecessary to stop the flow of blood through it. This method succeeds best in sacculated aneu risms. In tubular aneurisms it causes gradual contraction, but not by a deposit of fibin.
When the sac contains fluid blood only, the chances of success are more favorable. In an already partly-filled sac coagulation may be too sudden and imperfect.
:Recovery is shown, when compression above the sac has ,been resorted to, by cessation of pulsation in the sac when pressure is removed, by no thrill or bruit being present, and by the development of a collateral circulation.
The collateral circulation which de velops after the sac has been filled with fibrin indicates that the sac has been obliterated.
Sudden enlargement of the collateral circulation, occurring both in cures hap pening spontaneously and in those due to compression, may cause considerable pain. The latter, therefore, may be looked upon as a favorable symptom.
In aneurisms of the extremities and neck compression gives good results. This causes, when cure takes place, the formation of coagula in the aneurismal sac, through or alongside of which, how ever, a canal remains through which the blood passes. The coagula shrink grad ually and become more solid and firmly adherent to the inner wall of the aneu rismal sac. Compression can be carried out only with intelligent patients. Bill roth (Wiener klin. Woch., No. 50, '93).
[When compression has ultimately to be abandoned, its temporary use is of advantage in so far as it prepares the way for establishment of the collateral circulation. JOHN H. PACKARD, .Assoc. Ed., Annual, '92.] Compression by means of the contrac tile power of ordinary collodion, in small aneurisms; successful in three cases. 1NriMains (Amer. Mcdico-Surg. Bull., Apr., '93).