An antiseptic gauze dressing should be applied to the neighboring region while the needle is left in the sac.
One needle usually suffices, but it may be necessary to use two or three.
Any superficial ulceration, inflamma tion of the sac, or erysipelatous indura tion is a contra-indication.
Needles may also be used to transfix the aneurism or for the purpose of caus ing coagulation„ as in electrolysis.
In acupuncture very fine gilded nee dles are introduc6d into the sac, crossing one another, and thus forming a centre around which the blood coagulates. They are removed several days later. This method is seldom, if ever, successful. In galvanopuncture two insulated nee dles are introduced into the sac at about an inch apart, and being brought into contact by their internal extremities a galvanic current is passed through them. This method was proposed by Phillips in 1S29. It exposes to embolism, suppura tion in the sac, and haemorrhage through the needle-punctures.
Electrolysis Through Introduced Wire. —The introduction into the sac of fili form material, especially wire, as recom mended by Moore (see below) having given evidences of value, D. D. Stewart, of Philadelphia, showed the great advan tage of combining electrolysis with the introduction of wire in sacculated aneu risms, and has published cases in which satisfactory results were obtained. The aneurisms treated were not susceptible of cure by medical or surgical means. The procedure is a distinct advance in curative means.
Final report of a case of a very large innominate aneurism completely cured by the employment of electrolysis through ten feet of snarled, coiled, fine, gold wire, introduced into the sac; death at the expiration of three and a half years from cerebral thrombosis. The newer method consists iu introduc ing into the sac, under the strictest anti septic precautions, a fine silver or gold, coiled wire, previously so drawn that it may be readily passed through a thor oughly insulated needle of somewhat larger calibre than the wire and, after introduction, assume snarled spiral coils, that, with a moderate amount of wire, the entire calibre of the sac will be reached, unless the cavity be already filled with coagula or the sac be of un usual size (as was the case with one aneurism so treated).
The wire must be neither, in amount or calibre, too great nor too bulky or highly drawn that the results to be de sired be interfered with. Nor should the
wire be of a material so brittle as steel nor of hard-drawn iron, lest fracture occur in process of contraction of sac, with danger of rupture. Nor should it be of soft iron, as was recommended on theoretical grounds by Stevenson; for, with the last, so great a quantity of detritus will result, due to the decom position of the iron and the formation of insolub'e salts under the current's in fluence, even with low that danger of emboli result.
Silver or gold wire is undoubtedly preferable material.
The amount of wire required depends necessarily upon the calibre of the aneu rismal sac, and must be decided upon with the greatest nicety of judgment, since with too small an amount little or no result will be obtained, and, with too great a quantity, permanent cure through obliteration of sac by contrac Case of aortic and innominate aneurism, with erosion of the clavicle and ribs. Photograph was taken thirty-five months after Dr. D. D. Stewart had caused an arrest of the growth of the aneurism by electrolysis.
tion of clot cannot be expected. For a globular sae of approximately three inches in diameter, three to five feet are sufficient; for a sac of four to five inches, eight to ten feet.
The anode, or positive pole. should in variably be the active electrode. This is connected with the wire and the nega tive rheophore—a large clay plate, or an absorbent cotton pad of equal dimensions made after the method of Massey—is placed upon the abdomen or the back. The current is slowly brought into cir cuit and its strength noted by an accu rate milliamperemeter. The increase is gradual for a few moments until the maximum strength supposed to be re quired is reached. It is maintained at this until the approach of the end of the session, and then gradually diminished to zero, after which the wire is sepa rated from the battery, the needle care fully withdrawn by rotation and counter pressure, and the released external por tion of the wire gently pulled upon and cut close to the skin, the cut end being then pushed beneath the surface. This latter procedure is facilitated by using care in the introduction of the needle to first the skin at the site of punct ure a trifle to one side, in order to pro cure a somewhat valve-like opening.