Experience has shown that the cur rent-strength must be rather high—from 40 to SO milliamperes—and the sitting long—from three-fourths of an hour to one and a half hours. Thus used, the following effects may be expected: The mere introduction of coiled, snarled wire without the conjoint use of galvanism, if practiced judiciously, is in itself a method of value, since the presence of wire, if engaging all parts of the sac, acts both as an impediment to the blood stream and at the same time offers to the eddies set up multiple surfaces for clot-formation. Hence this method has more to commend it than that by mere galvanopuneture n ith needles. By gal vanopuneture, although firm coagu]a are produced, they are of such trifling dimensions and engage such small areas of sac-wall that, without impeding in the least the blood-current, their dissolution rather than their accretion quickly fol lows. By the application of a strong gal vanic current through coils of wire so disposed that all areas of the sac are reached, it follows without exception, as has been noted in all recorded cases, that consolidation by virtue of clot-formation is promptly and invariably produced. The solidification is rapid, and is gen erally manifest before the end of the electrical session. through changes ap parent to the eye and hand, in the pulsa tion and in the degree of consistence of the sac-wall. These changes become more decided in the course of a few days, until, after a time, in the most favorable cases a hard nodule, with a communi cated pulsation only, replaces the pre vious expansible tumor. This was the history of four of the ten cases now recorded,—that of Kerr, that of Rosen stein, the second case of author's, and the case of Hershey,—and partially so in the case of Barwell, of Roosevelt, and in the first of the author's, all of which latter cases were totally beyond the slightest hope of cure at the time of treatment, as was also the case of Abbe. D. D. Stewart (Brit. Med. Jour., Aug. 14, '97).
Treatment of abdominal aortic aneu risms by a preliminary exploratory cceliotomy and peritoneal exclusion of the sac followed later by wiring and electrolysis. The main difficulty lies in the fact that a determination of the situation of the aneurism. even when a cceliotomy is performed. is very great. The objections to the method are as fol low: 1. The cure of the aneurism may lead to tne death of the patient by ob literating the orifice of important vis ceral arteries; this is most likely to oc cur in dealing with aneurisms of the upper or coeliac division of the abdom inal aortic tract: i.e., in about 50 per cent. of the cases. 2. Secondary rupture of the sac from the strain put upon weak portions of the sac in multilocular aneurisms, after partial coagulation of the contents has taken place (particu larly likely to occur in subjects of gen eral endarteritis with atheroma). 3. Escape of wire through a large aneu rismal orifice into the lumen of the aorta, with migration upward into the heart, leading to perforation, traumatic endarteritis, endocarditis, with the for mation of secondary thrombi and em boli. 4. Danger of perforating the sac
by stiff wire or by overcrowding the sac with too much wire. 5. Danger of ex tension of clot from the coagulum in the aneurism to the main artery, lead ing to fatal blockade at the bifurcation, with gangrene of the lower extremities.
6. Danger of rupture of sac from sudden withdrawal of abdominal support and displacement of adherent organs in the course of the exploratory laparotomy.
7. Danger of mistaking a fusiform for a sacciform aneurism. S. Danger from emboli and thrombi following incom plete coagulation of the blood in the sac (a very rare and practically un known occurrence in abdominal cases). 9. Danger of shock. 10. Danger of sep sis. Rudolph Matas (Amer. Medicine, June 22, 1901).
Case of aneurism in which temporary improvement by wiring and electrolysis obtained, the patient dying later as a result of rupture of the sac. From an experience of eight operations of this character he concludes that electrolysis in properly selected cases of aneurism is a valuable measure and prolongs life. The operation itself is neither dangerous nor painful. The failure of permanent cure does not depend so much upon the failure of the operation to limit the disease locally as to the fact that the adjacent parts of the blood-vessel are weak, and, when the bulging area is solidified by the clot, these lateral areas may later on give way. Even in these cases life is prolonged by the closing of the weakest area, and it is not to be forgotten that in at least one case (Stewart's) life was prolonged three years, death taking place from an alco holic debauch. Hare (Therap. Gaz., Jan. 15, 1003).
Introduction of Foreign Bodies into the Soc.—Catgut, silk, horse-hair, fine wire, especially, have been introduced into the sac to promote coagulation, but this measure does not meet with the approval of the profession.
dutyllus's Operation.—The oldest op eration is that of Antyllus (fourth cent ury), which was at first employed only for small traumatic aneurisms of the elbow. It consisted in tying the artery above and below the sac, opening the latter, and removing its contents. It was often attended by suppuration, secondary hemorrhage, and ankylosis, owing to the fact that the artery was tied immediately above and below the sac, the artery being itself diseased in these regions.
In 1710, Anel, believing that the sac would collapse, tied the artery above the aneurism, but the true cause of success in such eases was not discovered until, in 1875, John Hunter proved experi mentally that aneurism was not due to localized weakness in the vessel, hut to a pathological condition of the arterial wall, extending beyond the sac.
The Antyllus modified operation may be exceedingly difficult, on account of branches springing from the sac, and from the artery above and below the sac being so thickened as to make it almost impossible to tie them. After emptying the sac a probe should, therefore, be passed into the arteries above and below, and the latter only then tied.