Not unfrequently a slight pulsation returns in the tumour, which daily increases and constitutes a secondary aneurism, which may arise either from the inosculating branches between the ligature and the sac, or from others communicating directly with the sac, or thirdly, the blood may retrograde from the inferior or distal aperture of the artery into the sac. In such an event, we should first try the general or debilitating plan, and if it fails, secure the artery close above and below the tumour, and even if this last fail, perform amputation, but not amputate at once as recommended by some authors. There is another mode of operating for aneurism, invented either by Brasdor or Desault, and lately practised with success by Messrs. Wardrop, Lambert, Bush, and Evans, and advocated by Bichat, Scarpa, Hodgson, and Breschet. When the tumour is situated in an artery so near the source of the circulation, that a ligature cannot be thrown around the vessel between the heart and the sac; and this consists in securing the artery beyond or distad to the tumour. This method will evidently succeed, provided there is no arterial branch immediately contiguous to the sac, either on its proximal or distal extremity, and none ori ginating from the tumour itself to induce the blood to enter the sac; for on applying the ligature, the blood will flow by the anastornosing branches proximal of the tumour, leave that in the sac quiescent, which will therefore coagulate and lay the foundation of a cure. This we consider an in genious and very valuable operation.
Oir limits will not permit us to enter into a detail of the various aneurisms which affect the different arteries with their operations; suffice it to say, that the arteria innominata, with its divi sions, and the abdominal aorta, distad to the inferior mesenteric, with its divisions and subdivisions, have been secured. For an account of these aneu risms, the reader is referred to Hodgson on the Diseases of the Arteries and Veins, and for the steps requisite to be pursued in these operations, to Lizars's Anatomical Plates. The carotid artery was first secured by Mr. John Bell or Hebenstreit, a German surgeon; the subclavian by Mr. Ramsden; the brachial by Anel; the arteria innominata by Dr. Mott; the abdominal aorta by Sir A. Cooper; the internal iliac by Mr. Stevens; the gluteal by Mr. John Bell; the external iliac by Mr. Abernethy.; and the common iliac by Dr. Mott.
Varicose aneurism, named also venous aneurism and aneurismal varix, occurs commonly at the bend of the arm from vencsection, but has occurred to the subclavian artery and vein, the popliteal artery and vein, the common femoral artery and vein, and the posterior tibial artery and vein, from punctured wounds of these vessels. In this disease the artery and vein are simultaneously wounded, and a communication is established between them, by which the arterial blood flows directly into the cavity of the vein. When it takes place at the bend of the arm, inflammation is excited at the wounded points of the vein, the fascia of the biceps and the artery, forming a bond of adhesion between them, and a passage for the blood. A tumour is soon formed of a bluish colour, which pulsates like an artery, and communicates a tremulous motion to the touch, and rustling noise to the ear, somewhat resembling the hissing noise of air ejected from a syringe, and occasionally so loud during the night as to prevent the patient sleeping.
The pulsation is only distinct in the centre of the tumour, and the contiguous veins arc more or less varicose. The artery above, or proximad to the tumour, becomes larger, and vibrates strongly, while below, it is smaller. If the tumour be emp tied, and sufficient pressure be applied, either above or below, to check the cutaneous venous circulation, it immediately fills; but if the pressure above be enough to compress, the brachial artery, the tumour diminishes. This species of aneurism appears sometimes within three or four hours after venesection, while at others not for several weeks; it has a circumscribed appearance, is about the size of a large walnut, with the cicatrix made by the lancet in the centre. It increases very slowly. ,xcites little pain, producing more a sense of weight, numbness and feebleness of the arm, and is the least dangerous of aneurisms, never rupturing spontaneously, but being liable to be converted into the false, with which it is sometimes complicated. The treatment consists in the application of com pression and bandage, wearing the arm in a sling, or keeping it in the horizontal position; or, lastly, in securing the artery, which probably from its being the shorter means of cure, and perfectly safe, is the best remedy.
Aneurism by anastomosis, named also nxvus maternus, tumeurs variqueses, or fongueses san guines, tumeurs erectiles, hmmatoncus, blood sponge, and in common language, strawberry or raspberry tumour, begins usually at birth, having the appearance of a red, purple, or livid stain, but occasionally there is at once a distinct prominent vascular tumour; in some cases the disease remains long dormant, while in others, this vascular plexus of vessels increases in number and size distending the skin, which ruptures in sultry weather, or in intense cold, producing hemorrhage, which becomes each time more momentous, until at last it proves fatal. This is particularly the case when it attacks a surface delicately covered with integu ments, as the lips. It is more frequently situated about the head than elsewhere, sometimes involving a great extent of surface, lips, mouth, fauccs, pha rynx, neck, and chest; and the same vascular plexus has been discovered within as well as without the cranium, the capillaries of the dura mater being equally affected. This disease has occurred occa sionally in the adult, from accidental violence, beginning in the form of a mere pimple or speck, and soon becoming a throbbing incontrollable vas cular tumour, bleeding on the slightest exertion, drinking, mental emotion, exposure to the sun or cold. In infancy this disease must be distinguished from the congenitm notx, or growths of hair, Ste. John Bell, who first correctly described this vascular tumour, conceived there were cells intermediate to the capillary arteries and veins, in which opinion he is joined by Dupuytren and \Vardrop, hut from what we have witnessed in careful injection and dissection of such tumours, and what is developed in the spleen, placenta, corpus cavernosum et spongiosum penis, especially the latter in the ele phant, no cells exist in these tumours, but that the delicate veins form large and frequent anastomoses, which, from communicating freely with each other, and adhering together, resemble cellular tissue.