In young children, before they have been inocu lated, it has been cured by inducing adhesive in flammation with vaccine lymph, and obliterating the blood-vessels; but this fails in the adult. If this application fails, or the child has been already vaccinated, in which case it seldom succeeds, com pression should be tried, together with astringents, and if both of these fail by the time the child is four months old, it should be treated by ligature, as recommended by John Bell, White and Lawrence. The securing the arteries leading to the tumour has been occasionally successful, but has as often failed, even in the most scientific hands. The extirpation of the tumour is objectionable in early life, as we require to cut at some distance from the tumour, in order to avoid the blood-vessels, thus leaving a great extent of surface to granulate and cicatrize, and causing considerable deformity, if situated about the head and neck. Potassa, or kali purum, applied so as to produce gentle ulceration and sloughing, has also succeeded, hut it is only advisa ble in very small nxvi materni, as it has proved fatal even in Boyer's hands. For an elaborate de tail of the diseases of the arteries, the reader is re ferred to Hodgson on Dis. of Jrt. and Veins—Bres chet's Translation of sante. Ed. Med. and Sorb. Journal, vol. xxii. p. 4, and vol. xix. p. 45, and Ed. Med. Clair. Trans. vol. iii., also to mortification, already mentioned in this article Under bloodletting we have shown the proneness of the veins to inflammation, and its fatal tendency; and also under ulcers with varicose veins, adverted to the impropriety of securing them with a ligature. The uterine, the crural, the external, the internal, the common iliac, and spermatic veins, even on wards to the renal and vena cava inferior veins, have been found inflamed, thickened, and filled with purulent matter and coagulated lymph, after abor tion, ordinary accouchment, and in puerperal fever. Similar appearances have been seen in phthysis pulmonalis and in carcinomatous affections of seve ral organs. A greyish coloured fluid has been found in the splenic and hepatic veins. Inflam mation in veins, although rarely, sometimes ter urinates in ulceration, producing hemorrhage, and commonly begins in the serous tunic; the adhesive inflammation, however, more frequently obliterates their cavities and prevents hemorrhage: and when sphacelation occurs in the contiguity of veins, they become plugged with coagula of blood, as already mentioned under mortification. In violent exer tions, cramps, cold stage of ague, and blows, the veins are sometimes lacerated. The veins, from gravity or pressure, frequently become varicose, or present a serpentine swollen knotted appearance, on the lower extremities, the spermatic cords and scrotum, the spermatic plexus of the ovaria, the rec tum, especially at its termination or around the anus, and on the integuments in the hypogast•ic and ingui nal regions. III many of these, especially the cutane ous of the leg and the hemorrhoidal veins, coagula of blood are found, which, obliterating the cavity, have produced a spontaneous cure. The veins arc also subject to circumscribed distension or dilatation, varying in size from a small nut to that of a pigeon's egg, and sometimes to such an extent as to rupture and prove serious and even fatal. These (listen sions are occasionally accompanied with pain, and, when situated superficially, sometimes with inflam mation and suppuration of the skin and cellular substance in their vicinity, forming ulcers.
The treatment of varicose veins consists in afford ing them support, or obliterating them with po tassa. The saphena major and minor of the leg, when affected, require the roller to extend from the toes to the groins, and are much benefitted by being bathed with a decoction of oak bark, and attention paid to the bowels. When potassa is used, it is
applied above or proximad to the varicose portion of the vein, so as to produce an eschar on the skin, by which the vein inflames, the blood coagulates, effusion of lymph follows with an adhesion of the sides of the vein and consequent obliteration of its canal. The veins, like the arteries, have been found cartilaginous and studded with calcareous deposi tions, and loose calculi in their cavities. In some cases the same diseased structure as that in the vicinity, as, for example, schirrus, has been found -growing from the serous tunic of veins. The larg est veins of the system, even the vena cava infe rior, have been found obliterated, and the circula tion carried on by the superficial ones, and the vena azygos.
Hemorrhage from a a blood, and pmrupi to break out, the dread of both the ancients and moderns, has greatly retarded operative surgery, and pre cisely in proportion to our ignorance of anatomy. When an artery is wounded, the blood of a bright vermilion colour flows in distinct jets, while when a vein is cut, it flows of a dark purple colour, in a more equable or smooth stream. In the smaller veins contiguous to the capillary arteries, the stream is interrupted, or flows per saltum, as if an artery was wounded. When an artery is merely punctured, the hemorrhage generally soon produ ces fainting, and the blood injects its cellular sheath, which forms a coagulum that becomes a temporary barrier to its flow ; but if this process be disturbed, or if inflammation and ulceration follow, the he morrhage recurs from time to time, until at last it proves fatal. In such cases, therefore, if the vessel be large, as that of the thigh, it should be instantly secured by throwing a ligature around, above and below the scat of the wound, as the retrograde flow from the free inoculation is liable to reproduce the bleeding. But if no disturbance accrue to this pro cess of nature, the wounded edges of the artery in flame, effuse coagulable lymph, and are united by the adhesive inflammation ; and if the wound he trifling, the continuity of the vessel is preserved. A long continuance of quiescence is requisite, how ever, to ensure safety from aneurism. It will be at once seen, that the same causes preventing the success of securing the principal artery of a limb for aneurism, will operate here, and that mortifica tion will be even more liable to follow in this case. When an artery is divided transversely, an impetu ous flow of blood takes place, producing fainting, its ends are constricted and retract into the con tiguous cellular tissue, which is injected with blood, that soon coagulates, while the blood flows by the proximal branches, allowing a coagulum of blood to take place in the trunk, which thus gradually be comes obliterated, as if secured in aneurism, and thus the hemorrhage is for a time arrested. If this natural process be undisturbed, slight inflam mation follows with the effusion of coagulable lymph in the artery, between its coats, and in the cellular substance in the vicinity, which becomes gradually consolidated, and proves a perfect bar rier to after bleeding. This, however, is not always the case, particularly if a branch be near the wound, the blood flows impetuously by the trunk, produces fainting, which recurs at each successive rallying of the system, or at once proves fatal. The artery consequently ought to be secured, as in the first in stance. If the axillary in its mesh of nerves, veins, and branches, be wounded with a sharp pointed in strument, the subclavian as it runs over the first rib should be tied, and compression applied to the wound, as was lately practised by Langenbeek with success.