A'XEfRISM. 



AVEURISM. 



3J 



colour i* pile yellow ; the specific gravity Ml ; UM odour peculiar. 

 psMtratiag. and much dialiked by Mm* IMOO*, the French name of 

 UM plant, TrMwf rat. The taste is hot, and rather sweetish. It 

 require* 1440 part* of water to itianlro uoe put of oil. It is Terr 

 oluble in alcohol and ether. Hence, to form the a-,*a auttki (dill- 

 water), the instruction* of the pharmaooprria are rarely complied with, 

 but a portion of the oil is previously dissolved in alouhol and then with 

 ugar rtifftnert through distilled water, by which means a more potent 

 agent U obtained. The oil is sometimes administered by dropping it 

 on wear, and so forming an oloo saaihinim 



Dill it a carminative agent of considerable power, and in most 

 frequent uee, particularly to allay the spasmodic affection* "f the 

 bowel* of infante, and to assist the expulsion of flatus. This practice, 

 though attended with temporary benefit, U in the end hurtful. A much 

 more rational plan U for the mine who suckles the child to be meet 

 careful in her diet, to retire to net early, and to discharge faithfully 

 all the duties which devolve upon her u a mother. She may take the 

 dill, when troubled with indignation and flatus, with more safety than 

 tli.- infant, and al*> with more advantage, as, by promoting the diges- 

 tion, it augment* the quantity of the milk and improve* it* quality. 

 Lake those of never*) other umbelliferous plant*, the wed* are fatal to 

 bird*. uch a* chaffinches. 



Dill-water U often made the vehicle of purgative or other medicines 

 to prevent griping. One of the bent laxative* for infant* is made with 

 equal port* of dill-water and compound decoction of aloe*, to which n 

 few drop* of aromatic spirit of ammonia may be added. Thi* u much 

 more appropriate than the domestic doses of magnesia and rhubarb, no 

 often given to infant*, and which I >r. Reid declared to be the cause of 

 death in one-half the children which din) in London under two yean 

 of age. The insoluble nature of the woody fibre of rhubarb render* it 

 very irritating to the sensitive stomach* of infante, to whom nothing 

 olid should ever be given. The evils of magnesia are manifold. 



A NKURISM is a Greek word (artupmr/^t), literally signifying 'a 

 widening or extension.' It is now used to signify a tumour, consisting 

 of a preternatural enlargement of an artery. The artery is the only 

 seat of this disease ; and any artery of the body may be the subject of 

 it, but it is much more common in some arteries than in others. The 

 corresponding disease in a vein is called a varix. [VARIX.] 



An artery is composed of three membranes, which are firmly united, 

 and form the walls of a strong elastic and extensible tube. These 

 membranes are called tunics or coats. In the healthy state of the 

 artery these tunics yield only to a certain extent to the impulse >! tl,. 

 blood, so that the tube possesses only a certain diameter ; but in a 

 state of disease the impulse of the blood distends these tunic* to a pre- 

 ternatural extent, causing that part of the artery which is diseased to 

 *well out into a tumour or bag. The distension of the coats i the 

 artery progressively increasing, they are at last capable of no further 

 stretching, and consequently are torn asunder and burst. But the inner 

 and middle coats of the artery are not as extensible a* the external coat ; 

 the two former coats are therefore ruptured a considerable time before 

 the latter give* way, in which caw the only proper coat of the artery 

 f< 'lining the wall of the aneurismal tumour is the external. This coat 

 in it* turn getting progressively thinner and thinner as the dilatation 

 goes on, at length bursts like the former ; the blood escapes, and life is 

 suddenly extinguished. But sometimes the tumour does not burst 

 even after the rupture of the external coat of the artery ; for there is 

 placed around the artery a dense and strong membranous sheath, con- 

 sisting of what U termed cellular membrane, which sheath is for more 

 extensible than any of the coats of the artery, and it is found that 

 sometime* the aneurismal sac, or the bag-like tumour which the dilated 

 artery forms, consist* only of this condensed cellular membrane ; nil the 

 proper coats of the artery having been rent and destroyed by the pro- 

 gressively distending force. Thus an aneurism may consist simply of 

 the dilatation of the coat* of an artery without the rupture of any ; or 

 of the dilatation of some with the nipt in : or of the rupture 



of all ; the bag of the tumour being formed solely by the cellular sheath 

 of the artery. 



When the coats of the artery have bunt, and this portion of the tube 

 u dilated into a sac, it is evident that this sac is beyond the direct cur- 

 rent of the circulation, and that the larger the bag, the farther its con- 

 tents will be from the influence of the direct current of the blood. The 

 consequence is, that the blood contained in the aneurismal sac undergoes 

 a peculiar change, a modification of the process of coagulation [BLOOD, 

 XAT. HIST. Drv.] ; the thinner part of the blood being removed, while 

 a portion of the thicker part, or the fibrin, remains. In this manner 

 there is left upon the internal surface of the sac a stratum of the 

 thicker or fibroin part of the blood. Successive depositions are made 

 of this fibrotis part of the blood by which the cavity of the tumour is 

 gradually diminished. At length the sac becomes entirely filled with 

 this substance, which forms for it a firm plug. The deposition of this 

 fibrin is not confined to the aneurismal sac, but U continued into the 

 artery iteetf, both above and below its dilatation, until it reaches the 

 next important ramification which is given off from the artery, where 

 it stops. In this manner the circulation through the aneurismal |x>rtion 

 of the vessel i* prevented ; the blood in determined into other channels; 

 this portion of the vessel, being no longer of any sen-ice in carrying on 

 the circulation, is blocked up, and in this manner is effected a mx.nta- 

 neous core of the disease. 



But thi* beautiful curative process, though it occasionally happen, in 

 not the usual course. When the external coat or the cellular sheath of 

 the artery are stretched beyond a certain point, it would | seem that its 

 vitality is diminished ; at length a part of it mortifies or dies ; an 

 eschar is formed ; the eschar sloughs away ; an opening is thus formed 

 in the tumour; the blood rushes out, and the patient die*. Tin- i 

 the mode in which the aneurismal sac burnt* when the aneui 

 situated on the external part of the body. But if the aneurism be 

 internal the process is different ; the tumour becoming thinner and 

 thinner by successive distension, burst* suddenly by a crack or fissure, 

 through which the blood is discharged. 



The first symptom which denote* the formation of an aneuri 

 the perception of an unusual throbbing in the diseased artery. If tin 

 situation of the artery be such that it can be seen or felt, a small 

 tumour is manifest. This tumour, when carefully observed, is : 

 to have a pulsatory motion, this motion, as well as the tumour itself, 

 disappearing when the part is compressed, but instantly reap|iearing 

 on the reuiov.d of the pressure. Commonly, the tumour i- without 

 pain, and without any discoloration ,,f tl,. -km. The m.ignit 

 the tumour, whatever its size when first discovered, is steadily pro 

 gresaive : in pt.']>ortion as it grows larger, the pulsatory i 

 diminishes, and when it has attained a very considerable size the 

 pulsation is no longer perceptible. The tumour continually enlarging, 

 produces a variety of effect* on the parts with which it come* in con- 

 tact. Some it pushes aside, others it carries with it, and < i 

 destroys. The adjacent muscles, for example, whether they are p i 

 directly over the aneurism, or are at one side of it, are usually stretched, 

 displaced, dwindled, and sometimes entirely confounded with tl 

 tiguous jiarts. The nerves, too, are frequently pushed out of their 

 natural situation ; or. if they adhere to the sides of the sac, as they 

 oft. n dr>, they are necessarily stretched as the tumour enlarges, and 

 thin distension of the nervous cords sometimes occasion- uii.n-.- |.,,in. 

 The cartilages and bones, pressed upon by the advancing tumour, 

 gradually disappear, and at length are so completely destroyed that ii"t 

 the slightest vestige of them remains. In general, as Imi^ 

 tumour U small, it is unattended with pain ; but the changes which it 

 produces in other part*, such as the stretching "I the IMTU-S and the 

 absorption of the bones, is sometimes attended with intolerable pain, 

 capable of being mitigated by no means hitherto discovered. Death at 

 last puts an end to the pain and the patient together by the bursting of 

 the sac, the approach of the fatal event being clearly indicated by the 

 increasing thinness, softness, and darkness of the tumour. 



The importance, in practice, of discriminating between this most 

 dangerous disease and all other tumour* is manifest ; but the diet ; 

 is not always easy, or at any rate i- not alw.i\> made. Many a death 

 has happened in consequence of incisions having been mini 

 aneurisms which were mistaken for abscesses. 



There is something in the structure of the larger arteries which 

 predisposes to this disease. Their coat* arc thinner in relation 

 magnitude of the column of blood with which they are filled than 

 the coot* of the smaller arteries. The internal are much more - 

 to aneurism than the external arteries. The curvatures of the arteries 

 are another predisposing cause. The period of life at which ai 

 is most frequent is between the ages of thirty and fifty. Sir Astley 

 Cooper, however, states that he has seen the disease in a child only 

 eleven yean old, and that he has operated for it with success in a man 

 of eighty-five. It is much more common among moles than females. 

 Out of sixty-three cases of this disease, fifty-six were males and only 

 seven females. Aneurism so often follows a sudden violent shock, 

 sustained either by the whole body or by a limb, and more especially by 

 the sudden violent extension of a limb, as apparently to justify the 

 common opinion that external violence is among the most frequent 

 exciting causes of the malady. 



Excepting in the exceedingly rare case in which a spontaneous cure 

 is effected, thig disease, when left to itself, uniformly proves fat il 1>\ 

 the ultimate rapture of the tumour, in consequence of which the 

 intient expire* either instantaneously, from tile great and midden loss 

 of blood, or by degrees, from repeated losses of it. 



The cure of aneurism consists in the obliteration of the preternatural 

 cavity of the artery. The obliteration of this cavity is the sole object 

 of the operation which is found to be the only sure and effectual mode 

 of curing the disease. This operation consists in cutting down u)...ii 

 the artery and passing a ligature around it above its dilatation. The 

 immediate effect of the ligature, of course, is to stop the flow of blood 

 into the sac ; its ultimate effect is to excite inflammation in the coots 

 of the vessel, by which its sides, brought into clone contact 

 ligature, permanently adhere together, thus inducing an obliteration of 

 the cavity of the vessel. The success of the operation depends entirely 

 on the completeness of the adhesion of the sides of the vessel, and the 

 consequent obliteration of its cavity. But this adhesion will not take 

 place unless the portion of the artery to which the ligature is applied 

 be in a sound state. If it IK- diseased, as it almost always is, near the 

 seat of the aneurism, when the process is completed by which tli. 

 ligature is removed [INFLAMMATION], htcmorrhago takes place, and the 

 patient dies just as if the aneurism had been left to itself. For a long 

 time, surgeons were in the habit of applying the ligature as close as 

 possible to the seat of the aneurism ; they laid o|n the aneurismal sac 

 in its whole extent, and scooped out the blood contained in it. Tl 



