ANEUKISM ANGELICA. 



229 



occur in any part of the body except the last species, 

 viz. the varicose aneurism, which can only take 

 place where a vein runs over an artery. 



" Aneurisms," says professor Lizars, " occur more 

 frequently in men than in women, the former sex 

 being more subject to those occurring in the ex- 

 tremities, the latter to those in the trunk, and in 

 many individuals it is a constitutional disease. 

 Aneurism occurs most commonly between thirty 

 and forty years of age, and is said to attack the 

 irritable, the passionate, the glutton, the drunkard, 

 the debauched, the syphilitic, the mercurial, and 

 the rheumatic. Coachmen, post-boys, postilions, 

 soldiers, particularly dragoons, sailors, porters, la- 

 bourers, and miners, are said to be most subject to 

 it." We have not, however, sufficient data to fix 

 so very particularly on any class, as the statistics 

 of disease are yet miserably deficient in practical 

 details. These classes of individuals, indeed, by 

 indulgence in vice, appear to dispose their arteries 

 either to calcareous depositions, or to a brittle 

 condition, so that in the violent exertions which 

 occur in their labours, these vessels rupture and 

 form aneurism, in consequence of the circulation 

 being propelled at such periods with greater force 

 than the artery has power of resisting ; but even in 

 the ordinary circulation of such constitutions, if an 

 artery be weakened, it is unable to resist the mo- 

 mentum of the blood, and therefore gradually yields 

 and dilates ; and our own experience, which on this 

 subject has been considerable, bears us out in these 

 observations. Violent shocks or contusions, for- 

 cible pressure on arteries, the reiterated bursting 

 of parts, the force employed in reducing luxated 

 joints, the violence of falls, fractures, and wounds, 

 are also causes of aneurism. The largest artery, 

 the aorta, is, as we have already observed, most 

 subject to this disease; the next in frequency, is 

 the femoral, or artery of the thigh, and its continu- 

 ation, the .popliteal; the third is the inguinal; the 

 fourth, subclavian, and axillary ; and the fifth, the 

 carotoid. The smaller series of arteries, the radial, 

 ulnar and tibial, are seldom attacked, with the ex- 

 ception of the temporal, which, from being selected 

 for arteriotomy, or bleeding from the arteries, is 

 exceedingly subject to aneurism. The reasons for 

 this order are very obvious, being chiefly conse- 

 quent on the impetus of blood, and the deficiency 

 or delicacy of the adventitious tunics or coats, to- 

 gether with the deficiency of support by the conti- 

 guous structure. To render the meaning of the 

 two preceding sentences more clear to the general 

 reader, aneurism is most common in the larger ves- 

 sels that are most subjected to the impetus of blood, 

 especially such as have less bony or muscular sup- 

 port. 



With respect to the cure of aneurism, medicine 

 can indeed effect little good ; and the instant an 

 individual finds aneurism existing even in a small 

 artery, he should lose no time in reporting his case 

 to a skilful practitioner. 



The usual treatment consists in general and local 

 remedies, the former being chiefly applicable to in- 

 ternal aneurisms, or those situated within the cavi- 

 ties ; the latter to the external aneurisms, or those of 

 the extremities, neck, and external parts of the head. 

 The general remedies are abstracting blood in small 

 quantities, confining the patient to bed, and low diet; 

 the application of a firm compress to the tumour, 

 with a bandage rolled from the toes upwards to the 

 groin, for those of the lower extremities. This is also 

 named the palliative treatment, being that of Va- 



salva, who was the inventor, and in whose hands, 

 as well as others, it has succeeded. Cold astrin- 

 gent applications, especially tar, hive been also 

 recommended. " But in the aneurism of the ex- 

 tremities, there are," says professor Lizars, " many 

 cogent objections to this. In the first place, the 

 patient may be so reduced by the confinement, as 

 to be unable to withstand the subsequent confine- 

 ment after the operation, since in many cases it is 

 necessary to remain quiescent in bed for three or 

 four months, for fear of secondary haemorrhage. 

 In the next place, if much blood be effused, the 

 absorbents are incapable of removing it, and in- 

 flammation, suppuration, or ulceration, or gangrene, 

 takes place, producing great reduction of strength. 

 Thirdly, occasionally great pain is produced by th-e 

 pressure. This plan, can, therefore, only be ju- 

 diciously pursued at the very commencement of 

 aneurism." 



With respect to the treatment of the varicose 

 aneurism, this species appears sometimes within 

 three or four hours after the artery has been 

 wounded in the operation of venesection, or blood- 

 letting, while at others not for several weeks. It 

 has at first a circumscribed appearance, is about the 

 size of a large walnut, with the cicatiix, or mark 

 of the wound made by the lancet, in the centre, 

 and has not so quickly proceeded to that varicose 

 state we have already described as in other cases. 

 It increases very slowly, excites little pain, pro- 

 ducing 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 false aneurism, 

 with which it is sometimes complicated, and the 

 dangers of which we have already stated. The 

 general treatment consists in the application of 

 compression and bandage, wearing the arm in a 

 sling, or keeping it in a horizontal position, or, 

 lastly, in securing the artery, which, probably 

 from its being the shorter means of cure, and in the 

 hands of an expert surgeon, perfectly safe, is the 

 best remedy. 



Notwithstanding the gloomy prospect that pre- 

 sents itself to the subject of aneurism, there are 

 some redeeming shades in the picture, there being 

 no less than jive ways in which a spontaneous cure 

 of the disease sometimes takes place ; but this can 

 never happen in the aorta or large arteries near the 

 heart, although Petit, a French surgeon, describes 

 the remains of an aneurism he had discovered even 

 of the carotid artery,, which had originally been the 

 size of an apple, and after having undergone a spon- 

 taneous cure, was found after death not larger than 

 an olive. 



" The spontaneous cure in all these five ways," 

 say the writers in Costello's Surgical Dictionary, 

 "is produced on the same principle, viz. the effu- 

 sion of concreted fibrin within the sac, and a por- 

 tion of the artery adjacent to the aneurism, and 

 which fibrinous concretion is caused, or permitted 

 to be formed, whenever the circulation of the blood 

 within the sac becomes ^ preternaturally languid. 

 The concreted fibrin is ultimately absorbed, and 

 the aneurismal sac *nd the artery from whence 

 it originates, gradually contract, the sac becom- 

 ing a fleshy tumour, and the artery an impervious 

 tube." 



ANGELICA, OR ARCHANGELICA. This 

 plant, which derived its name from its real or sup- 

 posed angelic virtues, is a native of Lapland and 

 Iceland, but has been long cultivated in our gardens. 



