98 



SURGERY. 



when raised or held to one side. An aneurism expands ccincidently 

 with pulsation; a solid tumour will not alter its volume by pressure 

 either upon the distal or cardiac side. 



Causes. — The disease is more frequent in men than in women, 

 and seldom occurs before puberty ; the j^'^'^disposing cause may be 

 said to be disease of the coats of the arteries ; the exciting causes 

 are muscular exertion, mental emotion, and intemperance. 



Cure. — This may either be spontaneous or surgical — the sponta- 

 neous being owing to pressure on the cardiac side of the tumour, 

 occlusion of the aperture of communication, coagulation and absorp- 

 tion, or by inflammation from sloughing of the cyst ; this however is 

 oftener the cause of death, than a means of cure. Medical treat- 

 ment may mitigate the symptoms, such as bleeding, rigid diet, 

 horizontal position, and cold and astringent applications. 



Compression is a means of cure which is slow, painful, and rarely 

 effectual. 



The ligature is alone to be relied on. Previous to the time of 

 Hunter, the vessel was tied immediately above the tumour, and the 

 sac opened. Hunter tied the artery at a distance from the sac, in a 

 healthy part, and allowed the sac and its contents to be absorbed ; 

 this is the present mode of operating. Abernethy applied two 

 ligatures, and divided the artery between them. Brasdor's operation 

 is directly the opposite to Hunter's, tying the artery immediately 

 beyond the tumour. Wardrop modified this, and tied the artery 



beyond the tumour and 

 beyond its first bifurca- 

 tion. The effect of a 

 ligature is to arrest the 

 blood and divide the in- 

 ternal and middle coats; 

 a coagulum or plug is 

 formed up to the first 

 branch, and lymph is 

 effused from the cut 

 edges of these coats, 

 and also surrounds the 

 ligature upon the exte- 

 rior of the artery. The 

 lymph in the artery 

 above the ligature firm- 

 ly consolidates the in- 

 ternal and middle coats; 

 and the cellular coat 

 being compressed by 

 the ligature is subse- 

 quently destroyed, and 



