104 SURGERY. 



VARICOSE ANEURISM. 



This is usually the result of a wound, and occurs most frequently 

 in the elbow after bleeding. An opening remains both in the artery 

 and the vein, and a cyst is formed with this double communication. 



The arterial blood en- 

 '^'_ ■ ters the vein, and pro- 



duces greater or less 

 distension of it. This 

 enlargement of the 

 vein is recognised by a 

 peculiar thrill, resem- 

 bling the purr of a 

 cat : it may exist for 

 some time without any inconvenience, and is to be removed by 

 tying the artery above and below the sac, and oftentimes it is 

 necessary to tie the vein. 



Aneurismal varix is another variety, occurring under the same 

 circumstances, at the bend of the arm. The vein and artery com- 

 municate, as in the former, but without any cyst interposed ; the 

 swelling is less, but more diffused, and varicose distension of the 



veins is very great. The 

 Fig. 36. limb below the tumour is 



imperfectly supplied with 

 arterial blood, and, con- 

 sequently, cold, numb 

 and vitally weak, and 

 also liable to congestion 

 ~~ ' and oedema. It is to be 

 treated by pressure, so as to repress the swelling, and moderate the 

 sanguineous mixture: this will palliate the symptoms, and permit the 

 use of the limb. A permanent cure can only be effected by tying the 

 artery above and below the aperture of communication. 



Aneurism by anastomosis presents itself in various forms: 1. 

 Capillaries of a portion of integument may be equally and perma- 

 nently dilated, producing discoloration and slight elevation of the 

 part. This is one form of naevus, or congenital mark, which is 

 attended with no danger, and may be considered as a deformity 

 rather than as a disease. 2d. The structure may consist chiefly of 

 dilated veins fed by arterial branches. This structure is not found 

 in the true skin, but in the adjacent cellular tissue ; or it may be 

 submucous, as is exemplified by one variety of hemorrhoid. 3d. 

 The swelling may consist chiefly of dilated and active arteries, 

 supplied with large tortuous veins, which are mere conduits from the 

 tumour ; the tumour is erectile, and varies in bulk and tension, 



