426 DISEASES OF THE GREAT VESSELS. 



TREATMENT. Venesection repeated at short intervals, a treatment 

 formerly much in vogue, is entirely without benefit in the treatment of 

 aneurism. This is true also with regard to digitalis, which, like vene- 

 section, was supposed to reduce the pressure from within, and to re- 

 strain further expansion of the sac. Nor is it otherwise with the plan 

 of placing a patient, with aneurism, upon a " vita minima ; " that is, 

 almost starving him to death, so as to reduce the volume of the blood. 

 The action of this method, formerly much in use, can only be to aid in 

 rendering the sufferer dropsical, and in hastening his death. The sug- 

 gestion of acetate of lead, and of drugs containing tannin as a means 

 to promote coagulation of the blood, and to fill the sac with clots, is 

 founded upon theory alone, and deserves no reliance. 



Having recognized the existence of an aneurism, we must see that 

 the patient shun all agents which tend to increase the action of the 

 heart. Let him live moderately; guard him from the! temporary 

 plethora which follows every excess ; prescribing, however, a nourish- 

 ing nitrogenous diet to counteract the threatening impoverishment of 

 the blood. 



When a tumor develops upon the wall of the thorax, and when 

 the skin upon it begins to redden, let the patient wear a tin vessel 

 upon the prominence, shaped according to the shape of the tumor, and 

 filled with cold water. Electro-puncture, which has been employed a 

 few times even against aortic aneurism, in order to produce coagulation 

 of its contents, has hitherto had too little success to warrant repetition 

 of the operation. To allay the pain, we are reduced to the exhibition 

 of narcotics. 



CHAPTER III. 



RUPTURE OP THE AORTA. 



THE aorta seldom bursts, if its tunics be sound. In most cases of 

 its spontaneous rupture, its coats are the seat of the degeneration de- 

 scribed in the previous chapter, or of the simple fatty metamorphosis 

 mentioned while treating of aneurism. This is the case, even when 

 an excessively-distended aorta gives way above a stricture, for then, 

 too, the coats are almost always diseased. 



In some cases the rupture at first involves the inner and middle 

 tunics alone, while the adventitia, which is more yielding, and more 

 easily distensible, remains for a time unbroken. The blood then flows 

 in between the tunica media and adventitia, and forces them asunder ; 

 and thus a fusiform tumor, filled with blood, is formed, which commu- 

 nicates with the artery through the opening in the media and intima 

 anewrisma dissecans. According to the observation of RokitansJcy 



