surgery; 
body’ where the living principle is so strong 
and active in every part, that, by that energy 
alone it regenerates any lost substance, or 
re-unites, in a more immediate way, the 
more simple wounds.” J. Bell’s Discourses 
■on the Nature and Cure of Wounds. 
Of aneurisms. 
Wounded arteries cannot always be se- 
cured. Very often, as we have above stated, 
a large vessel is divided or punctured at a 
considerable distance from the surface of the 
wound, or in situations where the artery can- 
not be commanded : the blood is by conse- 
quence immediately and profusely poured out, 
j spreads among tire contiguous parts, and pro- 
duces an aneurismal tumour. This is the 
false or diffused aneurism of authors, and the 
manner in which it is formed is sufficiently 
1 obvious. 
The progress of this aneurism varies ac- 
i cording to the situation and size of the artery 
I that has been wounded. In the course of a 
j few hours, the blood has been known to 
' diffuse itself through the whole extent of a 
limb ; at other dimes a very small tumour 
about the size of a horse-bean will remain 
j of the same size for some weeks. As the in- 
i crease of the tumour in false aneurism is ge- 
nerally occasioned by a diffusion ot blood 
among. the surrounding parts; it does not, 
like the true aneurism immediately to be 
noticed, become more prominent as it en- 
larges. In the first stages of the disease, a 
pulsation is almost always perceived in the 
tumour. This gradually lessens, and often at 
length becomes imperceptible. Alter some 
; time, more or less according to the depth and 
magnitude of the wounded vessel, the skin 
1 becomes of a livid appearance, the member 
becomes stiff, painful, and the contiguous 
joint immoveable, the integuments at length 
j give way, and if the artery is large a fatal 
haemorrhage ensues. 
When an artery has been accidentally 
punctured by the transfixing of a vein, an ac- 
cident which has happened sometimes in 
blood-letting at the arm, the extravasated 
! blood either diffuses itself into the sur- 
; rounding cellular substance, or, when the 
! vein and artery are more immediately in 
1 contact, the communication between the 
i vessels is preserved ; the vein, by the 
I consequent impetus of blood comes to, be 
i dilated, and what has been denominated va- 
ricose aneurism occasioned. 
This kind of tumour may be recognized by 
the tremulous kind of motion which attends 
' it, accompanied by a peculiar hissing noise, 
and by the tumor entirely disappearing for a 
j time upon pressure. 
When from accident or disease the coats 
of an artery lose in any particular point their 
; ordinary power of resistance to the blood’s 
impetus, and the diameter of the artery be- 
comes in consequence dilated, the true or 
encysted aneurism is formed. It was, indeed, 
I to this dilatation of arteries, without the 
rupture of their coats, and extravasation of 
blood, that the term aneurism was originally 
and is more properly applied. 
In this disease, although it may.be situated 
near the surface, the outer skin at first is ot a 
I natural appearance, the tumour is compres- 
r sible, and a pulsation may almost always be 
I observed in it. As the swelling increases, the 
j skin becomes paler than ordinary, parts of 
the tumour are often firmer than others, and 
the pulsation cannot be discovered at all 
points upon pressure. Pain now comes on, 
the skin becomes discoloured as in false 
aneurism, an oozing of bloody matter is per- 
ceived, and at length the tumour bursts, and 
if the seat of the disease has been a large 
artery, in one of the cavities of the body 
where compression cannot be applied, death 
k the inevitable consequence. Sometimes 
the fatal termination is occasioned by the 
gradual destruction of surrounding parts. 
73Q 
succeeded to external injury ; for this reason 
a diffused and varicose aneurism promises to 
be remedied by operation, with more surety 
than the true or encysted aneurism. 
Aneurisms, likewise, are more or less dan- 
gerous according to their situation. V> lieu 
thev are formed in large blood-vessels near 
the heart, they are not the subject ot ope- 
ration ; and it had generally been conceived 
that even in the extremities, when they were 
this 
seated high up, as in the axilla, or ham, 
! would be inadmissible on account of the com- 
Even bones have become carious in conse- j plete stoppage to the circulation, which was 
quence of their proximity to a large aneur- i imagined a necessary consequence ot obliter- 
ism. " j ating the great artery of the thigh or arm. 
Besides these three species of aneurismal % an anatomical and practical investigation 
tumours, the false, the varicose, and the | ^subject, it has, however, been demon- 
encysted, Mr. J. Bell describes another dis- 
ease, which lie calls aneurism from anasto- 
mosis. This, our author observes, is con- 
stituted not by the dilatation of any one 
branch of an artery, but by a mutual enlarge- 
ment of the smaller arteries and veins; it pro- 
ceeds from a trivial size to a large and for- 
midable tumour; it is characterised by per- ’ w 'thout operation, 
petual throbbing, which at length becomes a j ' r ”"~ 
continual and distinct pulsation. It beats | 
strated that the inosculating vessels are in 
either instance sufficient to supply the limb ; 
and that where failure attends the operation 
for aneurism, it is to be ascribed to other 
sources. In this substitution of the collateral 
branches for the arterial trunk, consists, in- 
deed, the cure of aneurism, when it is effected 
strongly when the circulation is unusually 
accelerated; in spring and. summer, its pul- 
satory motions become fuller and more acute ; 
it goes on to form sacs among the cellular 
Treatment. The cure of every species of 
aneurism has been attempted by continual 
pressure on the tumours. In the false, or 
diffused aneurism, however, no advantage 
can be derived from this treatment. In the 
varicose aneurism, moderate and equal pres- 
substance, or among the dilated veins. These sure may be attended with benefit , and even 
become at length livid, and burst from time to 
time ; and then, as in other aneurisms, the j 
tumour pours out its blood, and, according to 
its extent, reduces the patient. 
Diagnostic marks. The existence of an 
aneurismal tumour is not always to be pro- 
nounced with decision, for although pulsation 
might be regarded as a true diagnostic cha- 
racter of the disease, it is not absolutely so ; 
for other tumours may be situated so near a 
the true aneurism, when the artery is so 
situated that pressure can be made, has 
been cured according to the accounts of 
authors by this means. When attempts 
of this kind do not seem to promise any 
benefit, the operation ought to be speed- 
ily performed. 
When first the operation for aneurism was 
practised, it was invariably the rule to secure 
if possible the large artery leading to the 
tumour by the tourniquet; then to cut into 
large artery, as to be regularly affected by its ; the saCj lay the cav j ty 0 f t h e tumour freely 
pulsations. When there is any doubt of the ; and fairly ope n, c i ear it of the clotted blood, 
nature of the swelling, pressure should be j secure lhe artery b y ligature, and treat the 
made on it ; and if it disappears 01 lessen>, and ; wound according to circumstances. In some 
immediately recovers its size upon the pres- 1 cases it is nece ssary still to pursue this plan, 
sure being taken off, it may be considered as as in a large and sp ,,. a ding aneurism of the 
an aneurism. In the advanced stages, how- 1 
ever, even of an aneurism, the reduction can- 
not always be effected. 
Causes. The simple statement of the ’ been proved that this inode of operating is 
groin ; but where the artery leading to the 
tumour can be dissected and taken up 
before it reaches the cavity of the sac, it has 
mode in which the two first species of aneur 
ism above noticed are occasioned, is a suffi- 
cient account of the causes producing them. 
The true or encysted aneurism appears for the 
most part to depend upon a diseased dispo- 
sition ; often, indeed, it is brought on by vio- 
lence or accident, but even then the pre-dis- 
position is generally to be suspected. Women 
are less obnoxious to aneurism than men, 
especially the large aneurism of the ham ; 
and this Mr. J. Bell ascribes to their ex- 
the most expedient. Mr. John Hunter first 
proposed it, by directing, in popliteal aneur- 
ism, that the great vessel from which it is 
nourished should be laid bare on the tore part 
of the thigh, that the artery should be obliter- 
ated by ligature at this part, and that the 
tumour, now deprived of its nourishment,, 
should be left to be dissipated by the ab- 
sorbents. This plan is now generally adopt- 
ed. T he surgeon dissects down upon the 
artery, in the part which is judged most con- 
emption from the hard labour of the other j venient for the operation, ties the vessel at 
sex. To this conclusion, however, it has | two places’ at half an inch or more distant 
been objected, that even where the labour of from each other, cuts it across in the mid- 
females is greater than that of the men, and j die between the ligatures, and thus destroys 
where even their occupations are such as to i its communication with the tumour ; the 
occasion those exertions which principally ! blood is gradually solicited by the inoscu- 
endanger the artery, the immunity is still the bating branches, which enlarge and come at 
same. ! length fully to supply the place of the trunk. 
When aneurism is produced gradually and j In performing this operation, the surgeon 
without violence, this disorded pre-disposition j is to dissect the artery very clean ; it should 
is more evident. In this case, likewise, the ! be carefully lied by itself, without including 
prospect of cure from operation will be more the accompanying nerve ; a firm waxed lisra- 
fainfly marked than when the tumour has , ture, without gpy intervening substance, is .to 
5 A 2 ' 
