SURGERY. 
with eccasionai darting pains, affects all the 
surrounding fparts, so that the tiimonr be- 
comes fixed to the muscles and skin, whicli 
latter has a dull leaden colour. V/hen cut 
into it exhibits a hard gristly appearance, 
with white ligamentous bauds, extending 
into the surrounding fat. When it becomes 
a cancer, a large chasm is formed by ulce- 
ration and sloughing : the sore is unequal, 
with thick indurated edges, and copious 
discharge of fetid sanies, combined fre- 
quently with bleeding. A fungus often 
arises. Previously to thi.s period the ab- 
sorbent glands are generally swelled, and 
they afterwards take on the same disease. 
Extirpation in the earliest state is the only 
safe treatment ; it may be performed after 
tlie glands are affected ; but then those also 
should be removed. Here, however, as 
well gs when ulceration has occurred, the 
disease often recurs. Cicuta, belladonna, 
digitalis, mercury, arsenic, &c. have been 
tried internally without success. Opium is 
necessary as a palliative. Caustics com- 
posed of arsenic have often been used, in 
order to destroy the tumour by slough- 
ing, probably never with success in a true 
schirrus. 
Ganglions are small hard tumours, not 
painful, containing in a cyst a fluid like 
white of egg; connected with a tendon, 
and occurring most frequently on the hands. 
Pressure, stimulating applications by means 
of friction, or extirpation by the knife, may 
be employed. 
Aneurisms are swellings formed by the 
dilatation pr rupture of arteries ; the former 
being named true, and the latter spurious; 
but this distinction is of little use in prac- 
tice. The tumour pulsates, except when 
the artery above is compressed ; it is not 
painful ; it may be made to disappear by 
means of pressure in an early stage. When 
it has grown to a great size, the imlsation is 
often diminished, for at first the blood does 
not coagulate in the bag, which is the case 
afterwards to a great extent. The size of 
the tumour becomes very inconvenient, its 
pressure causing cedema, caries, &c. The 
skin at last grows thin and .bursts, when 
the patient dies of bleeding. Aneurisms of 
this kind generally occur spontaneously, 
from a diseased state of the arterial coats ; 
but sometimes a str ain or blow gives rise 
to them. 
When an artery is wounded, and the 
bloor;! escapes into the cellular substance, a 
false aneurism is foniied. This happens 
at tlie bend of the arm from bleeding. The 
'swelling is irregular, the' skin livid; and 
pulsation may or may not be present. 
The varicous aneurism is where the ar- 
tery has been wounded in phlebotomy, and 
the blood escapes from it into the vein, 
causing a varicous enlargement of that ves- 
sel, with pulsation, and a pecitliar hissing 
noise. This is not dangerous, and requires 
no treatment. 
'I’he treatment of aneurism consists in 
preventing the flow of blood into the tu- 
mour, which then gradually diminishes. 
Hence it is obvious that those of the aorta 
can admit of no remedy. In the limbs, how- 
ever, they may be cured by the operation 
of exposing the artery at a considerable dis- 
tance from the tumour, nearer to the heart, 
passing a double ligature under it, tying 
these at the parts where the vessel is sur- 
rounded by its natuj-al connections, and 
dividing it between them. A single liga- 
ture will be sufficient, but it is not so safe. 
In this way any artery may be operated on, 
from the axillary above the clavicle, the 
external iliac above the crural arch, and the 
carotid by the side of the trachea, dow'n, 
to their respective ramifications. The false 
aneurism should be opened opposite to the 
wounded part of the vessel, the tourniquet 
being previously applied ; the coagula re- 
moved, and two ligatures placed on the 
artery as in the preceding kind. 
Varices ai-e dilatations of the veins, occur, 
ring in parts where the return of the blood 
is contrary to gravity, or where pressure is 
made on the trunks so as to obstruct that 
return : hence they are most frequent in the 
legs. The affected vessels swell into irregu- 
lar knots, in which the blood is at first fluid, 
but afterwards coagulated. The complaint 
at first is not painful, but afterwards be- 
comes so, and gives rise to troublesome 
ulcerations. The vessel sometimes bursts, 
and considerable bleedings follow. 
The cause shoul 1 be removed, and a 
tight bandage applied, the horizontal posi- 
tion being preserved. When this treatment 
does not succeed, the trunk of the vein 
may be tied with two ligatures, and divided 
between. 
Hemorrhoids, or piles, are varices, often / 
attended with hemorrhage. Leeches, cold 
applications, attention to regqnen, open 
state of bowels, and balsam copaivae, are 
nreans of temporary palliation. A radical 
cure may be effected by cutting off the 
excrescences with scissars, or tying them. 
Scrophula attacks particularly the lym- 
phatic glands and bones, occasioning a soft 
