SURGERY. 719 
visible foundation; but shall content ourselves with giving a 
descriptive catalogue of the various changes that the different 
animal structures undergo, without endeavouring to fix pre¬ 
cisely the nature of the morbid action that gives rise to them. 
At the same time, we must not be accused of deeming 
this a matter of slight consideration. Every one must have 
noticed a connection between inflammation and morbid de¬ 
positions. No point in the whole range of pathology are 
we more desirous to ascertain, than whether this inflamma¬ 
tion produce these depositions, or whether these depositions, 
by the irritation their growth excites, cause the inflamma¬ 
tion. But if inflammation were the sole cause of all the 
above-mentioned degenerations, that and these would be 
synonymous, or, at least, inseparable. It is true this would 
be of little consequence in a practical point of view, if ex¬ 
perience shewed that the treatment proper for chronic in¬ 
flammation prevented the formation of tubercle, cancer, &c. 
&c. Unfortunately such is not the case. 
Arteries are subject to few changes from chronic action. 
Besides depositions of bone and cartilage on their inner sur¬ 
faces, they exhibit scarcely any disease, except aneurisms. 
These are enlargements or dilatations of certain parts of arte¬ 
ries-; according to some, they arise from a rupture of the 
inner or muscular coat, and from a consequent dilatation of 
the outer coat; but others affirm, that though this is often the 
case, yet that aneurisms may arise from a simple dilatation of 
all the arterial coats. The latter opinion, though supported 
by good authorities, has one physiological fact strongly 
against it; namely, that when we inject an artery, however 
forcibly dilated, it preserves its round form whilst the mus¬ 
cular coat remains entire; but that no sooner is that broken, 
than the outer coat bulges out into an irregular tumour, like 
an aneurismal sac. 
The first change that takes place in an artery, is the dila¬ 
tation of its coats;—the second, the rupture of the muscular 
coat;—the third, the deposition of the layers of coagula in 
the tumour. The action of the heart continuing to act on 
the tumour, gradually enlarges it, until at length it bursts, or 
the patient dies. On the other hand, if the coagula are 
freely deposited, they may gradually close up the orifice of 
the artery altogether, and thus the patient’s life may be saved. 
An instance is on record, where even the aorta was thus 
closed. 
An aneurism is known from other tumours by its pul¬ 
sating synchronously with the heart, and by its subsiding 
when pressed upon. But these diagnostic, signs must not 
be considered infallible; an extensive abscess will, if it lies 
over an artery, have a pulsation; and if it has extensive 
sinuses, may subside when pressed. It is a symptom more 
to be depended on that we find the tumour subside, if we 
intercept its blood by pressing on the artery that supplies it. 
This, of course, would cause any tumour to leave off beating; 
but an aneurism would, if not filled with too solid a coagu- 
lum, subside under this pressure which, of course, could not 
happen to any other tumour. 
There are several artificial divisions of aneurisms. They 
are called diffused, if long, and circumscribed if short; 
false if the blood gets through all the coats of the artery into 
the surrounding cellular tissue; and false aneurisms are again 
divided into false circumscribed, and false diffused, and the 
like. But there are only three sorts of aneurism that require 
notice. The common aneurism, the aneurismal varix, or 
varicose aneurism, and the anastomosing aneurism. The 
first we have described ; the second is brought about when 
in bleeding we cut through the vein into the artery, the con¬ 
sequence of this is, that the blood of the latter vessel is 
driven into the former, which begins to pulsate synchronous¬ 
ly with the heart and to dilate. The third is totally dif¬ 
ferent from any of the preceding forms of disease, as it pro¬ 
ceeds from a morbid growth, or dilatation of the arterial 
ramifications, by which a very vascular interstitial substance 
is produced, which has a singular propensity to increase to a 
great and dangerous extent, and which, when cut or broken, 
bleeds with incredible obstinacy. 
The cure of aneurisms is constitutional and local. The 
constitutional treatment is by large and frequent bleedings 
and low diet, to slacken the action of the heart and facili¬ 
tate, as it is supposed, the deposition of coagula in the 
tumour. The success of this plan, in a few instances, is 
affirmed by some surgeons, but it is difficult to reconcile this 
with the fact, that bleeding in general tends to prevent the 
deposition of coagulating lymph. In fact, it seems we 
bleed commonly to prevent morbid adhesions, while, in. 
aneurisms, we bleed to cause them. The fact is, however, 
that the constitutional treatment, though a few patients have 
got well under its influence, probably did neither good nor 
harm, but allowed nature to effect a spontaneous cure. 
Aneurisms have been cured by long continued pressure, 
especially varicose aneurisms; but in general when a large 
aneurism is formed, the only way to cure it is to tie the 
artery that supplies it with blood. Every artery of the body 
has been tied up to the abdominal aorta, but of course the 
nearer the heart the greater the danger. Desault formerly, 
and Mr. Wardrop recently, have endeavoured to shew, that 
when aneurisms are formed near the heart, and it is dan¬ 
gerous to tie the arteries that supply them, a cure may be 
effected by tying the artery beyond the tumour. In this 
case, the artery so tied becomes obliterated up to the aneu¬ 
rism, the aneurism itself becomes obliterated, and a small 
part of the vessel that supplied it. Success has crowned 
these endeavours to a certain extent; but not so much as 
to establish that the new operation is as effectual as the 
old. 
The method of tying arteries for aneurisms, as well as to 
prevent haemorrhages, is now pretty nearly settled amongst 
surgeons. To make as small an opeuing as possible, to use 
as fine a ligature as will effectually compress the vessel, to 
remove as little of the surrounding tissue as possible, and 
to exclude from the ligature every thing but the vessel, are 
the principles that should be held in view. The accom¬ 
plishment of these ends, in different parts of the body, is, 
however, attended with extreme difficulties, and can only be 
effected by perfect anatomical knowledge, and great prac¬ 
tical tact. 
The anastomosing aneurism, and the nasvus maternus, 
which bears a faint resemblance to it, may both be relieved 
by tying the artery which supplies them. 
The only disease the veins are subject to, is varix. This 
is an enlargement of their calibres; it occurs, for the most 
part, in old persons, and is of little consequence unless the 
varicose vein opens into an ulcer, or grows so large that it 
threatens to burst. The treatment for slight cases, is to sup¬ 
port the limb by proper bandaging. When this fails, and 
the ulcer is troublesome, we should cut through the vein; 
this is dangerous if we make a wound, on account of the air 
getting into the vein, or inflammation being set up and com¬ 
municated to the heart; but a plan first suggested by Mr. 
Brodie, is not, we believe, liable to these ill consequences. 
It consists in passing a curved bistoury, in an oblique direc¬ 
tion, through the skin, dividing the vein, and leaving the 
skin immediately over it uncut. 
We come now to the consideration of tumours; con¬ 
cerning which we have nothing novel to offer, either in 
arrangement or description. We shall, therefore, make free 
with some considerable extracts from Mr. Abernethy’s ex¬ 
cellent work on the subject. He is of opinion “ there can 
be little doubt, but that tumours form every where in the 
same manner. The coagulable part of the blood being either 
accidentally effused, or deposited in consequence of disease, 
becomes afterwards an organized and living part, by the 
growth of the adjacent vessels and nerves into it. When the 
deposited substance has its attachment by a single thread, all 
its vascular supply must proceed through that part; but in 
other cases the vessels shoot into it irregularly at various parts 
of its surface. Thus an unorganized concrete becomes a 
living tumour, which has at first no perceptible peculiarity 
as to its nature; though it derives a supply of nourishment 
from the surrounding parts, it seems to live and grow by its 
own 
