Aneurism

“ An aneurism is a widening or dilatation at some point of an artery. The most important aneurisms occur in the arch of the aorta, that is, in the large curved artery which comes directly from the heart itself and of which all the other arteries are branches. Aneurisms develop, according to the expression of a distinguished American physician, in the special votaries of three heathen divinities, Vulcan, Bacchus, and Venus,—that is, in those who have worked too hard, in those who have drunk too hard, and in those who have devoted themselves too much to the pleasures of the flesh. ”

“ Thus in one case (described by Bollinger) there were six of these aneurisms affecting the abdominal aorta and its branches in the same horse. The verminous aneurism may occur from the sixth month of life onwards, and with increasing age; the number of horses free from such aneurisms becomes continually smaller.
5. The size of the aneurism varies between that of a pea and that of a man’s head. The dilatation is, as a rule, equal on all sides, the form being usually thumb-shaped or bottle-shaped, passing into that of a cone or long oval figure. ”

“ If the aneurism be occasioned by rupture of the artery, we must seize in the fingers along with the skin as much as possible of the aneurism, and then below what we hold in our hand we push a needle having a double thread, and after it has passed through we cut the double, and thus with the two threads we bind the tumour on this side and on that, as we mentioned for staphyloma. ”

“ When the aneurism is spontaneous, there is no guide to tell us where the aneurism may have first originated; it may be that it is high up in the pelvis, and that the visible tumour is only its expansion in the direction of least resistance, or the coats of the vessel may be extensively diseased. The only chance is ligature of the internal iliac.
1. The old operation, or ligature of the gluteal artery in the hip. ”

“ Vesalius was consulted about a tumor in the back, which he pronounced to be an aneurism; but an ignorant practitioner having made an opening into it, the patient instantly bled to death. Nothing can be more easy than to confound an aneurism of the artery of the neck with the swelling of the glands in its neighborhood: with a swelling of the cellular substance which surrounds the artery; with abscesses of various kinds; but if a surgeon were to fall into this error, and to open a carotid aneurism, his patient would certainly be dead in the space of a few moments. ”

“ The first error committed in this case was in calling and believing a wounded artery to be a circumscribed, false, or diffused traumatic aneurism. Nothing can be called an [223] aneurism, by which word a dilated vessel or a diseased shut or closed sac is understood, which has one or more holes in it, made by a ball, or by anything else, the wound or track of which remains open. It is simply a case of wound in which an artery has been divided or injured, and while this track of the ball remains open, no ingenuity of argument can make it otherwise. ”

“ This adhesion will not take place unless the portion of the artery to which the ligature is applied be in a sound state. If it be diseased, as it almost always is near the seat of the aneurism, when the process of nature is completed by which the ligature is removed, hemorrhage takes place, and the patient dies just as if the aneurism had been left to itself. For a long time the ligature was applied as close as possible to the seat of the aneurism: the aneurismal sac was laid open in its whole extent, and the blood it contained was scooped out. ”

“ He relates the case of a cure having been accomplished by the application of a sponge with bandages. (Meth. Med. v, 7.) The passage quoted by our author is from his work De Tumoribus (11.)
Aëtius gives a most interesting account of aneurism. He states that it arises most frequently in women during labour, owing to the breath being violently retained, but that it may take place in any part of the body from a wound, as when an [312] unskilful surgeon in opening a vein at the bend of the arm, opens an artery at the same time. ”

“ Pulse.—Partial or total obliteration of a large vessel, dilatation of the aorta, compression of an artery by a tumor, may produce a radial pulse [p. 809] similar to that of aneurism. Moreover, we may find the radials differing from each other in persons who are perfectly healthy. It follows, therefore, that, taken by itself, the pulse does not contribute very decisive evidence of an aneurism. When the diagnosis of an aneurism is established or confirmed by other signs, then the added evidence of the pulse does possess some value. ”

“ Aneurism, for example, is a disease of an artery, and consists of a preternatural dilatation of its coats. This dilatation arises from debility of the vessel, whence, unable to resist the impetus of the blood, it yields, and is dilated into a sac. When once the disease is induced, it commonly goes on to increase with a steady and uninterrupted progress, until at last it suddenly bursts, and the patient expires either instantaneously from loss of blood, or by degrees from repeated losses. When left to itself, it almost uniformly proves fatal in one or other of these modes ”

“ The Pressure and Ligature Methods of treating Aneurism.—In the course of a lecture on aneurism of the femoral artery Mr. Paget, adverting to these two methods, speaks of them thus: “Taking large numbers of cases of aneurism together, they are very nearly balanced, on the one side for pressure, and on the other for ligature. In favour of pressure there is the experience of the surgeons in Dublin. They seem to have a much larger number of aneurisms, especially of aneurisms of the popliteal artery, to treat than we have in England, and they have certainly a large amount of success. ”

“ Aneurism may become very large; as it increases in size it presses upon and causes the destruction of neighboring tissues. The cavity of the aneurismal sac is filled with fluid or clotted blood or with layers of fibrin which adhere closely to its wall. Death is produced usually by the pressure and interference of the aneurism with adjoining organs or by rupture. In worm aneurism we usually find large thrombi within the aneurismal dilatation of the artery, which sometimes plug the whole vessel or extend into the aorta. ”

“ Albucasis treats of aneurism in the following terms. When an artery is divided, and the skin heals over it, a tumour frequently is the consequence, and the same thing sometimes happens from the wound of a vein. Aneurism of an artery is characterized by a deep-seated tumour in the situation of an artery, the swelling subsiding when pressed upon by the fingers, and being attended with a hissing sound. When it arises from the wound of a vein it is round and exposed. ”

“ A false aneurism is where there is a rupture of the coats, and the blood is found in the adjacent tissues.
Treatment.—Drain blood from a large vein. Inject half strength fluid for the first part of the injection, followed by enough normal fluid to secure preservation. The aneurism itself, will not affect the circulation of fluid to any great extent. Massage the face downward. Give a complete cavity injection. For transportation, govern yourself according to the transportation rules. ”

“ Legg considers the production of acute aneurism by the rupture of abscesses or cysts as doubtful.
Chronic aneurism is almost confined to the left ventricle, and, as Cruveilhier pointed out,72 is the result of fibroid degeneration of the muscle. In a few instances fatty degeneration appears to have been the cause. The monographs of Thurnam,73 Pelvet,74 and Legg75 give the most complete account of the disease. They are more common in men than in women, and the majority of the cases occur after middle life. ”

“ When an aneurism involves the entire periphery of the aorta, it may be cylindrical, fusiform, or globular in shape, and receive names accordingly. When it is a mere bulging on one side of the artery it is saccular in shape. Obviously, the opening into the fusiform aneurism is quite or nearly the entire length of the tumor, whereas in the false saccular type the orifice may be reduced to a mere puncture of the arterial wall. ”

“ When an aneurism arises from the aortic arch it implicates those important organs which are gathered together in contact with itself. The aneurismal tumour may press upon and obstruct the bronchi, H H*; the thoracic duct, L; the oesophagus, I; the superior vena cava, H, Plate 26, or wholly obliterate either of the vagi nerves. ”

“ When an aneurism of the innominate includes the aorta, then the whole sac forms virtually a dilated aorta, and no difference in the radials will appear. Hence it follows as a corollary: Given an innominate aneurism, if the radials remain equal the aorta is certainly involved. When the left radial pulse is alone affected, the aneurism lies beyond the brachio-cephalic branch, and may or may not involve the left subclavian.
[p. 811] The sphygmograph is of less avail in aneurisms of the descending portion of the thoracic aorta or of the abdominal aorta. ”

“ Aneurism of the trunk or primary branches of the pulmonary artery, on the other hand, is an exceedingly rare disease. But few cases are on record. Aneurisms may be spindle-shaped or sacculated, of moderate size, and are usually situated on the trunk. Lividity of the face, dyspnoea, cough, dysphagia, headache, pain in the chest and epigastrium, are the principal symptoms ”

“ Wounds of an artery or vein, or both, may result in an aneurism or an arterio-venous aneurism. Wounds of nerves may cause paralysis and anæsthesia of the parts supplied. Wounds of muscles or tendons may cause weakness or complete loss of motion of particular joints. Wounds of the soft parts, if infected, may lead to cellulitis and phlegmonous inflammation, which may result in much injury. Wounds of joints, if penetrating, are serious, for without the proper treatment they may result in suppuration in the joint, disorganization of the joint, and final ankylosis. ”

“ Varicose aneurism is a false aneurism formed by communication between the aorta and the vena cava, the pulmonary artery, the right auricle, or the right ventricle. It is almost without exception rapidly fatal and not amenable to treatment. ”

“ Aneurism of the aorta is a local dilatation of that vessel. When all the arterial tunics persist unruptured in the tumor, it is a true aneurism. When one or more of the tunics are torn in the process of expansion, it becomes a false aneurism. When all the tunics of the artery rupture and the blood escapes into the neighboring cellular tissue, it becomes a diffuse false aneurism. The internal and middle coats of an artery may burst, and the blood escape into and coagulate in the space between the middle and external tunics, and this is termed a dissecting aneurism. ”

“ A traumatic aneurismal tumor of this nature differs essentially from aneurism which has taken place as a consequence of disease, and not of direct injury. If a spurious aneurism form from disease, the artery is in general unsound for some distance above and below the tumor. In the aneurismal tumor from a wound, the artery is perfectly sound, except as far as concerns the seat of injury. ”

“ Aneurism may occur at any age, but it is rare before the age of thirty years, and most prevalent between the ages of forty and fifty years. Aneurism is also less frequent in the female sex. The distal pressure symptoms of aneurism are more variable than in other morbid growths of the mediastinum, and especially dysphagia is less constant. Great emaciation without intense pain is adverse to the diagnosis of aneurism, while severe pain with occasional exacerbations is favorable to this diagnosis. ”

“ When an artery is wounded, and the external opening in the integument heals so as to prevent the blood from issuing through it, a traumatic, spurious, circumscribed, or diffused aneurism is said to form, according to the facility which is offered by the structure of the parts for the confinement or diffusion of the extravasated blood. ”

“ The instruments which have been invented for the cure of aneurism, by compressing the main trunk of the artery, will be found eminently useful, if applied with care, in many cases of hemorrhage in which it may be doubtful what vessel is actually injured, as in the case of Wilson, page 215, and in cases also of wounds of the hand or foot in which bleeding occurs through the medium of collateral branches. ”

“ A large round tumour forms on the neck from the inner parts, whence it obtains the appellation of bronchocele, of which there are two varieties, the steatomatous and the aneurismatical. The aneurismatical we judge of from the symptoms of aneurism, and abandon as hopeless, like all other aneurisms which it is dangerous to meddle with, as is the case most especially with those of the neck, owing to the size of the arteries. ”

“ And in whatever conditions the patient is, or is likely to be, there will still be the broken leg, until it is set. The same with many organic diseases. An experienced physician has but to feel the pulse once, and he knows that there is aneurism which will kill some time or other. ”

“ A certain person was affected with a large pulsating tumour on the right side of the neck, called an aneurism, just at that part where the artery descends into the axilla, produced by an erosion of the artery itself, and daily increasing in size ”

“ If a true aneurism happens, that is, a swelling arising from a general weakness of the coats of an arterial vessel, or from a wound or rupture of some of its coats, it may be often distinguished from a tumor proceeding from any other cause by a degree of pulsation, supposing the situation of the injured vessel be superficial; as may be evinced in recent aneurisms of the humeral artery, which sometimes happen from bleeding near the bending of the elbow-joint ”