The method of cure is the same in the true, the false, and the mixed aneurisms: the varicous needs but little, if any assistance: if it is enlarged by exercise and be-cotaes painful, indulge a little rest, and moderate the future labour; perhaps bathing the part with a little spirit may afford some relief, but bandages and all other pressure must be avoided.

To palliate, when the operation is impracticable, bleed as often as is required to keep the force of the circulation moderate; let the diet be temperate, and the exercise very gentle; keep the bowels constantly free; where pressure is used, it must be such as only lessens the force of the blood, but does not resist it; flannel bandages, or knit stockings, etc. are the most proper for this purpose. But all pressure should be avoided when the aorta is the seat of the aneurism, however the tumour may appear externally: it is true that, if the integuments give way, and the coagulum formed on the inside of the tumour hath lost its support, the assistance of a bandage is immediately necessary, as it is the only means to prevent a fatal haemorrhage: in this dilemma, if the substitutes to the integuments are judiciously applied, and accompanied with such topical medicines as resist both suppuration and putrefaction, the life of the patient may be preserved for some time. In one instance, recorded in some of the Medical Observations, where several aneurisms occurred in the lower extremities, the blood lost by the bursting of one cured the rest. This circumstance might lead us to try active bleeding in true aneurisms.

When the operation can be admitted, it is advisable first to attempt the cure by compression, because it sometimes proves effectual; is always a good preparatory step to the operation, by its enlarging the collateral anastomosing branches, and disposing the part to have a more free circulation after the division of the artery: but when the tumour is large, the palliative method should not be long continued, because it injures the neighbouring parts, and will occasion more inflammation and sloughing when the operation is performed.

The pressure, whether before or after the operation, should be confined as much as possible to the affected part, that the passage of the blood through the anastomosing vessels may be free; by which we may prevent the mortification that sometimes ensues from a want of a free circulation.

Some few instances of small aneurisms, and punctures of the artery from bleeding, have succeeded by the use of a bandage, but they almost all require the operation at last, which is performed nearly in the same manner in every part; but larger aneurisms cannot receive any advantage from the pressure; therefore, when used long enough as a preparative to the operation, the latter should not be delayed. Plenck's apparatus is well adapted to close the wound instead of the common bandage; and the German surgeons have introduced several refinements in the management, which are perhaps unnecessary. Yet where the aneurism hair-been cured by compression, it is more probable that the canal of the artery is obliterated, than that the wound is so firmly healed as to resist the arterial current.

If, however, the cure be attempted in this way, the pledget should be very carefully laid on the wounded artery, so as to close the wound accurately without pressing on the veins or any anastomosing artery; the limb should be kept at rest, blood taken from the other arm, and every part of the antiphlogistic plan rigorously adopted. When it is probable that the wound of the artery is firm, the bandage and pledget should be removed; and gcntly loosening the tourniquet, we should observe whether any tumour appears on the part. If there should not, a more moderate pressure must be Still for a time continued.

In the event of having wounded an artery, M. The-den advises us to let the blood (low for a time, and while the proper bandages are preparing, to keep a strong general pressure on the cavity of the elbow. A spiral bandage must then be applied, inclosing a cylindrical compress along the artery. The whole must be wetted with his own aqua traumatica, q. v.; but as wetting contracts the linen, the bandage should not at first be drawn too tight. In three or four days the bandages grow slack, and they must be again applied, and every precaution taken against any of the folds slipping.

Mr. Bell observes, that in diffused or false aneurisms, pressure cannot be applied to the artery alone, without it the same time affecting the rcfiu,ent veins; and as this circumstance, by producing an increased resistance to the arterial pulsations, must undoubtedly force an additional quantity of blood to the orifice in the artery, there is reason to suppose it hath been productive of mischief. But though pressure ought never to be attempted in any period of the diffused aneurism, yet in some stages of the other species it may be often employed with advantage. In their early stages, while the blood can be yet pressed entirely out of the sac into the artery, by the use of a bandage of soft and somewhat elastic materials, properly fitted to the part, much may be done in preventing any considerable increase of the swelling: indeed, by this continued support, complete cures have been at last obtained. Yet, though pressure to a certain degree hath sometimes proved useful, it ought never to be carried to a great length: tight bandages, in these cases, always counteract the intention. The greatest length to which pressure ought to go, should be to serve only as an easy support to the parts affected. With compression, other means should at the same time be used; such as low diet, occasional bleeding, a lax state of the bowels, freedom from strong exercise, etc.

The Operation for the Aneurism is the Humeral Artery.

Having taken away some blood, and promoted such other discharges as seem needful, apply the tourniquet near the shoulder, tighten it so that the pulse cannot easily be perceived; lay the arm in a convenient situation; then make an incision on the inside of the biceps muscle, above and below the elbow, a considerable length, which, being in the course of the artery, will discover it as soon as the coagulated blood is removed. Be careful not to cut the larger veins, nor the bag; the same attention is necessary7 in cutting the aponeurosis of the biceps; for this aponeurosis, the capsula, the bag, and the skin, are all united by the pressure.

If the orifice does not readily appear, let the tourniquet be loosened, and the effusion of blood will direct you to it; then carry a crooked needle armed under it, tie the vessel just above the orifice, and when you have secured the upper part, slacken the tourniquet a little; forif on slackening it there is any haemorrhage from the inferior parts of the artery, it plainly appears that the collateral branches are open, and that there is a free Circulation. The first ligature secured, make a second a little below the orifice, and leave the intermediate space of the artery to slough away without dividing it.

Avoid taking up the nerve with the ligature if you conveniently can; the readiest method to do this is, as it lies on the inside, at a little distance from artery, to relax that vessel by bending the arm moderately, and to raise the artery from its bed by a probe introduced into its orifice, or by pinching it up with the finger and the thumb: the nerve is easily distinguishes from the artery by feeling; and thus the artery may be drawn from the nerve. If the nerve should be taken up, and a portion of the adjacent flesh being taken up with it, no inconvenience need be feared.

After the operation, the limb is generally some little time without pulsation, which, if it does not recover in twenty-four hours, amputation is not to be deferred. This operation is indeed often necessary; but warn spirituous applications, and dry heat from warm sand and ashes should be first tried, and continued so long as the operation can be safely deferred.

In the London Med. Obs. and Inq. vol. ii. page is an instance of an aneurism in the arm being cured by the operation; but, instead of the ligatures, a steel pin was passed through the lips of the orifice in the artery, and secured by twisting thread about it, as in the hare-lip; after a few days the pin came away with the dressings.

Under some particular circumstances, taking up the femoral artery in popliteal aneurisms may be performed with success, and the leg preserved, where the misfortune occurs from falls, bruises, or punctures, in sound, healthy constitutions; but if the aneurism arises gradually in habits where there is reason to suspect a diseased state of the arteries, amputating the limb is certainly the least dangerous mode, and should be preferred.

The advantages of Mr. Hunter's operation for the popliteal aneurism, viz. tying the artery far above the aneurismal sac, are owing to the wound being small; for the true aneurismal sac is untouched, and disappear from absorption; as well as from the greater probability of the artery in a distant part being sound. Mr. Lambert's method of stitching the wound of the artery by the hare-lip suture (Med. Obs. and Inq. vol. ii. p. 360), and M. Descham's (Medecine Eclairee par les Sciences, iii. 67), have been seldom followed, or generally approved.

See instances of aneurisms of the femoral artery being cured in the Lond. Med. Obs. and Inq. vol. iii. p. 106. And in the Edinb. Medical Commentaries, vol. ii. p. 176. Also in Warner's Cases of Surgery.

See Aetius Tetrabib. 7. serm. iii. cap. 10. P. .Egi-neta, lib. vi. cap. 37. Marcus Aur. Severinus de Efficaci Medicina. Morgagni de Sedibus et Causis Morborum. Mem. de lacad. Roy. an 1712, 1733. Philos. Trans. Abr. vol. iii. viii. De Haen de Aneurismatib. Rat. Medendi. Mem. de lacad. Roy. de Chirurgie. Scrip-tores de Aneurismatibus cura. Lauth. Monro's Remarks on the Formation of Aneurisms, in the Edinb. Med. Ess. vol. ii. and iv. Le Dran's Operations in Surgery. Sharpe's Operations of Surgery. Dr. Hunter's, and others', Observations on Aneurisms, in the Lond. Med. Obs. and Inq. vol. i. ii. iii. and iv. Lond. Med. Journal, vol. vii. Transactions for promoting Medical and Chirurgical Knowledge, vol. i. Bell's Surgery, vol. i. White's Surgery, p. 115; and Home on the same subject.

Aneurisma Praecordiorum. Called also car-diogmus, cardionchus; aneurism in the heart, or in Q 2 the aorta near the heart, which occasions pain in the praecordia.