AN aneurism is a tumor formed by arterial blood, and communicating with an artery. A true aneurism is formed by the coats of an artery getting weakened by some cause, and swelling out so as to form a pouch or sac. (Fig. 179.) There are other kinds of aneurisms, which need not be described.
Symptoms. An aneurism may be felt as a tumor somewhere along the course of an artery, and it beats under the finger Eke the pulse. The beating is caused by a fresh quantity of blood being pushed into this sac with every stroke of the heart. If it be small, pressure on the artery above it will so far shut off the blood from it, that it will feel flaccid or soft. The patient will often say that the tumor began to appear after some violent strain, when something appeared to give way. In the chest, aneurism will produce an unnatural pulsation felt by the patient. In the belly, it may generally be felt as a tumor through the abdominal walls.
Distinction. Tumors which lie directly over arteries are lifted up every time the blood is driven along under them, and hence they pulsate like aneurisms; but they do not pulsate when small, whereas aneurisms do from the beginning of their growth. Aneurisms are soft at first, and hard afterwards; whereas tumors are generally hard at first, and finally soft.
Treatment. In some few fortunate cases, aneurisms get well spontaneously. If the flow of blood through them can be stopped, that which is within them will coagulate, forming a hard tumor, which will gradually waste away. To cure them, therefore, we must stop the circulation through them; and this may be done, in some cases, by compression. The pressure upon the artery must of course be above the tumor, and should not be so great as to stop the blood altogether, but only very materially to diminish its flow. The pressure is applied by an instrument having two pads, an are of steel, a joint in the middle, and a screw by which the padded extremities are pressed together. (Fig. 180.)
When this mode of treatment is not practicable, the artery must be tied between the aneurism and the heart. The patient should be placed in be~ with the limb wrapped up to preserve its temperature, and placed in an easy position. Nothing cold should be applied to it. The force of the circulation should be reduced by the tincture of veratrum.
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