Avicenna and Alsaharavius do not describe the operation. Alsaharavius directs us when an artery has been opened in bleeding at the arm, to attempt a cure by means of compresses and tight bandages. (Pract. xxix, 11.)
It will be perceived from the foregoing account of the practice recommended by Aëtius, that the ancient surgeons were aware of the advantages of securing the artery above the seat of the aneurism, as practised by the late Mr. John Hunter, and that they actually had recourse to two ligatures in the manner directed by Mr. Abernethy; but that they afterwards opened the tumour and evacuated its contents, not having yet learned from experience to trust to the absorbent powers of the system. It will likewise be remarked that carotid, axillary, and inguinal aneurisms were in ancient times abandoned as incurable; so that modern surgery may undoubtedly boast of having so far improved upon the practice of the Greeks and Arabians.
Sprengel gives an interesting history of the operation for aneurism. (Hist. de la Méd. xviii, 3.) According to him, John de Vigo was the first who conceived the idea of curing aneurism by compresses and styptics. This, however, is not exactly true, for, as mentioned above, Galen, Rhases, and Alsaharavius recommended compresses and bandages to prevent aneurism after the accident which most commonly gives rise to it.
SECT. XXXVIII.—ON BRONCHOCELE.
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.
The steatomatous we operate upon like steatomes in general, distinguishing and avoiding the vessels, in the same manner as we described for strumæ.
Commentary. The surgical operation for bronchocele is described by Celsus. He says that its contents may be evacuated by caustics, but that the knife is a more expeditious process of cure. For this purpose he directs us to make a single incision down to the cyst, and to dissect it from the surrounding parts with the fingers. When its cyst cannot be removed he recommends us to destroy it with caustic medicines. (vii, 13.)
Aëtius and Albucasis give exactly the same account of bronchocele as our author.
The poet Juvenal alludes to the prevalence of bronchocele among the people at the foot of the Alps. (Sat. xiii, 162.)