[17] [This aneurismal diathesis occasionally exists in an astonishing degree. Thus, Pelletan relates an example in which there were upwards of sixty tumours of this kind; and a still more remarkable one is recorded by Mons. J. Cloquet. In this case the number of dilatations exceeded two hundred, the largest of which were not bigger than a common pea. (Elements of Path. Anat., vol. i., p. 283.) An instance similar to that in the text occurred at Cincinnati two years ago, in a man between thirty and forty years of age, in whom Professor Mussey secured the right femoral artery for popliteal aneurism. Three years previously the same operation was performed on the left limb for the same affection by Dr. Speer, of Pittsburgh.—ED.]
[18] [This is commonly called Brasdor’s operation, after the surgeon who devised it. Mr. Wardrop, of London, is its greatest advocate. It has proved successful only in a few cases out of upwards of twenty in which it has been performed.—ED.]
[19] [For some very interesting examples of this hemorrhagic tendency, the reader is referred to Mr. Wardrop’s excellent little work on Bloodletting, and to the first volume of my Elements of Pathological Anatomy. A few years ago a case came under my notice in which fatal hemorrhage was caused by lancing the gums over the two central incisors of the upper-jaw, in a male child between five and six months old. He was labouring at the time under an attack of cholera, so prevalent in our early summer months; and the day after the operation purpuric spots appeared in different parts of the body, the largest being situated on the abdomen and the scalp, just behind the ear. The bleeding was at length arrested by the twisted suture, made by transfixing the gum with three very small needles, the points of which were broken off close to the jaw, and the threads applied in the usual manner. Notwithstanding this, the child died exhausted on the fifth day, hemorrhage having, in the meanwhile, taken place from the stomach and bowels. It may be proper to add, that the infant had been delicate from his birth, and that there was no hereditary predisposition to the singular affection which carried him off.—ED.]
[20] [In one instance I succeeded perfectly in effecting a cure with the seton. The tumour, about the size of a twenty-five cent piece, occupied the vertex, and possessed all the properties of the erectile tissue. The child was eighteen months old, and the swelling had made its appearance a few weeks after birth. Half a dozen coarse silk threads were passed, by means of a curved needle, under the base of the tumour, where it was allowed to remain for nearly a month. Considerable suppuration supervened, followed by the complete obliteration of the enlarged vessels. In the hands of Mr. Wardrop, of London, the caustic potash, applied to the surface of the tumour, as in making issues, appears to have been attended with great success. The practice of tying the principal arterial trunks connected with the swelling almost constantly fails, and is rarely resorted to except by ignorant and reckless surgeons.—ED.]
[21] [The first accurate account of osseous aneurism was published in 1826, by Mons. Breschet, in the second volume of the “Répertoire Générale d’Anatomie et de Chirurgicale.” It has since been noticed by other surgeons, particularly by Professor Lallemand of Montpelier, and Mr. Bell of Edinburgh, and there is reason to believe that it is of more frequent occurrence than is generally imagined.
The disease is most commonly seated in the head of the tibia. It has been observed also in the scapula, as in the case mentioned in the text, the femur, wrist, and ankle. The male is more liable to it than the female, and it rarely makes its appearance until after the period of puberty. The cause of the disease has not been satisfactorily explained. In some cases it is produced by external violence, as a blow or fall; in others, especially when seated near a large joint, it is traceable to gouty and rheumatic affections.
The enlargement, even in its early stage, is tense and painful; being attended with distention of the superficial veins, swelling of the surrounding structures, and slight discoloration of the skin. In a short time a deep-seated pulsation, or throbbing, synchronous with that of the left ventricle, and similar to what is witnessed in some erectile tumours, may be perceived in the affected part. In the advanced stage of the malady the beating is accompanied by a sort of undulating movement, and is easily interrupted by compressing the main artery of the limb, between the tumour and the heart. The enlargement varies in size. In a case mentioned by Mr. Bell, it was more than nine inches in circumference, by upwards of six in length. In some instances, pressure applied to the tumour with the finger imparts a peculiar crackling sensation, not unlike that of dry parchment or an egg-shell. The soft parts around the disease are generally œdematous, the whole limb is apt to be swollen, and the motions of the contiguous joints are constrained and painful. Towards the last the general health always seriously suffers.
On inspection, the outer table of the bone is found to be considerably attenuated, in many parts destroyed, and in some so flexible and elastic as to be bent with the same facility as cartilage. Frequently the bone is extremely brittle, and may be crushed like an egg-shell. The areolar texture is partially absorbed, and the medullary canal filled with coagula, which are often arranged in concentric layers, as in old aneurismal sacs in other situations. The investing membrane in the immediate vicinity of the disease is thickened, as well as preternaturally dense and firm, and the vessels ramifying through the tumour are greatly enlarged.
The only effectual remedy for this disease, provided its location be favourable, is amputation. In the early stage relief may possibly be afforded by securing the main artery of the limb. Lallemand relates a case in which ligature of the femoral artery completely arrested an aneurismal affection of the head of the tibia; but this must be regarded as an exception to the general rule.—ED.]
[22] [In this country we have a number of insects, the sting of which is sometimes attended with considerable pain and swelling, or even high inflammatory excitement. Of these, the most common are the bee, wasp, hornet, yellow-jacket, and humble-bee, which all secrete a subtle poison contained in a reservoir in the abdomen, from which it is projected by the barbed dart when in the act of stinging. Severe and even dangerous wounds are occasionally thus inflicted; indeed, in a few instances death has been known to follow, especially in persons of a nervous, irritable temperament. Another insect, from the bite of which a good deal of irritation often results, is the musketoe, which abounds everywhere, during the hot summer and autumnal months, along the water-courses of the western and southern states. The little punctures made by this animal I have known in several instances to degenerate into unhealthy sores, furnishing a thin, sanious discharge, attended with more or less itching, and exceedingly difficult to heal. The late Professor Dorsey mentions a case—that of a lady who previously enjoyed good health—in which the bite of the musketoe terminated in gangrene and death.