fusion of decomposed blood in the cellular tissue, sometimes presenting the appearance of small petechia or flea bites, extending over most of the body, and attended by itching or pricking. In one case in the blockading fleet off Vera Cruz (1846,) the face of a petty officer presented the appearance of having been washed with diluted ink before other symptoms of illness appeared. The patient felt well, performed his duties all day aloft, and desired to return to them, but was not allowed. The following day he was confined to his cot; the purpura appeared on the extremities, the gums and mouth became more sore, and severe pain racked every joint and limb. See Vol. II. p. 199.

TREATMENT. In addition to the dietetic treatment demanded by scorbutic influence when present, our reliance in every form of purpura must be placed on the following remedies: Arsenicum, Ammonium-carb., China, Hamamelis, Rhus-tox., Gallic-acid, Sulphuric-acid, Secale-cor., Carbo-veg., Ferrum, Sulphur, Heparsulph., Calcarea-carb., Phosphorus, Phosphoric-acid, Mercuriushyd., Apis, Cantharis.

When the malady has succeeded a severe attack of typhoid fever with great debility, diarrhoea, abdominal tenderness, thirst or adipsia, oedema of the extremities, nightly restlessness and jactitation, and great emaciation, Arsenicum, third dilution in water, will give speedy relief.

Rhus-tox., at the same dilution, may often be prescribed for the same group of symptoms after Arsenicum.

When the disease occurs as a sequence of small-pox, or measles, or scarlet-fever, or erysipelas, Ammonium-carb., China, Rhus-tox-, Hepar-sulph., and Apis are our best remedies. We usually employ the first and second attenuation of these drugs.

Phosphorus and Phosphoric-acid have been successful in cases which were apparently connected with sexual excesses, and seminal losses.

China and Ferrum will be required in chlorotic patients afflicted with the disease. We have observed the best results from palpable doses of these remedies; although cures have been effected with the higher potencies.

Mercurius-hyd., followed by China, have effected cures of cases occurring in persons suffering from chronic hepatic disorders. Cantharis is also an excellent remedy in cases of this description.

The higher potencies of Calcarea-carb. and Sulphur will be demanded in cases dependent on, or connected with a scrofulous dys. crasia.

GENUS XI-EXANGIA. ANEURISM.

Aneurism consists in a dilatation of the parietes of an artery. It generally embraces the entire circumference of the vessel, and may extend to a greater or less distance, even to the entire length of the aorta. When all the coats of the artery are dilated but not ruptured the case is one of "true aneurism." The vessel is frequently thinner than natural, the middle coat is deprived of its elasticity, and the ves sel yields like a vein to the impetus of the blood. In other cases the coats of the dilated portion are hypertrophied.

Dilatation with rupture of one or more of the coats constitutes "false aneurism," as described by the old authors. The internal and middle coats are frequently ruptured; the blood comes in contact with the external or cellular sheath, dilating it to a pouch or sac. The tumor thus formed presses upon the surrounding cellular tissue, condensing it, and thus acquiring an additional envelop, often much thicker than the cellular sheath of vessel originally. "The interior of the sac contains fibrinous coagula arranged in concentric layers the more exterior of which frequently become so dense as to be distinguished with difficulty from the parietes of the sac." (Copland, Vol. 1. p. 132.) The parts surrounding the tumor become attached to it through irritation at first, but are afterwards worn away by absorption promoted by the pulsations. In some cases the internal arterial tunics are perforated, which is followed by hæmorrhage; this may immediately terminate in death, or may be checked by the obstructions furnished by the surrounding tissues; when it forms "diffused aneurism," as described by various authors.

DIAGNOSIS.-Aneurism, when deep-seated, presents no positive signs of its existence. Dr. Hope says he has met with many cases in which large aneurisms existed without awakening even a suspicion in the mind of the medical attendant. Sometimes it occasions no inconvenience, and is only revealed by the sudden death of the patient who had considered himself in perfect health. (On Diseasas of the Heart.) Aneurism of the aorta may be suspected when there is a sense of oppression of the chest; dissimilarity of the pulse of the wrists; but these symptoms may also arise from other causes. Corvisart pointed out a "purring tremor" beneath the middle and upper part of the sternum, when the aneurism is in the descending aorta, and above the clavicles in aneurism of the arch; but this is often indistinct and may also arise from other causes. A wheezing or sibillous respiration and a whispering or croaking voice, with anxious and laborious breathing, are caused by aneurism of the aorta when the tumor presses on the large brouchi; pressure on the oesophagus obstructs deglutition,

renders it painful, and sometimes impossible. Erosion of the bodies of the vertebra by the pulsation of an aneurism produces a gnawing or boring pain in the spine; pressure on the brachial plexus of nerves causes aching of the left shoulder, extending to the neck and scapula, impaired power, and numbness of the arm; pulsation beneath the sternum, or above the clavicles, violent pulsations of the carotids; but none of these symptoms alone are conclusive signs of aneurism of the aorta. A perceptible tumor is visible about the fifth and sixth ribs of the right side when aneurism of the ascending aorta attains a certain size; its seat varies when the aorta is enlarged in other parts. The strong pulsations always present in the tumor indicate its nature; the indications furnished by all preceding symptoms are of doubtful value. In advanced stages of aneurism of the aorta there are coughs with mucous or bloody expectoration, dyspnoea, spasmodic attacks of suffocation, pain in the left shoulder, axilla, inner side of the arm, left side of the neck, pricking pains in the tumor, whizzing or rushing at the top of the sternum or under it; dragging downwards of the larynx, generally without fever. (Copland, Dict. Pract. Med. 1.)

The distinguishing symptoms of true aneurism in the various arteries are extraordinary throbbing in a particular spot occupied by a small pulsating tumor, which disappears when compressed, but returns when the pressure is removed. Without change of color in the skin the tumor increases in size, and in the same ratio the pulsation diminishes. The coagulated blood lodged in the sac of the large aneurism prevents the obliteration of the tumor by pressure and lessens the communication into the artery beyond it. The pulse below the swelling becomes weak and small, and the limb becomes cold and oede

matous.

There are three species of aneurism: 1. True Aneurism which is known by the presence of a pulsating tumor. 2. False or Spurious Aneurism in which there is always an aperture in the artery from which the blood gushes into the cellular substance. 3. Varicose Aneurism. This species of aneurism can only happen where a vein. runs over an artery; as where the brachial artery is punctured in opening a vein. The blood from the artery rushes from the artery into the vein which becomes varicose.

CAUSES.-Aneurism of the aorta is more common in males than females. It is caused by inflammatory irritation of the coats of the vessel by which its elasticity and vital power of resistance are dimin ished; the habitual use of ardent spirits; augmented action of the heart produced by mental excitement and corporeal exertion; hypertrophy of the left ventricle consequent upon chronic inflammation of the vessel, and influenced by moral and physical causes; excessive mental

sugas: Tiens psical exertions suddenly made; though a mori re essei has generally existed previously.

Fass-Aæeurisms sometimes terminate favorably by gradual rain the sae ami absorption of the coagula; by compression Ki cove me sac: by gangrene of the sac and obliteteater: by the influence of inflammation in the vicinity, sure of me artery by the coagulable lymph thrown out; and allesve nżammation within the artery closing its calibre. When se er reis arre, and beyond the reach of a surgical opez te mors always great; as the aneurism is liable to be rupvaring servient, and death usually results from hæmorrhage sons The fatal event may be generally foreseen, as the MUZ way becomes particularly tense, elevated, thin, soft, a s parnie color." (Hooper, p. 67.)

-Nature's effort towards the cure of aneurism is directsu ne nowing out of coagulable lymph which, with the fibrine of my took tens à laver, more or less organized on the inner surface The researches of John Hunter show that this effort of macy ma le assisted by measures which promote the general health, sri pro es de vital energies, but restrain or retard the action of the ·S pictude of body and mind, a light digestible diet, the ace of spirituous and malt liquors, are indispensible ressures" "Change of air is beneficial, but all active exers: the digestive secreting and excreting functions. ei to. The circulation may be partially controlled Digitalis. The application of ice to the tumor by several European physicians. In one case reRepository, 1817, ice was kept on the tumor night ne seral weeks, by means of an ox bladder." "The skin sorteer & Ürk, and by perseverance in the employment of the wholly disappeared." Though in this case the dissvi in some other cases the ice treatment has produced as been successful in some cases, in which the were beneficial than the coldness of the ice.

pressure

azeous cure of aneurism of the femoral artery by the les was reported in a letter by Dr. L. Spalding to

esses pressure made upon the artery above the tumor has at the only treatment relied upon by modern surgeons is ened by John Hunter in 1785. A ligature is applied. 3. seme distance above the aueurismal tumor; the curhove Ang das interrupted, the tumor ceases to enlarge, and eva echa de diarnished by absorption. The artery being • Care fear the diseased point is likely to be in a sound

state, the adhesion of its sides is more certainly effected, the wound is more simple and easily healed, the circulation is carried on through anastomosing vessels, and the system is less disturbed than by an ope ration performed upon or near the tumor. (Erichsen's Obs. on

Aneurism, p. 374.)

Compression has been successfully employed to remedy aneurism by diminishing the flow of blood through the artery without obstructing it. "A partial current through the sac enables the fibrine to be readily entangled in the parietes of the sac in the first instance, and this goes on increasing until it becomes filled: the collateral branches having been previously enlarged, the circulation is readily carried on through them." The compression is effected by two or three small "clamps" by which a graduated degree of pressure can be exerted; and when too much irritation is given in one place it is slackened while the necessary pressure is kept up by others. This treatment, proposed by Hutton in 1842, and since improved by others, has been successful in several cases. It is always safe and often applicable where the operation by ligature was contra-indicated. (Bellingham, pp. 14. Dublin, 1845.)

In 1859, Mr. Hart proposed to the Royal Med. and Chirurgical Society to retard the current of blood in the vessels of the limb by flexion of the leg upon the thigh. Cases illustrating the merit of this procedure have since been given where the formerly trusted methods had failed. Mr. Hart says: "The object in healing aneurism is not to cut off the supply of blood, or altogether at once arrest the circulation in it, but to cause such a retardation in it as will lead to the gradual deposit of fibrinous lamina in the interior, and so effect its gradual consolidation. The former method is uncertain and dangerous; the latter safe and permanent in its results." To attain this partial arrest of the circulation in the limb, a flannel bandage is rolled around the leg from the foot upwards, sloping below the tumor, so as not to compress it in any way. The leg is then bent on the thigh, retained in a fixed position, by means of three pieces of bandage attached to the ankle and along the leg. Confinement to bed is unnecessary, the patient can move about the room with a crutch. After a few hours the limb will require to be released from its restrained position; but, after an interval of a night, it is again bound up and retained so for several days. Absolute necessity for the retention of the flexed position will probably be gone in a week, but, as a measure of precaution, it is desirable that it be kept up for some days longer. To relieve the stiffness and aching of the knee-joint which results from its forced position, Mr. Hart uses a linament of chloroform and oil. Perhaps Arnica would be more efficacious than Chloroform. The flexion should be employed with care and graduated. Some distinguished