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Cases like rupture of an aneurysm during labor, extensive hemorrhage, the entrance of air into the uterine veins and sinuses, and common lacerations will be omitted, together with complicated births like those of double monsters, etc., but there are several other cases that deserve mention. Eldridge gives an instance of separation of the symphysis pubis during labor, a natural symphysiotomy.
In large trunks, by diminishing the elasticity of the vessel wall, they are liable to lead to the formation of aneurysm. Changes in the arterial walls closely resembling those of syphilitic arteritis are sometimes met with in tuberculous lesions.
Jessop records a remarkable case of multiple aneurysm. This case was particularly interesting as it was accompanied by a postmortem examination. Pye-Smith reports an extremely interesting case in which death occurred from traumatic aneurysm of an aberrant subclavian artery. The patient fell from a height of 28 feet, lost consciousness for a few minutes, but soon recovered it.
The man who has chronic inflammation of a large artery, the result, for instance, of gout, arduous, straining work, or kidney-disease, and whose artery yields under cardiac pressure, has a spontaneous aneurysm; the barman or window-cleaner who has cut his radial artery, the soldier whose brachial or femoral artery has been bruised by a rifle bullet or grazed by a bayonet, and the boy whose naked foot is pierced by a sharp nail, are apt to be the subjects of traumatic aneurysm.
Popliteal, carotid and other aneurysms, which are not of traumatic origin, are sometimes dealt with on this plan, which is the old "Method of Antyllus" with modern aseptic conditions. Speaking generally, if an aneurysm can be dealt with surgically the sooner that the artery is tied the better. Less heroic measures are too apt to prove painful, dangerous, ineffectual and disappointing.
Diagnosis. Pain referred along the course of the sciatic nerve on one side, or, as is sometimes the case, on both sides, is a symptom of tumours of the uterus, the rectum, or the pelvic bones. It may result also from the pressure of an abscess or an aneurysm either inside the pelvis or in the buttock, and is sometimes associated with disease of the spinal medulla, such as tabes.
Laryngotomy was done with the hope of removing a foreign body, but the man died on the tenth day. A postmortem examination disclosed the existence of an aberrant right subclavian artery in the posterior mediastinum, and this was the seat of a traumatic aneurysm that had ruptured into the esophagus.
Such wounds may also be followed by reactionary or secondary hæmorrhage, or later by the formation of a traumatic aneurysm. Conditions which influence the Natural Arrest of Hæmorrhage. The natural arrest of bleeding is favoured by tearing or crushing of the vessel walls, owing to the contraction and retraction of the coats and the tendency of blood to coagulate when in contact with damaged tissue.
The origin of the tumour from bone may be revealed by the presence of egg-shell crackling, and by examination with the X-rays. If the condition is believed to be innocent, the treatment is the same as for aneurysm preferably by ligation of the main artery; if malignant, it is the same as for sarcoma.
When the femoral below the origin of its deep branch or the popliteal artery is obstructed, the veins remaining pervious, the anastomosis through the profunda is sufficient to maintain the vascular supply, and gangrene does not necessarily follow. The rupture of a popliteal aneurysm, however, by compressing the vein and the articular branches, usually determines gangrene.
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