1481

The Present Treatment of

Aneurysm.

THE LANCET.

LONDON: SATURDAY, JUNE 1, lD1E.

AT a time not yet very far distant the treatment of

aneurysm was a matter of great importance ; it was a subjecton which many papers were written and which was often

discussed ; but at the present time the disease attracts muchless notice, and of it much less is heard. For this there maybe several reasons ; the disease is certainly far less commonthan formerly. This is one reason, and now the scope of

surgery has widened so greatly that many other matters haveattracted much of the notice that was formerly devoted tothe treatment of aneurysm. Yet it was a happy thoughtto arrange a discussion on this subject recently in the

Surgical Section of the Royal Society of Medicine. That

aneurysms of all kinds are less often seen nowadays than

formerly there appears little doubt, but it seems to be clear

that the aneurysms which have most decreased in number

are those which may be more particularly called surgical,such as aneurysm of the popliteal artery, while the

diminution in the number of aneurysms of the largevessels of the thorax and abdomen is much less marked.

In the discussion at the Royal Society of Medicine all formsof aneurysm were considered in which surgical treatmentcould be applied, but it is not unlikely that the discussionwould have been more interesting if it had been limited to

one or other of the groups of aneurysms ; either would have

given ample material for a valuable discussion. Nevertheless,in spite of the fact that two essentially different matterswere discussed, much that was of interest came out.With regard to the treatment of popliteal aneurysm several

speakers expressed the opinion that the Hunterian operationwas very satisfactory, and that no other method gave betterresults. The operation does undoubtedly give very goodresults if it is employed only in cases really suited for it ; thereal danger nowadays is the risk of gangrene, and thereforeit should not be employed in any case where there is anyindication that the circulation of the limb is already com-

promised. It is curious that no surgeon advocated excision

of the sac, which is only a further extension of the oldoperation of Antyllus, who tied the artery on both sides ofthe aneurysm. Mr. GILBERT BARLING, who opened thedebate, and whose paper appeared in THE LANCET of lastweek, spoke strongly in favour of Matas’s obliteration

operation, for which the somewhat uncouth title of

s endoaneurysmorrhaphy " has been coined. At presentit is necessary to use this lengthy title or to call it the

"obliteration operation," for MATAS has devised and

employed two other operative methods of dealing with

aneurysms. In this operation the aneurysm is opened and

the vessels entering and leaving it are closed by means ofsutures, and the cavity of the sac is obliterated by sutures.The special advantages of the operation are said to be

that the vasa vasorum are less likely to be damagedthan by a ligature, that the main vein is less likely to be

injured than by proximal ligature or excision, and that thecollateral circulation is less likely’to be disturbed. Mr.

BARLING had collected details of 14 cases of aneurysm

treated by the obliterative method : one of these died

from sepsis; gangrene followed in three other cases, but

all three recovered after amputation. The American results

appear to be more favourable than these, but it is early yet inthe operation for a definite opinion to be formed of its value

as compared with other methods. It is clear that it deserves

trial and that it is not difficult to perform. For the treat-

ment of aneurysms not amenable to ordinary surgical pro-cedures, such as aneurysms of the aorta, the main point dis-cussed was the value of the wire treatment. Mr. D’ARCY

POWER presented some statistics of the results obtained, andhe demonstrated COLT’S apparatus by means of which a cageof fine wire can be inserted in an aneurysm ; and some results

were mentioned. COLT’S method appears to be decidedlysuperior to the older method of introducing a wire, andsome successful cases have been reported, but it is not

yet possible to say with any certainty which is the best

method of dealing surgically with internal aneurysms.

We were glad to hear Mr. BARLUW refer to the immensedifference which had been made in the treatment of

aneurysm by the introduction of LISTER’S methods ; byantiseptic surgery four-fifths of the danger of operativeprocedures have been removed, and thus it is possible to

carry out many operations which would have been absolutelyimpossible before. That within recent years several new

processes for dealing with aneurysm have been introducedis clear, but their ultimate position has not yet been settled.It is not improbable that aneurysms will continue to

diminish in frequency, and, if so, the problem will lose

some of its importance, but the general advance in surgicalmethods has put into our hands weapons which we did not

formerly possess..

Spiritualism and Reason.IT has been frequently observed that epochs marked

by a weakening of dogmatic belief in religion are very oftencharacterised also by a luxuriant growth of the manifesta-tions of an extravagant credulity in speculations about the

supernatural. It is very much as if some tendency, which intimes of a different intellectual character finds its natural

channel in the tenets of the organised creeds, is released fromrestraint when these docti inal embankments break down, andwill then, in minds of an inferior order, flow over into crudeforms of superstition. Evidences of a psychological atavismof this sort abound at the present time, and it may perhapsbe questioned whether their growth has not been unwittinglyfostered by the reaction which has set in within recent yearsagainst the aggressive agnosticism of an earlier generation ofscientists. The more tolerant attitude towards spiritualproblems which has replaced the iconoclastic temper of thescientific world in the Victorian era, admirable as it is in