In healthy states of the body, wounds of arteries and veins are alike healed in this manner. But it may happen in both that the process is interfered with. In the case of an artery, the temporary bond of union may as soon as it is formed yield before the impulse of the blood. The intention is then not carried out. A fresh attempt is made: a fresh in its turn may yield in a similar

layer of fibrin is deposited, and this way; and thus an aneurism is formed, the union by first intention being frustrated by mechanical means. After an aneurism has attained any size, the quantity of fibrin not only prevents the divided coats of an artery from coming together, but actually tends to pull them apart. The opening into the artery is generally much smaller than the diameter of the tumour, and as the outer layers of fibrin are forced outward, they tend to widen the aperture into the vessel. Now, the blood flows almost as quickly through the veins as through the arteries, and yet we do not find aneurisms in veins. In order that the divided coats of an artery may unite in the same way as those of a vein, it is only necessary that they should be placed under the same circumstances. The essential condition is that the layer of fibrin which unites the divided edges should be left at rest until it has acquired sufficient consistency to resist any mechanical causes of disturbance to which the part may be subjected. In this mode of union it is only necessary that the fibrin deposited should be of proper quality, and should not be disturbed. Any larger deposit of fibrin, whether in arteries or veins, is an indication of imperfect action. It shows that the original intention having to a greater or less extent failed, successive subsequent attempts have been made to accomplish the same object. When the healthy natural process of union by first intention takes place, the calibre of the vessel is not obstructed; but in some cases, where the quality of the blood is altered, or where it has become mixed with some other matter, a coagulum of a greater or less extent will form within an artery, and occasionally this will entirely obliterate its canal. Sir Wm. Fergusson showed me some years ago an instance in which he had pressed the coagulum out of an aneurismal sac, and in which the distal arteries in consequence ceased to pulsate. If in such a case the blood were to coagulate around the fibrin so as to obstruct the canal of the vessel for any length of time, a permanent cure of an aneurism situated upon the obstructed vessel might be expected; but, as I have said, with healthy blood it is very rarely that such coagula form within the cavities of arteries which are not diseased.

The statements that I have now made carry conviction to my own mind that neither slowness of motion of the blood, nor any large quantity of coagulum, is necessary for the due performance of the process of union.

It takes places commonly and readily in veins even after a wound has been opened several times, without any obstruction to the circulation; and all that is requisite in order that it may in like manner take place in arteries is that the circumstances may be similar. Thus it is not retardation of the circulation, nor the quantity of fibrin deposited, that is essential for the cure of an aneurism; but some mode of preventing the impulse of the blood upon the newly-formed adhesions: in other words, apposition and rest. These objects may be attained in various ways. Whether intentionally or not, all the operations for aneurism which ha e been introduced, since the severer operation of amputation, as recommended by Pott, and that of opening the sac as advised by the older surgeons have been abandoned, tend to favour these conditions. What has been termed the Hunterian operation does so in a marked degree: the coagulum is left undisturbed, and the impulse is taken off the injured vessel. Instrumental compression, which has lately been used with a considerable amount of success, has evidently the same effect. This practice, as old as the time of Hunter, failed at first from the fact that those who attempted it tried to stop the current of the circulation, and thus produced a degree of pain which it was impossible for the patient to bear. With digital pressure the effect is essentially the same, but the degree of compression must necessarily be constantly varying.

The treatment by flexion is a discovery due to Mr. Ernest Hart. The sac, and consequently its contents, are prevented from being distended by being pressed upon in all directions by surrounding structures. The impulse of the blood, by the compression of the tumour against the upper part of the artery, is at the same time diminished.

Thus in all these methods of treatment the same essential conditions are provided for-viz., rest, and apposition more or less direct of the diseased or divided coats of the artery. It is true that cures have been effected in other ways. Thus the coagulum has been rendered so firm by galvanic action, or by the injection of the perchloride of iron, that it has not yielded before the pulse of the heart; and this is to do by artificial means that which is naturally done in animals. And instances where this mode of treatment has been successful does not in the least militate against the necessity of the two conditions upon which I have insisted.

Now, in the various plans of treatment which I have mentioned, we may observe a gradual progress towards the accomplishment of the same end by more simple means. The old operation involving the opening of the sac was succeeded by modifications of the Hunterian operation. This, in many cases, was superseded by various modes of compression; and this again by the less painful and less tedious plan of acute flexion.

I have now the pleasure of subbmitting to the consideration of the profession what, I believe, may prove a still more simple and more certain plan of treatment, at least in some cases-viz., the treatment by acupressure. I cannot but remember that six years ago I had the plea sure of reading before the Medical Society of London a paper, which was subsequently published as a separate essay. In this I advocated acupres sure in certain operations upon the veins-a mode of proceeding which I had at that time practised for a period of seven years. In performing the operation for varicocele it had occurred to me occasionally to wound one of the branches of the spermatic artery, which was not controlled by the needles already introduced. Arterial hæmorrhage would then take place; but this was always commanded by introducing another needle, so as to compress the bleeding vessel. During this period a case occurred which left a strong impression on my mind that the action of arteries in other situations might be more simply and more effectually controlled by acupressure than by other means.

A young man had a wound in the palm of his hand, from which there was a copious hæmorrhage. Various attempts were made to secure the divided ends of the vessel. These all failed. The radial artery was tied, and the ulna artery was tied, and I believe ultimately that the brachial artery was tied; but however this may have been, the arm was at length amputated. It occurred to me that the hæmorrhage might have been restrained by means of needles passed through or underneath the bleeding vessels; and this I mentioned to a friend at the time before the amputation was performed. That such a mode of treatment might be effectual in similar cases has since been fully shown by Sir James Simpson's admirable work on " Acupressure as a Means of arresting Surgical Hæmorrhage."

I will now give a case in which I had an opportunity of putting this plan of treatment into practice in a case of traumatic aneurism.

Henry G, aged nineteen, admitted into St. George's Hospital on the 16th of September, 1866. On the 9th of September he received a wound on the lower part of the left popliteal space from a sharp knife. The wound at the inner side of the leg passed obliquely outwards to the extent of an inch or more. There was a great deal of hæmorrhage at the time, but this was stopped by a handkerchief being tied round the limb, The handkerchief was allowed to remain untill the 12th, when it was removed, but again applied. There was not any hemorrhage at this time. Having removed the handkerchief on the 16th, the bleeding recurred. He was now admitted into the hospital. There was a tumour on the lower and rather to the inner side of the popliteal space about the

size of a large chesnut. This could be felt and seen to distend with each arterial impulse. When the tumour was forcibly compressed by the thumb, the posterior tibial artery still pulsated. A consultation of the hospital was held upon the case, after which a long slender needle, previously made for the purpose of acupressure, was introduced immediately to the outside and above the tumour, which was at the same time pressed inward by the point of the finger. The needle was made to penetrate deeply into the popliteal space; its point was then turned inward, and brought out immediately behind the internal tuberosity of the tibia. From the grating sensation conveyed to the fingers at this time, the needle must have passed through some fibrous or tendinous structures. A small quantity of blood escaped at each aperture which the needle had made; this was not of a dark colour, and there was no evidence of any large vessel having been pierced. The pulsation in the tumour stopped immediately that the needle was introduced, but the pulsation in the posterior tibial artery in the lower part of the leg could still be distinctly felt. It appeared from this, and from the experiment previously made of compressing the artery, that the aneurism had arisen from a branch of the popliteal artery, and not from the popliteal itself, and that the acupressure needle must have passed between the main artery and the wounded branch. Although the tumour had ceased to beat, a piece of cork was placed immediately above it and a little to its outer side, and confined in its position by an elastic band passed over the extremities of the needle. September 20th-There had been a little pain up the thigh, but none near the aneurism: no pulsation in the tumour.

22nd. The india-rubber band was removed, but the needle was allowed to remain. There was some very slight irritation at the points where the needle passed through the skin. There was no other pain or inconvenience. The skin of the leg for a considerable distance was still discoloured, presenting the appearance of having been bruised.

24th. The acupressure needle was removed (on the sixth day). Some serous fluid followed its extraction, and a very small quantity of blood. A pad of lint was now placed over the situation that the needle had occupied, and retained in its position by a bandage.

26th. The pad and bandage were removed. looking fluid escaped from the original wound. tumour, nor fresh hæmorrhage.

Some dark, grumous

No pulsation in the

27th. The bandage was again removed, and a smaller quantity of the same kind of fluid escaped from the wound as on the preceding day.

29th. The wound discharged only a very small quantity of serous fluid.

Oct, 2nd.-There was now no discharge from the wound. Some thickening could be felt in the situation of the aneurism, but there was not the slightest pulsation. The pulsation in the posterior tibial artery continued natural. The skin of the leg still remained discoloured.

4th.-Feels quite well, and is in no pain. The wound has nearly healed.

6th.-Was allowed to get up.

13th.-Has had no unfavourable symptom since the last report. The discoloration of the limb has disappeared. He left the hospital apparently quite well,

The patient presented himself at the hospital on the 20th, and again on the 27th, when, with the exception of the scars of the original wound and of the acupressure needle, the limb was perfectly in its natural condition.

This occurred in a young man; it was a traumatic aneurism, and it was in a branch only of the main artery. It does not therefore follow

that an ordinary aneurism of the popliteal artery would be cured by the same plan of treatment. On the other hand, it must be considered that this must have been a large branch, that it was very near its parent trunk, that it doubtless had its accompanying veins and nerves, and that these sustained no injury from the degree of pressure which was applied to them. Considering that an aneurism of this size and in this situation was so speedily and so completely cured by acupressure-considering that the degree of pressure required is not such as to stop the circulation, and taking into account the fact that an acupressure needle may at any moment be removed, the facts are, I think, sufficient to justify the trial of this mode of treatment in other cases of aneurism. Should increased experience confirm the à priori reasoning, there is, I think, little doubt but that it would be a simpler and more effectual way of pre venting the arterial impulse than any other hitherto practised.

In conclusion, I may mention that the needles best adapted for compressing large arteries are curved, with rounded, not cutting points These, when used, should be held firmly in a handle which can easily be removed. With a needle of this kind it is not easy to wound a large vessel in the living body.-Lancet. Savile-row, October, 1866.

THE TREATMENT OF CANCER BY INJECTIONS.

By CHARLES H. MOORE, F.R.S., Surgeon to the Middlesex Hospital. THE ingenious method of treating certain cancerous tumours com municated to the Association at its last annual meeting by Dr. Broad