The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XXXII. Of an Aneurisma, that is, the dilatation, or springing of an Artery, veine, or Sinnew.

AN Aneurisma is a soft tumor yeelding to the touch, made by the bloud and spirit powred forth under the flesh and Muscles, by the dilatation * 1.1 or relaxation of an Artery. Yet the author of the definitions seemes to call any dilatation of any venous vessell by the name of an Aneurisma. Galen calls an Aneurisma an opening made of the Anastomasis of an Arte∣ry: Also an Aneurisma is made, when an Artery that is wounded closeth too slowly, the substance which is above it being in the meane time agglutinated, filled with flesh and cicatrized, which doth not seldome happen in opening of Arteries unskilful∣ly performed and negligently cured; therefore Aneurismaes are absolutely made by the Anastomasis, springing, breaking, Erosion, and wounding of the Arteries. These * 1.2 happen in all parts of the body, but more frequently in the throat, especially in wo∣men after a painfull travaile. For when as they more strongly strive to hold their breath, for the more powerfull expulsion of the birth, it happens that the Artery is di ated and broken, whence followes an effusion of bloud and spirits under the skin. The signes are, a swelling one while great, another small, with a pulsation and a colour not varying from the native constitution of the skinne. It is a soft tumor, and so yeelding to the impression of the fingers that if it peradventure be small, it wholy vanisheth, the Arterious bloud and spirits flying backe into the body of the Artery, but presently assoone as you take your fingers away, they returne againe with like celerity. Some Aneurismaes doe not onely when they are pressed, but also of them∣selves make a sensible hissing, if you lay your eare neare to them, by reason of the mo∣tion of the vitall spirit rushing with great violence through the straitnes of the passage.

Wherefore in Aneurismaes in which there is a great rupture of the Artery, such a * 1.3 noyse is not heard, because the spirit is carryed through a larger passage. Great Ane••∣rismaes under the Arme pits, in the Groines and in other parts wherein there are large vessells, admit no cure, because so great an eruption of blood and spirit often followes uppon such an incision, that death prevents both art and Cure. Which I * 1.4 observed a few yeares agoe in a certaine preist of Saint Andrewes of the Arches, M. Iohn Maillet dwelling with the chiefe President Christopher de Thou. Who having an Aneurisma at the setting on of the shoulder about the bignes of a Wall-nut, I char∣ged him, hee should not let it be opened, for if it did, it would bring him into manifest * 1.5 danger of his life, and that it would be more safe for him, to breake the violence thereof with double clothes steeped in the juyce of Night-shade and Houselike, with new and whayey cheese mixt therewith: Or with Vnguentum de Bolo or Empla∣strum contra rupturam and such other refrigerating and astringent medicines, if hee would lay upon it a thin plate of Lead, and would use shorter breeches that his doub∣let might serve to hold it too, to which hee might fasten his breeches instead of a swathe, and in the meane time he should eschew all things which attenuate and in∣flame the blood, but especially he should keepe himselfe from all great straining of his voyce. Although he had used this Diet for a yeare, yet he could not so handle the matter but that the tumor increased, which he observing goes to a Barber, who suppo∣sing the tumor to be of the kinde of vulgar inpostumes, applies to it in the Evening a Causticke causing an Eschar so to open it. In the Morning such an abundance of blood flowed forth from the tumor being opened, that he therewith astonished, im∣plores all possible ayde, and bidds that I should be called to stay this his great blee∣ding, and he repented that he had not followed my directions. Wherefore I am called, but when I was scarce over the thre should, he gave up his ghost with his blood. Wherefore I diligently admonish the young Chirurgion that hee do not rashly open * 1.6 Aneurismas unlesse they be small in anignoble part, and not indued with large vessells, but rather let him performe the cure after this manner. Cut the skinne which lyes over it untill the Artery appeare, and then separate it with your knife from the parti∣cles about it, then thrust a blunt and crooked needle with a thred in it under it, binde it, then cut it off and so expect the falling off, of the thred of it selfe whiles nature covers the orifices of the cut Artery with new flesh, then the residue of the cure may be performed after the manner of simple wounds. The Aneurismaes which happen in * 1.7 the internall parts are uncurable. Such as frequently happen to those who have of∣ten had the unction and sweat for the cure of the French disease, because the blood, being so attenuated and heated therewith that it cannot be contayned in the recepta∣cles of the Artery, it distends it to that largenesse as to hold a mans fist; Which I have observed in the dead body of a certaine Taylor, who by an Aneurisma of the Ar∣••erious * 1.8 veine suddenly whilest hee was playing at Tennis fell downe dead, the vessell being broken: his body being opened I found a great quantity of blood powred forth into the Capacity of the Chest, but the body of the Artery was dilated to that largenesse I formerly mentioned, and the inner Coate thereof was bony. For which cause within a while after I shewed it to the great admiration of the be∣holders in the Physitions Schole whilest I publiquely dissected a body there; the whilst he lived said he felt a beating and a great heate over all his body by the force of the pulsation of all the Arteryes, by occasion whereof hee often swounded. Doctor Syluius the Kings professor of Physicke at that time forbad him the use of Wine, and wished him to vse boyled water for his drinke, and Crudds and new Cheeses for his meate, and to apply them in forme of Cataplasmes upon the grieved and swolne part. At night he used a ptisan of Barley meale and Poppy-seedes, and was pur∣ged now and then with a Clyster of refrigerating and emollient things, or with Cassia alone, by which medicines hee said hee found himselfe much better. The cause of such a bony constitution of the Arteries by Aneurismaes is, for that the hot and fervid blood first dilates the Coates of an Artery, then breakes them; which when it happens, it then borrowes from the neighbouring bodies a fit matter to restore the loosed continuity thereof.

This matter whilest by litle and litle it is dried and hardened, it degenerats into a

Gristely or else a bony substance, just by the force of the same materiall and efficient causes, by which stones are generated in the reines and bladder. For the more terre∣striall portion of the blood is dried and condensed by the power of the unnaturall heat contayned in the part affected with an Aneurismae; whereby it comes to passe that the substance added to the dilated and broken Artery is turned into a body of a bony consistence. In which the singular providence of nature, the handmaide of God is shewed, as that which, as it were by making and opposing a new wall or bancke, would hinder and breake the violence of the raging blood swelling with the abundance of the vitall spirits; unlesse any had rather to refer the cause of that hard∣nesse to the continuall application of refrigerating and astringent medicines. Which have power to condensate and harden, as may not obscurely be gathered by the wri∣tings of Galen. But beware you be not deceived by the forementioned signes; For * 1.9 sometimes in large Aneurismaes you can perceive no pulsation, neither can you force the blood into the Artery by the pressure of your fingers, either because the quantity of such blood is greater than which can be contayned in the ancient receptacles of the * 1.10 Artery, or because it is condensate and concrete into Clods, whereupon wanting the benefit of ventilation from the heart, it presently putrifies; Thence ensue great paine, a Gangren, and mortification of the part, and lastly the death of the Creature.

Notes

• * 1.1

  What it is.
• * 1.2

  In what parts they chiefly happen.
• * 1.3

  Prognosticke.
• * 1.4

  A History.
• * 1.5

  Aneurismaes must not rash∣ly be opened.
• * 1.6

  How they must be cured.
• * 1.7

  These of the inward parts incureable.
• * 1.8

  A History.
• * 1.9

  Lib. 4. Cap. ••lt. de praes, ex¦puls••.
• * 1.10

  A Caution in the knowing of Aneurismaes