on too
much care to ensure asepsis is impossible.

TRAUMATIC ANEURISMS

The experience of the campaign fully bears out that of the past as to
the steady increase of the number of aneurisms from gunshot wounds in
direct ratio to diminution in the size of the projectiles employed.
Every variety of traumatic aneurism was met with, and most frequently of
all, perhaps, aneurismal varices and varicose aneurisms. While so
experienced a military surgeon as Pirogoff could say, in 1864, that he
had never seen a case of aneurismal varix, every young surgeon lately in
South Africa has met with a series. Again, although the condition is a
well-known one, it has been rather in connection with civil life; for
the great majority of recorded cases were the result of stabs or
punctured wounds such as are liable to be received in street brawls, or
as a result of accidents with the tools of mechanics. Thus of ninety
cases collected by K. Bardeleben in 1871, only 12 or 13.33 per cent.
were the result of gunshot wound.

_False traumatic aneurism or arterial haematoma._--This condition was met
with comparatively frequently, and bears a very close relation to that
already described under the heading of interstitial haemorrhages. The
latter might almost have been included here, since the difference
between the two conditions depended merely on the size of the vessels
implicated. The exact correspondence in the period of development of
some of the arterial haematomata, and of the occurrence of the aseptic
form of secondary haemorrhage, also explains the pathology of the two
conditions as identical; except that in the former the effused blood is
retained in the tissues, while in the latter it escapes externally. The
history of these cases was uniform and characteristic. A wound of the
soft parts, or sometimes a fracture, was accompanied by a certain degree
of primary interstitial haemorrhage, which might or might not have been
associated with external bleeding. A haematoma resulted in connection
with the wounded vessel, the general tendency in the effusion being to
coagulation at the margins and subsequent contraction. Meanwhile the
opening in the artery became more or less securely closed by the
development of thrombus, and possibly by retraction of the inner and
middle coats of the vessel. With the return of full circulatory force as
shock passed off, or with the resumption of activity and consequent
freer movement of the limb, the tempora