be avoided. It is inadequate, and proved
more dangerous as far as the vitality of the limb was concerned, the
latter point probably depending on the interference with the collateral
circulation by pressure from the extravasated blood, which is unrelieved
by the operation. I know of at least two cases of gangrene which
occurred consecutively to proximal ligature of the femoral artery for
this condition.

_True traumatic aneurisms._--The cases met with differed so little from
those seen in ordinary civil practice, that but slight notice of them is
necessary. They differed from the last variety mainly in the more
localised nature of the tumour, the greater firmness of its walls, and
the more pronounced expansile pulsation. The development of this form of
aneurism was probably influenced by several circumstances, such as the
more complete rest secured for the patient, the locality in the limb as
affecting movement of the spot in the vessel actually wounded, the size
of the opening in the vessel, and the degree of support afforded by
surrounding structures. (Examples are furnished by cases 6-9.)

Under the influence of rest, all that I saw tended to contract and
become firmer, and they so far resembled spontaneous aneurisms as to be
readily cured by proximal ligature of the artery. The ideal treatment no
doubt consists in local incision and ligature on either side of the
wounded spot, with or without ablation of the sac. The choice of direct
or proximal ligature in any case depends on the position of the
aneurism, and the ease with which the former operation can be carried
out. In all these cases a very great advantage in the localisation and
diminution of the tumours was gained by postponing interference until
they became stationary. I need scarcely add that any evidence of
diffusion indicated immediate operation. The preference of direct or
proximal ligation will probably, to a certain extent, always depend on
the personal predilection of the surgeon, but while proximal ligature
has often given good immediate results during this campaign, it cannot
be with certainty decided whether the patients are definitely protected
from the dangers of recurrence.

Reference to cases 7 and 9 as illustrating the possible spontaneous cure
of traumatic aneurisms is of great interest.

I saw a number of cases successfully treated by proximal ligature; also
a number where continuous improvement followed rest, and which were sent
home for