171 



Dr. Peace, at the Pennsylvania Hospital, and the details of it pub- 

 lished in the American Journal of Med. Sci. for 18-13. The sub- 

 sequent history of it now given, has been furnished to the Committee 

 by the operator. The artery was tied August 29th, 1842, and the 

 patient was discharged cured on the 8th of October. Five months 

 after it was done, the tumour, which had been very large, was found 

 to be hard, was greatly reduced in size, and continued free from 

 pulsation. He returned to a laborious occupation, and in November, 

 1843 — fifteen months after the operation — his attention was directed 

 to a re-appearance of the tumour. He now presented himself to his 

 surgeon, who found it soft, fluctuating, and of the volume of a small 

 orange, with the integuments covering it discoloured. He was re- 

 admitted into the hospital, and in a few days ulceration took place, 

 and he died after repeated hemorrhages. After his admission, liga- 

 ture of the aorta was suggested, with a view of prolonging life, but 

 it was found that pressure on this great trunk at its lower part did 

 not arrest the flow of blood, and was, of course, abandoned. The 

 pelvis, which was bequeathed to Dr. Peace, is now in his possession, 

 and shows that the ligature had been placed upon the iliac vessel 

 just above its bifurcation — a point at which it was perfectly sound — 

 and that the hemorrhage was due to the return of blood into the 

 tumour by the collateral vessels. These vessels being given off by 

 the aorta, above the point at which it is prominent upon the ver- 

 tebrae, and where it had been compressed in the examinations which 

 were made. 



That a ligature may be placed upon the aorta, there are recorded 

 observations to attest : that it will ever be followed by any lasting 

 benefit, there is every reason to doubt. Cooper's patient having 

 died in forty; James' in three, and Murray's in twenty-three hours 

 after it was done. As adding, however, to the list of cases, which 

 show that the collateral vessels are fully able to carry on vigorously 

 the circulation after its complete obliteration, a case which has 

 been detailed by Dr. West, in the No. of the Trans, of the Phila- 

 delphia College of Physicians for February of the present year, is 

 worthy of notice. The subject of it, who was aged 32, and died 

 suddenly from the rupture of an internal aneurism, was remarkably 

 muscular and athletic, with the superior half of his body more de- 

 veloped than the lower. The interesting feature of the case, for 

 our purposes, was, that in tracing the aorta beyond the origins of 

 the great vessels, its cavity was found to be entirely obliterated im- 

 mediately beyond the ductus arteriosus. At the point of oblitera- 



