84 Surgical Cases in the FinsL'uri/ Dispeiisuri/t 



above the sternum ; which now (Nov. 13th) extended from 

 the uptjer part of tliat bouc to the superior pait of the larynx, 

 with extremely strong pulsations, corresponding with the 

 motions of the heart, which were irregular. The tumour 

 readily disappeared on continued pressure, but on '.liat bcinp; 

 removed it in)mediately resumed iis former sis^c and appear- 

 ance He died on the 2fith of the same month. 



On raising the sternum the anturismal sac was in close 

 contact with the internal and superior part of that bone, but 

 did not contain " one particle" of coagulated blood : the 

 oricrln of the sac was from the superior part of the curve of 

 the asrta, immediately on the right side of the left carotid 

 artery: the opening by which it communicated with the 

 aorta \Vas about a quarter oi' an inch in diameter : the ascend- 

 ing aorta was enlarged a:id ossified in several points: the 

 muscular substance 5f tlic left ventricle of the lieart was 

 much thickened. 



The lungs were healthy, as well as the abdominal vis- 

 cera. 



The dissection of this, together with similar cases in my 

 possession (the prcoarationi of whicR are preserved), in 

 ■^ nhich this disease has proceeded llll it terminated the exist- 

 ence of the individual sufferers, without any coagidum bel/ig 

 foryned in the aiteurlsmal sac, are strongly opposed to an 

 opinion advanced in Mr. John Bell's Surgery. '^ It is not 

 less imaginary," says that author, " that the blood can be 

 •pushed back from the aneurisraal bag into the artery ; there 

 is no such thing^, it is a mere delusion ; as tlie blood coagu- 

 lates very soon, and docs not contain one particle floid 

 enough to be returned into the vessel." 



It is also considered by many, that in the operation for 

 aneurism and wounded arteries, where it is necessary to take 

 up the vessel, the passing of two ligatures round the vessel 

 and dividing it l)etween the ligatures, is of modern inven- 

 tion ; but it appears tiiat this mode of operating was known 

 to Paree, Fabrioius, and others. 



" Sonietim^s, also, the surgeon needs to cut the vessel 

 entirely acroi^s, by vyhich its ends shrinking both ways 



amons 



