ON THE ANTISEPTIC SYSTEM 89 



presented the appearance of a superficial sore, but not a granulating one : for 

 the deep surface of tlie dressing, being devoid of stimulating properties, had 

 failed to induce granulation in the tissues on which it lay. Meanwhile the 

 patient had been relieved from the pain which she previously suffered, without 

 experiencing febrile disturbance or any material inconvenience from the opera- 

 tion, except uneasiness in the wound the first two days, during retching occa- 

 sioned by the chloroform. The tongue had been natural throughout ; the 

 pulse had onh^ on one day been as high as 90, 72 to 84 being the usual rates ; 

 and lier appetite, which had been absent during the four weeks of agony that 

 preceded the operation, returned two days after it, as soon as the derangement 

 of the stomach from chloroform subsided. On the fourteenth day, as I was 

 arranging her pillows, she sat upright without inconvenience. Eour weeks after 

 the operation, the wound being completely cicatrized, she was allowed to move 

 about in her room ; and, just six weeks from the date of the ligature of the artery, 

 she descended three long flights of stairs, walked for some time in the streets, and 

 reascended the steps to her lodgings ; and, though fatigued by the effort, she felt 

 next day all the better for it. On the 31st of March, she called to see me, much im- 

 proved in strength, though with still some tendency to swelling of the legs, especiall}^ 

 the left, when in the erect posture. The aneurysmal swelling felt merel\- like a 

 slight glandular thickening. On the 25th of July, 1868, 1 again visited her. She 

 had derived much benefit from a stay at the seaside, and the tendency to oedema 

 of the extremities was greatly diminished. There was still absence of pulsation 

 in the external iliac artery, and the cicatrix remained quite sound twent\--iive 

 weeks after the operation. 



She continued for about ten months in fair health and strength : but, 

 in the latter part of November, she became affected with a peculiar spasmodic 

 disorder of the respiration, and on the morning of the 30th of the month, while 

 sitting up in bed, she suddenly exclaimed that something had given way within 

 her, and that she was dying, and then immediately expired. Next day I made 

 a post mortem examination, when the idea which she had expressed pro\-ed 

 correct — an aneurysm of the descending part of the arch of the aorta ha\ing 

 given way, and discharged an enormous quantity of blood into tlio mediastinal 

 and subpleural cellular tissue. The parts concerned in the operation ha\'ing 

 been removed and dissected, the following appearances were disclosed. Tlie 

 aneurysm was not entirely obliterated ; but remained about the size of a cherry 

 or large filbert, of somewhat fusiform shape. The upper two-thirds were solid, 

 being occupied by firm coagulum incorporated with the sac. The lower third, 

 situated just at the bifurcation of the conunon femoral, had been kept free from 

 coagulation b}- the regurgitant stream of blood from the jnolunda into the 



