the wound at the groin was observed to bleed; the blood was florid and arterial, and did not come away in a full stream, but gently oozed up, and apparently did not amount to more than five or six ounces. A compress of lint and adhesive plaster was applied. Digitalis was given, and his generous diet gave way to one of milk.

At 11, a. m., there was a return of hæmorrhage to a greater extent. The pulse was full and bounding. It was proposed to tie the external iliac artery, and secure the epigastric and circumflexa ilii; but the patient would not consent. He was therefore bled in the arm till the pulse became smaller and weaker, and a bladder containing salt and ice, pounded together, was applied over the groin.

About six o'clock in the evening a slight discharge of blood took place, and later at night the pulse rose in volume and strength. The blood removed in the morning presented a thin buffy coat.

22d. A very large and alarming bleeding suddenly burst forth at six o'clock, p. m., which produced a frightful effect, and placed the poor fellow in greater jeopardy than he had ever apparently been before. At his request, the operation was therefore instantly performed; brandy having been first given in small but frequently repeated doses.

The mode adopted by Sir A. Cooper was followed. When the peritoneum was arrived at, the epigastric artery was nearly exposed at the lower part of the wound, and by a little careful dissection, was cleared and tied, the subjacent membrane having sustained no injury. The peritoneum was then drawn to the inner side of the wound along with the cord, and the external iliac having been brought plainly into view, an armed needle was passed beneath it, and the ligature securely tied. The pulsation at the groin ceased. He nearly sank during the operation, but, under the influence of stimulants, he pulled through it. He did well until the 28th, when, at noon, hæmorrhage again appeared at the wound in the groin, and it is thought many ounces of blood were lost. It flowed at first gently from the part, afterwards in a larger stream, but not in a jet. Pressure with the hand restrained it. Graduated compresses of lint were carefully applied, and a truss so adjusted as to bring the pad to make firm pressure directly upon them. The truss, from the tightness with which it was applied, produced pain, which, however, an anodyne relieved. On the 30th, the truss was removed, the wound found to be healthy, and the instrument re-applied. Pulsation of the internal pudic artery was distinguishable. On the 4th of September, the stump was healed. On the 29th day, the ligature came away from the external iliac. The wound cicatrized, and, on the 101st day after the superficial femoral artery was tied, the man was down stairs, and fast recovering flesh and strength.

The observations of Mr. Hadwen are brief. He points out, what has often been insisted on, the disadvantages to which ligature of the common femoral artery is exposed, from the variable point of origin of the profunda and internal circumflex, as well as from the contiguous origins of the epigastric and the circumflex iliac branches.

"We are acquainted," he goes on to state, "with six recorded instances in which the common femoral artery has been selected for the application of a ligature, and two not hitherto given to the public. The dangerous hemorrhage which led the talented Abernethy to the performance of an operation never before attempted,

was produced by a ligature placed upon this vessel. Sir A. Cooper has twice tied this artery; in one instance with success, in the other, hemorrhage arose on the fourteenth day, and death was the consequence. Sir B. Brodie has also tied this artery, and the result was hemorrhage and death. Dr. Murray applied a ligature to it, and owing to a violent bleeding which placed his patient, when the ligature was about to separate, in the utmost danger, he very properly tied the external iliac. Mr. Ivory tied this vessel, and in consequence of subsequent bleeding was under the necessity of taking up the external iliac. These are the six cases already recorded. In five of them violent bleedings followed, and in two of them death was the consequence, and would, in all probability, have occurred in the remainder had not the external iliac been tied. The two other instances alluded to occurred to Mr. Hewson. One was attended with a favourable result, the other with such bleeding that nothing, probably, but the operation to which it led, could have prevented a fatal termination. So that of eight cases in which a ligature was applied to this artery, six were attended with consecutive hemorrhage, two with death, and two with a favourable separation of the ligature; giving to this operation a highly dangerous character.

Contrast with this the result of tying the external iliac. Mr. Hodgson, when he published his work on the arteries, knew of twenty-two cases where the iliac was tied, and not in one of these was there any secondary hemorrhage. Since that period the operation has been performed a great number of times, and, as far as I can ascertain, with the same exemption from this alarming occurrence. I cannot, indeed, find a single case recorded of bleeding attending the separation of a ligature placed upon this artery; so that it may be said, not merely, as Mr. Hodgson observes, that the external iliac may be tied with as much safety as any artery to which a ligature has been applied, but that, of all the large vessels of the human body, it is the one that may be tied with the greatest security, as far as the effects of the operation are concerned, and with the best effects upon diseases to which it is applicable.

There is no case, except that of wound of the artery at the groin, in which tying the common femoral possesses any advantage over the ligature of the iliac; I am therefore justified in concluding that the common femoral artery ought never to be selected, in any case of disease, for the application of the ligature, and that the operation should be exploded." 330.

We fully agree with Mr. Hadwen, indeed similar sentiments have been more than once expressed in this Journal, on the dangers of tying the common femoral artery. But there are two points, one of fact and one of doctrine, on which we cannot go so far as he does.

The point of fact is this. Mr. Hadwen says there is no authentic instance of secondary hæmorrhage after ligature of the external iliac artery. Singularly enough, his own case is such an instance. The patient recovered it is true, but so fortunate a result cannot always be counted on. We believe there are two other instances on record. In a case in which Sir Astley Cooper tied the external iliac, fatal secondary hæmorrhage occurred, from the site, as we have understood, of the epigastric artery. And a similar accident happened to Dupuytren. We remember reading the latter case, and, if we are not much mistaken, it was copied into an early number of this Journal.

Here then are three facts contrary to the supposition that secondary hæmorrhage has not followed the ligature of the external iliac artery.

The point of doctrine hinges on the point of fact. If bæmorrhage has followed ligature of the external iliac, it follows, of course, that this operation is not one of such absolute safety as is represented. Now the opera

tion on the lower part of the vessel is open to strong physiological objections. The ligature is applied, by the method of Sir Astley Cooper, close to the origin of the epigastric and circumflexa ilii. There is insufficient room for the inferior clot, and the very reason which makes the ligature of the common femoral dangerous, makes (not quite to the same degree) the ligature of the lower part of the external iliac dangerous too. This consideration, as well as some others connected with the method of proceeding, have almost proscribed the operation of Sir Astley Cooper from practice. It is little more than what the French call a "Procés d'Amphithéatre."

Before we conclude, we would remark that the idea of the great safety of ligature of the external iliac, in any part of its course, is exaggerated. Of three cases of this operation, which have occurred under our immediate observation, two have been fatal, and one (the high operation) was attended with secondary hæmorrhage. At the time when Mr. Hodgson's statistical calculations were made, there had been a run of luck in favour of the operation. This has often happened with lithotomy.

V. ACCOUNT OF A CASE OF ENORMOUS VENTRAL ANEURYSM; WITH THE POST-MORTEM APPEARANCES. By Sir DAVID J. H. DICKSON, M.D. F.R.S. Ed. &c. &c. &c. Physician to the Royal Naval Hospital, Plymouth.

Our friend Sir David Dickson is one of those who do not slumber at their post. The facts which occur at the Naval Hospital are sure, if valuable, to be communicated to the profession.

Case. A gunner, aged 36, was sent to the hospital at Jamaica, for reputed paraplegia, on the 22d September, 1836; discharged invalided on the 16th December; and received into the Plymouth Hospital on the 20th of March, 1837.

On admission, he complained, chiefly, of pain and uneasy feelings in the sacral region and loins, attended with weakness, partial loss of power, and numbness in the lower extremities, and imperfect command of the sphincter muscles; but his general health was not materially impaired. There was also a deep-seated and ill-defined hardness, or swelling, in the left side of the abdomen, which was at first referred to an affection of the spleen, but which, on further examination, was discovered to be a large diffused pulsating tumor, either in contact with the abdominal aorta, or more probably arising from an aneurysm of that great trunk itself or the common iliac artery and thus the deep-seated pains, and numbness in the sacral region and thighs, at first simulating rheumatism, and afterwards lumbar abscess, as well as the occasional alternations of loose and torpid bowels, eneuresis, &c., were accounted for, by the compression of the vessels and nerves, and espe cially of the hypogastric plexus. Although the tumor enlarged, his general health, on the whole, improved, and on the 6th of September he was as well as usual. But on that day, soon after ascending some stairs, he was seized with excruciating pain in the right iliac region, followed by excessive faintness, and a death-like paleness of the countenance, indicating the rupture of the aneurysm, and, after suffering much pain, he expired at 6, p. m.

Dissection. "Upon opening the cavity of the abdomen, a small quantity of

bloody serum escaped. The posterior reflection of the peritoneum, on the right side, presented an ecchymosed appearance, from subjacent semicoagulated blood, which, effused in vast quantity, had raised the membrane from its attachments behind, and separated the laminæ of its different processes from each other. The blood was discovered to have escaped by an ulcerated opening of the size of a shilling, in the side of an immense tumour near to the right kidney, which it had displaced forward and laterally; and which, on further examination, proved to be an enormous aneurysm of the descending aorta. The aneurysmal dilatation, upon further investigation, was found to commence from the posterior part of the artery, two inches above the cœliac axis, by a kind of neck, which extended to two inches and a half above its division into the iliac trunks; where, suddenly bulging out, it expanded over the whole of the abdomen. The tumour was so immense indeed, that with the exception of the cæcal region, from which it diverged to the left, it might be said to occupy the epigastric, both hypochondriac, the umbilical, and left iliac regions, and the pelvis. But to describe it more minutely, the aneurysm, accommodating itself to the concavity of the diaphragm, to which, as well as to the posterior inferior surface of the liver, it intimately adhered, lay behind the hepatic vessels and ducts, the pancreas, duodenum, &c. It was attached to the false ribs and spine, and descending between the latter and the vena cava and aorta, it continued downwards behind the ureters and iliac vessels, but separated from them by the iliac fascia, which, greatly condensed, formed one of its anterior coverings, and beneath which it insinuated itself. The tumour thence protruded in a conical form under Poupart's ligament, and appeared like an aneurysm of the left iliac artery. This vessel lay in front and the ureter crossed it obliquely, while the psoas lay internally. The iliac muscles and crural nerve externally, and the great sciatic nerve were closely attached to its posterior inferior part. When this immense aneurysm was laid open, it was found to be nearly filled with coagulated blood, of the consistence of wet clay, and some concentric layers of nearly colourless fibrine adhered, though not vascularly, to its walls. The lining of the sac, on the tumour being emptied, appeared of a vivid red colour, mottled with osseous scales, deposited in the fibrous tunic, which, in a great measure, prevented its collapse. A careful examination was then made of the coats of the aneurism: the external covered it completely, except where it adhered to the spine, where the tunics had entirely disappeared, and the last dorsal and first lumbar vertebræ were also partially absorbed. The middle coat was continued over the sac, or so gradually lost in the other coverings, which in some places were increased in thickness to nearly two inches, that its termination could not be detected. The internal tunic was continued for some way into the sac, where it became broken down, and undistinguishable from the adjoining clots. The abundant deposition of ossified matter in the middle coat prevented the collapse of the artery, from the pressure before and behind; and, by maintaining its cylindrical form, preserved a channel for the blood. Two small appendages, resembling knuckles, of intestine, were observed on the iliac portion of the great tumour, and containing blood of the same appearance; but they were distinct from it, being closed by the adhesion of their necks; and their walls were thin and of a purple grape colour. The abdominal and thoracic viscera, generally, were normal, with the exception of some pleural adhesions; and the body was muscular and not much emaciated. So intimate was the attachment of the tumour to the spine, that the lumbar and three dorsal vertebræ were removed with it." 405. A remarkable instance of aneurysm!

The next two articles are of a physiological character.

VI. ON NECROSIS; BEING AN EXPERIMENTAL INQUIRY INTO THE AGENCY ASCRIBED TO THE ABSORBENTS, IN THE REMOVAL OF THE SEQUESTRUM. By GEORGE GULLIVER, Esq. Assistant Surgeon, Royal Horse Guards.

The object of Mr. Gulliver has been to determine, by experiments on dogs and rabbits, in the first place, what becomes of the dead bone in necrosis; and, in the second place, the means by which it is replaced. But the present paper is exclusively devoted to the examination of the first question— whether dead bone admits of removal by absorption.

"While engaged in the formation of the catalogue of the museum of the Army Medical Department at Chatham, 1829, I was led, from the examination of numerous specimens of necrosis in that collection, to entertain a suspicion that the doctrine of the absorption of dead bone, so confidently asserted in the schools as an ascertained fact, might notwithstanding be founded in error,and a further attention to the subject tended to confirm this persuasion. As far as I could judge from my own observations, it did not appear necessary to attribute the form and appearance of the dead bone to the agency of the absorbents after it had ceased to be a part of the living body, the facts appearing susceptible of explanation otherwise; while many cases presented phenomena altogether at variance with the received opinion." 3.

Mr. Gulliver observes that the facts which are brought forward in proof of the absorption of dead bone are-the gradual disappearance of the sequestrum in many cases of alleged necrosis; the irregular and eroded state of the dead portion; the contact of granulations with the indentations on its surface; the absorption of the fang of a transplanted tooth; and finally, (on the authority either of Mr. Abernethy or of Sir William Blizard, that portions of dead bone have diminished in weight, after having been kept in contact with the granulations of an ulcer.

1. Upon the latter fact Mr. Gulliver remarks, in a note

"In Mr. Palmer's edition of the works of John Hunter, the following note appears. Portions of dead bone were often observed to be entirely absorbed in cases of necrosis; and in some experiments made by Mr. Thomas Blizard, in which disks of bone were bound on over ulcers, the surfaces of these disks were found to be eaten out, or destroyed, just as in common caries.' Vol. I. p. 255. The result of my experiments justifies the belief that there must be some mistake in this statement." 4.

And he mentions a suggestion of Dr. Davy, that, if dead bone be subjected to the combined action of air, heat, and moisture, it might lose weight from the decomposition of its animal part, especially if the discharge were long confined.

2. In opposition to the reputed fact of the absorption of dead bone confined in old, Mr. Gulliver urges that Wiedmann, F. Ribes, Jules Cloquet, had each observed examples in which it had been incarcerated for years, without apparent diminution, in a new osseous cylinder, from the internal surface of which more or less purulent matter was secreted. Mr. Liston adduces cases of detached pieces of bone in similar circumstances long remaining unaltered in form, in some of which amputation of the limb was required from the irritation of a dead portion so small, that it is inconceivable how it could have resisted absorption, if that were the process