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VII. Case of Conversion of the Heart, &c. By Thomas Spens,
covering the Stone in the Bladder, (with an Engraving.)
Opium. By Mr Edward Lloyd Knowles,
Art. VI. A Case, disproving the Doctrine, that the Surfaces of a Page
Wound in a State of Suppuration will not Reunite by
and Expeditious Mode of Curing Gout. By William
and on a Spasmodic Affection of the Thumbs and Toes,
which very commonly attends it. By George Kellie, M.D. 448
Comparative Anatomy. By James Woodham, Esq. 454
of 1804 ; also Observations on the Remittent and Intere
Wounded Arteries. Engravings intended to illustrate
some of the Diseases of Arteries. By Mr Joseph Hodgson,
Art. IV. A Treatise on the Medicinal Leech, &c. By J. R. Johnson, Page.
Art. I. An Introduction to Comparative Anatomy and Physiology.
By Willian Lawrence, F.R.S.
Affections. By John Reid, M.D.
By Charles Scudamore, M. D.
than leave the patient to a certain fate, I ventured (after pointing out the imminent danger) to propose an operation. He, judging, I suppose, from the little comparative pain, that there was no occasion to submit to such hazard, and perhaps indulging a hope that my prognostic might be fallible, would not consent; and from a want of confidence in myself, which in this instance I am not ashamed to acknowledge, and cannot even now deprecate, I did not press it. Palliatives were therefore only recommended, -rest, an avoidance of every thing which might quicken the circulation or determine to the head, such as exercise, crying, coughing, sneezing, or stooping, and withal a gentle pressure on the tumour by a flannel roller. As might have been expected, the disease gradually gained ground; and although it continued soft, fluid, and compressible, in four months it got to a very alarmirg size. The swelling, extended from the ear to the clavicle
which it rested, became very painful and pointed at three different places. Deglutition was impeded, and his speech affected. He now desired surgical relief, which at this stage was impracticable; and the catastrophe took place on the 15th July 1810, by bursting at the most prominent apex. Although I was sent for on the appearance of blood, and reached his house in a few minutes, I found him speechless and insensible; the hæmorrhage had ceased, but the skin was cold, and the pulse at the wrist scarcely perceptible. To give him the only chance which now remained of preserving life, I run a bistoury up and down the whole length of the sac, while the syncope continued, for the purpose of securirg the bleeding artery, but in vain. An immense gush of blood followed. It then poured more slowly and weakly, and with so little impetus, from the loss already sustained, that I could not discover the jets in a sac of great capacity, filled partly with clotted blood and membranous fibres, and in a fuw moments he breathed his last.
On dissection, I found the common carotid, arising from the şubclavian, perfectly sound, until where it branches into the external and internal of that name. Here the disease existed. The sac was deep and of large extent, occupying the whole side of the neck, pushing the nuscles to one side, adhering firmly to, and bounded by ihe integuments externally, the thyroid cartilage, os hyoides, and trachea internally, and pressing strongly against the vertebræ behind. It seemed of sufficient capacity to bold 12 or 14 ounces. But to convey a better idea of the nature of the disease, and the probability of success, had an operation been judiciously performed, I accompany this with two views, an anterior and posterior one, of the diseased artery, taken by my friend Mr Burke, with great exactness, from the dried preparation.