grew tired of doing nothing, and without the knowledge of his friends or physician, succeeded, by concealing his disorder, in entering his name in a privateer, and left Salem harbour on a cruise in November, 1814. That one evening, about three weeks after they had sailed, he was thrown into a violent fit of laughter, during which the tumour burst into his throat and caused him to throw up about "a quart of blood and corrupted matter," that he was very faint that night, but was comfortable, though too weak to sit up the next day. That a second discharge of "half a pint" occurred three days from the first, and that in a fortnight he was able to do the duty of a cook; and during the remainder of the cruise, (upwards of three months,) and since that time, his health had been so good, as to allow him to labour almost without interruption, although when he used sudden and strong muscular exertion, he felt a degree of pain in the chest, and difficulty in breathing.

I examined his neck attentively, found its appearance natural, but could not trace the slightest pulsation, either in the right side of the face or neck, or in any part of the right arm. He said there was no loss of strength in the right arm, but there was a greater sensibility to cold in it, and in the right side of the face and neck than formerly; and that, since his recovery, there had been nothing like sensible perspiration upon those parts. This last part of the statement was confirmed by a fellow labourer in the distillery, who assured me that he had often observed a profuse sweat upon the left side of Jethro's face, while the right side remained perfectly dry.

I considered this a case of spontaneous cure of aneurism, but since that time have had no particular intelligence from it, until very recently. To the politeness and friendship of Dr. Sewall of Ipswich, I am indebted for a communication which enables me to give its subsequent history. This communication evinces the same zeal and exertion for the promotion of the interests of the profession, which its author has displayed on former occasions, and which is worthy the imitation of all who have it in their power to register extraordinary cases, or trace, by the knife, the effects of disease. I give the Doctor's

own account.

"From the time of his return from sea, in the spring of

1815, Jethro continued to labour at his accustomend employments till early in the spring of 1817; when he suffered from an attack of inflammation of the lungs, and was admitted into the almshouse of this town, (Ipswich) under the care of Dr. Choate, whose politeness in the facilities and aid he has afforded in this case, lays me under great obligations. Dr. Choate informs me, that from the time Freeman came under his care till his decease, he was affected with an almost incessant cough, copious expectoration, hoarseness and difficult respiration, with wheezing as though his breath passed through a narrow aperture. He manifested great impatience of an erect posture, and always studied that position of the body which gave the greatest capacity to the chest. He continued in this situation till sometime in April 1817, when he was taken with profuse hæmorrhage from the mouth, and died in about five minutes."

Dissection.

"In company with Drs. Choate and Story, I made an examination twenty hours after death, and found the following morbid appearances. On opening the thorax, the lungs were found adhering to the pleura costalis in nearly their whole extent of surface, were dense and considerably distended with blood contained in the vessels and air cells. The heart and aorta were almost entirely empty. The arteria innominata was formed into an aneurismal sac three inches in diameter, in the form of a globe considerably flattened. The mouth of this artery was about twice the natural diameter. At the place of its bifurcation into the right carotid and subclavian, it was impervious and appeared to have been the seat of former inflammation, having with its cellular substance been formed into an indurated tumour of the size of a pullet's egg. The aneurismal sac was partially distended with blood, adhered firmly to the anterior and right side of the trachea, while it so compressed and flattened it, as to lessen its caliber more than one half. We found two apertures passing between the annular cartilages into the sac: these appeared to have been recently formed, and were probably occasioned by a rupture of the sac, and bursting of its contents into the trachea. The largest of these was three fourths of an inch in length. The carotid

and subclavian arteries in emerging from the aneurismal tumour, had degenerated into firm cords for about an inch; after which they were pervious in their various distributions, but considerably contracted in size, with their coats proportionably thickened. Many of the lymphatic glands in the neighbourhood of the aneurism, were enlarged to the size of grapes, and of a livid colour. The abdominal viscera exhibited a natural appearance except the stomach, which contained about a quart of fluid black blood. The coats of this organ manifested no marks of disease."

Remarks.

"It appears probable, that at the time the subject of the above case was exposed to great muscular exertion, the arteria innominata and a portion of the right carotid and subclavian arteries became enlarged into an aneurismal sac. This sac was so compressed in its middle, by the right clavicle, as to assume, in the course of its enlargement, the form of an hour glass, one half rising above the clavicle, the other remaining below out of sight. In the winter of 1814, while the patient was at sea, that part of the sac above the clavicle, having formed an adhesion to the contiguous parts, was ruptured, and discharged its contents into the trachea, which gave the idea of a spontaneous cure. Previous to this event,* an adhesion between the sides of that part of the sac compressed by the clavicle, must have taken place, to cut off the communication between the upper and lower sac, so as to prevent fatal hæmorrhage. This adhesion could not have taken place long before the rupture of the sac; for on examination but a few weeks before it was ruptured, the tumour exhibited a strong and distinct pulsation, and continued to increase in size. That part of the sac remaining below the clavicle probably continued to enlarge till it burst at the time of the patient's decease. From the size and situation of this tumour, and its pressure on the lungs and trachea, we can easily account for the cough, hoarseness, wheezing, difficult respiration, and impatience of an erect

* Dr. Sewall informs me, that before Jethro went to sea, in 1814, the pulsation had ceased in his right arm, and the right side of his neck and face.

posture which so constantly attended the patient during the latter periods of the disease.

"As the circulation in the right arm, and right side of the head and neck, through the medium of the arteria innominata must have been entirely cut off, at least since the rupture of the upper sac, in December 1814, it would be gratifying to know by what vessels these parts were supplied with arterial blood. There could never be perceived either debility, emaciation, or derangement of function in these parts, except coldness and want of perspiration. Was not the circulation carried on chiefly through the circle of Willis, or rather that part of the circle formed by the basilar artery by which the two vertebral arteries freely communicate with each other? I have regretted that it could not have been determined by an injection of the whole subject, by what vessels the parts deprived of pulsation were supplied with blood, since it would probably have furnished an interesting specimen of the resources of the animal economy in such cases. May not this case be considered as supporting the doctrinc of Bichat, that `the heart is unaided by the contraction of the arteries, in the circulation of the blood?*

"The blood found in the stomach, was probably swallowed during the continuance of the hemorrhage. Perhaps some part of it passed the œsophagus after the patient became insensible."

In addition to the above remarks of Dr. Sewall, I will offer only a suggestion by way of query, whether the aneurismal sac, the rupture of which destroyed the patient, might not have been formed after the spontaneous cure of the upper sac; or if it existed before, whether it must not probably have been very small compared with the other, at the time of its rupture in December 1814.

January 3, 1818.

R. D. MUSSEY.

* See an interesting memoir on the agents in the circulation of the blood. New England Journal, Vol. II. p. 9.

!

Observations on the Internal Use of Nitrate of Silver.
By WILLIAM BALFOUR, M. D.

[From the Medico-Chirurgical Journal and Review, for June, 1818.] CASE 1. On the 14th of August, 1816, Mr. A. applied to me, oppressed with a variety of very distressing complaints. The leading features of these were, general debility; debility of the inferior extremities, approaching to paralysis; complete relaxation of the sphincter ani; prolapsus of the gut, accompanied with frequent loss of blood; and a perpetual and copious gleety discharge. He dated the commencement of his complaints fourteen years back: had put himself under the care of some of the most eminent practitioners in this city, from whom he derived no benefit. He afterwards went to London, for the purpose of consulting the late Dr. Beddoes, who guessed the cause of his complaints the moment he saw him walk. Dr. Beddoes asked him if ever he had received an injury in the back? The patient declared positively he never had. But upon the doctor's insisting on it, came at last to the recollection of having been struck forcibly on the lumbar vertebræ by the shaft of a gig, a short time before he began to complain. From Drs. Beddoes and King, the last of whom was likewise consulted, he derived no further benefit than what resulted from the application of ligatures to some vessels of the rectum, by which hemorrhage was checked to a very considerable degree.

Mr. A. applied to me in the hope of profiting from those means by which I had succeeded in restoring some rheumatic gouty limbs, as detailed in my Treatise on Rheumatism. I began with gentle percussion to the sacrum, the glutei muscles, and the course of the sciatic nerve; with the view of exciting the action of the nerves supplying these parts, and of eliciting a transmission of nervous power from the spinal marrow. This operation was soon followed by increased command and power of the limbs; but had not been repeated above three or four days, when increased discharge of blood from the rectum took place. Till this occurrence, indeed, I was kept in ignorance of the state of the anus, having my attention directed to the im