fatigue and excitements of a depressing or exhausting kind; pleasant and buoyant social conditions; regularity and temperance, yet liberality in regimen; with such mechanical apparatus of support as may be temporarily requisite to the performance of reasonable exertion and the correction of faulty habits-these are the things to be considered.

The function of the deep fascia, in limiting and directing the flow of pus beneath it, is well known. It is sufficient to say, further, that the intricate arrangement of its various folds and processes, is in itself a most interesting, and surgically a most practical, subject for special dissection and study.

The part played by the cell elements of connective tissue is one of the first importance in all physiological and pathological processes; and these must receive a full estimate in the pathological study of the fasciæ; particularly as to their intrinsic softening and relaxation by chronic inflammation, independently of muscular derangements, or mechanical causes.

In addition to the general arrangement of fascia, aponeurotic and others, already alluded to, with their muscular connections, one series, owing to its bearing on daily practice, demands special mention here, viz: those by which the position of the pelvis and its contents is secured. This position is, as to the pelvis, nearly vertical, normally; the viscera within and above it being supported, not by its so-called "floor," but rather by its anterior walls, as a rest, aided by the anterior parietes of the abdomen; or suspended from its posterior and lateral walls; so that concussion throws them, not downwards, but forwards.

This position of the pelvis, so essential to avoidance of prolapse of its contents, with the bowels, toward the floor of its cavity is maintained by the iliac, psoæ, quadrati, recti femorum, and abdominal muscles, and especially the erector spinæ, aided and bound down by the latissimi and other posterior muscles, with the vertebral and other aponeuroses. Atony of these is a fruitful source of prolapse, by falsifying the pelvic position.

It may be well to state that for the maintainance of normal postures of the body, the description of the position of a soldier given in" Casey's Infantry Tactics" is a good guide. Or the following may answer: The weight of the body rests on the balls of the feet; the front of the chest directly over the toes; the chin over the sternum, in the same line; the base of the jaw horizontal; the eyes naturally glancing fifteen paces in front.

ARTICLE XIV.

Spontaneous cure of Aneurism. Report of Cases. By A. R. THOMAS, M. D., Professor of Anatomy in the Hahnemann Medical College, Philadelphia. That a spontaneous cure sometimes takes place in aneurism is well known, though the occurrence is by no means frequent.

The observance of such cases undoubtedly served to suggest to the early surgeons the treatment of aneurism by compression and ligation, as in the majority of cases of spontaneous cure, that end is effected by the formation of a fibrinous clot, which, filling the aneurismal sac, prevents the circulation of the blood through the same, a result aimed at by the surgeon in his operative interference.

A spontaneous cure of aneurism has been found to take place in four different ways. In by far the greater number of cases, the cure is effected in the manner already referred to. The blood deposits upon the inner surface of the sac, a layer of fibrinous matter, to which others are from time to time added, until the sac becomes finally filled with successive strata of this substance, preventing the circulation of the blood through the aneurismal sac, and obliging it to pass by collateral channels; while by the process of absorption, the tumor ultimately becomes more or less reduced in size.

A second method of cure is where inflammation and gangrene are set up in the tumor; a dense coagulum forming in the sac, and shutting off the circulation of the blood through the same. The ensuing sloughing and bursting of the integument and aneurismal sac, not being followed by fatal hemorrhage, a cure results, provided the patient has vitality sufficient to enable him to resist the prostrating influence attending such a degree of inflammation and gangrene.

A third method in which spontaneous cure may take place, is when the tumor is so situated as to press upon the artery above the point of disease so as to cause adhesion of its walls, and thus preventing the circulation through the sack, as in the application of a ligature.

A fourth mode of cure has been seen, when an aneurismal sac of the femoral artery burst beneath the fascia lata, just below Poupart's ligament, the pressure from the large clot there formed, obliterating the femoral artery, and thus effecting a cure.

A.,Obliterated aneurism of ascending
portion of arch of the aorta.
B., Aneurism of descending portion
of arch of the aorta, bursting into
C.,The oesophagus.

Transverse section of descending aorta,
showing the laminated character of the clot;
also the grooved border forming a channel

for the blood.

Shaded portion of the aorta
showing an aneurism filled
with a laminated fibrinous mass.

CVan Benthuysen & Sans, Albany

The following cases illustrate the first method of cure:

CASE I.

Mr. H— of this city, aged 60 years, after a hearty dinner, while walking in his yard, was taken with a sudden sensation of faintness and nausea, which was soon followed by vomiting the contents of his stomach, with a considerable quantity of blood. After entering the house the vomiting was frequently repeated, at each effort, large quantities of pure blood being ejected. Sinking rapidly, in an hour he was dead.

The family readily assenting, twenty-four hours after, I made a post mortem examination. Found the surface of the body pale. Upon exposing the chest, found at the right border of the sternum, just below the clavicle, a hard, inelastic tumor beneath the skin, of the size of a small orange. While not adherent to the integument, it appeared firmly attached to the walls of the chest beneath. Upon turning aside the integument and pectoral muscle, the tumor was found connected by a broad pedicle, to parts within the chest; absorption of considerable portions of the sternal ends of the second and third ribs, with the side of the sternum, having resulted from pressure of the tumor upon those parts.

The removal of the sternum at once demonstrated the aneurismal character of the tumor, by showing its connection with the ascending portion of the arch of the aorta; while a section of the same exhibited the interior filled with dense concentric layers of fibrinous matter, separable from one another, the outer layers being dry and hard, while the inner portion was less firm and more moist. See figure 1.

A further examination of the aorta, brought to light a second aneurism of the descending portion of the arch, which having burst into the cœsophagus, explained at once the cause of the hemorrhage and sudden death.

Upon inquiring of the family, found that the tumor upon the chest had been known to exist for fifteen or twenty years; that for some time the pulsations of the tumor were strong, but that all beating had for many years ceased; that he had never discontinued his work, that of a carpenter, and in fact, it had given him so little trouble, he had never consulted a physician in regard to it.

For a year or so previous to death, he had been troubled with a cough, particularly upon exercising, but otherwise had been in good health.