ragged laceration, more than an inch in length ; and from this point the blood had worked a passage for itself between the middle and outer coats of the aorta as far as the iliacs, into one of which it had burst through again into its proper channel. There was atheromatous disease of the artery ; and considerable hypertrophy of the left ventricle of the heart, though without valvular disease, or previous symp- toms.
Here, again, the rupture of the aorta must have taken place when the pain came on, and that into the pleural cav- ity at the time of death. (Med. Jour. Vol. LXXII. p. 80.) 1865. . Dr. C. Ellis.
1773. A ninth case. From a patient of Dr. Minot : a man of delicate health, and about forty years of age. He had
been sick for a week with very obscure constitutional symptoms, and died at last, suddenly.
In the back part of the aorta is a longitudinal rupture of the internal and middle coats, and commencing fi-om one- half to ttfree-fourths of an inch above the valves. The blood had forced its way between the middle and external coats as far as the right renal artery, where it re-entered the natural channel, as it had also in the thoracic aorta. There was also a rupture into the right auricle, by a slit an inch in length, as seen in the preparation. The heart was universally hypertrophied and dilated ; pericardium uni- versally adherent ; and there was considerable atheroma- tous disease of the aorta..
The hypertrophy of the heart, and disease of the arte- ries in this and in the last case were thought to sufficiently explain the rupture. (Med. Jour. Vol. LXXII. p. 81.) 1865.
Dr. C. Ellis.
The coincidence in the occurrence of rare cases has been observed here as well as elsewhere ; but in none has it been more remarkable than in these of dissecting aneurism : Nos. 1765-6; 1769 and 1771; 1772-3, these two last patients having died within less than four days of each other.
1774. Cast, in plaster, of the front of the chest, and showing a tumor about as large as the fist, that extends from above the sternum to the third rib. From a case of aortic aneu-
�� �
