cellular membrane between the artery and vein, by the impulfe of the arterial blood: the enlargement of this fac went on until its fides became firm and refifting, and then the blood from the fac was thrown with fuch force into the vein through the puncture in its lower fide, as to cause it to diftend very confiderably, for two or three inches above and below the fac; the intermediate portion of the vein however running over the fac being fupported by it, was very little enlarged.

As the upper portion of the vein was obferved to distend very rapidly, the skin covering it being very thin and every where marked with cicatrices; the patient apprehending a fudden rupture of the tumor, became very uneafy in his mind: the forearm was much diminished in fize, and the hand was conftantly cold. These circumftances together with the existence of the aneurismal fac, determined Dr. Wiftar and myself to advise the operation of tying the artery above and below the fac.

I performed the operation in April, 1804; within a quarter of an hour after, the pulfe of the artery at the wrift was dif tinctly perceived: in three weeks the wound was cicatrized, and the patient very foon recovered the most perfect ufe of his arm and hand. It feems unneceffary to defcribe the operation further than to mention, that after dividing the skin and cellular membrane covering the fwelling by a ftraight incifion, I diffected round the tumors, then tied the trunk of the vein above and below its enlargement, next tied the artery above and below the fac; the parts comprehended between the ligatures were then cut out, which has enabled me to have the annexed drawing of them made. They are reprefented of their natural fize.

Fig. 1. A A The bafilic vein diftended above and below the puncture.

B The cicatrix from bleeding.

D The aneurismal fac.

CC The brachial artery.

Fig. 2. A A The enlarged vein.

e Orifice of communication between the vein and ancurifmal fac.