THE CRITICAL CRITICAL REVIEW. For the Month of December, 1767. ARTICLE I. Medical Obfervations and Enquiries. By a Society of Phyficians in London. Vol. III. 8vo. Pr. 6. Johnston. TH HE utility of medical obfervations is fo univerfally acknowledged, that it is become a laudable practice of focieties, in most civilized nations, to communicate to the world, from time to time, a collection of all extraordinary cafes, of which authentic information can be procured. By this means, the hiftories of many important facts in phyfic are preferved, which, had they been left to the feparate publication of their different authors, would, in all probability, have perished. The extenfive correfpondence cultivated by fuch focieties, furnishes likewife the beft opportunities of ascertaining the real virtues of every new difcovered medicine, as well as the most fatisfactory teftimonies of the fuccefs of any method in practice. In the Preface to this volume, we are informed, that the Society has further poftponed the final determination of the merit of the cicuta, until its virtues be more clearly afcertained by future trials. In the mean time, there are now published fome inquiries relating to that fubject, communicated by Dr. Rutty, of Dublin, together with fome obfervations made in England, by a member of the Society. In a fubfequent volume, the public is encouraged to expect, not only a definitive character of the cicuta, but likewise some account of the fuccefs of uva urfi, ftramonium, hyofcyamus, VOL. XXIV. Dec. 1787. D d aco aconitum, and oxymel Colchici, which have been strongly re commended for the cure of dangerous and obftinate difeafes. The first article in this collection is a prolapfus uteri & veficæ, with a tone in the bladder, by Dr. White, of Manchefter. The narrowness of the paffage, and extreme pain the patient fuffered, upon touching the tumour, rendered the reduction of it impracticable but notwithstanding the conftriction upon the blood-veffels, it had never any tendency to mortification, during the whole time fhe was afflicted with it, which was the fix years preceding her death. : The next is a cafe communicated by Dr. Cleghorn, at Dublin, of a large feather of a goose-wing swallowed by a young lady, when he had thrust it down her throat to provoke vomiting. It was extracted from the cefophagus by means of a long flexible whalebone, to the extremities of which a piece of fponge was fixed, with two strings reaching betwixt each. The third history is an account of two aneurysms in the aorta, defcribed by Mr. Bayford. 'D.M. was an out-patient at one of the hospitals in town for feveral months, being troubled with irregular afthmatic com plaints, and fome flight fymptoms of a dropfy. Thefe laft increafing, and no advantage being found from the medicines ordered him without doors, he was taken into the house, Nov. 25, 1761.. His fymptoms then were, a great tightness at the pit of his ftomach, where a strong pulfation was obfervable. The pulfation was moft diftinctly felt in the epigaftrium, but was at the fame time fo confiderable as to affect all the neighbouring parts. So that even the hypochondria and lower part of the sternum were vifibly elevated, and depreffed with a motion exactly correfponding to the fyftole and diastole of the heart. To this oppreffion of the præcordia were joined a flight cough and a laborious refpiration. He had besides anafarcous fwellings of the legs and fcrotum, and there was a perceptible fluctuation of water in the abdomen; but the quantity of the fluid was not fo great, as to feem a fufficient caufe of his difficulty in breathing. "After a few weeks, he began to complain of pains at the lower part of his back, which increased to fuch a degree, that at length he became incapable of moving without affiftance. Thefe fymptoms, with little or no variation, continued to his death, which happened fuddenly, as he was raifing himself in bed, on the 3d of March, 1762. On opening the body, about five or fix quarts of water were evacuated from the cavity of the abdomen; and the vifcera being expofed, there was the appearance of an almost univerfal 403 Medical edical Obfervations and Enquiries. Fol. IIIshaanz univerfal mortification. However, it proved not to be really fuch, but the confequence of a large extravafation of blood between the lamelle of the omentum, mefentery, and mefocolon. On the right of the fpine, a large oblong tumor prefented itself, fituated behind the peritoneum, and extending from the diaphragm to the groin. This too, upon examination, was found to confift of extravafated blood, the quantity of which was at leaft four or five pound. On its removal, a large jagged opening was obferved leading into the cavity of a fpacious fac, which was lodged behind the ftomach, and was foon discovered to be an enlargement of the aorta. I may add, that the diaphragm was unufually relaxed, and hung down into the cavity of the abdomen, being depreffed by the upper part of the fac, which rested upon, and was closely connected with it. At the upper part of the thorax, a small aneurysmal tumor was formed by a dilatation of the common trunk of the right fubclavian, and carotid arteries.' The fourth number treats of a fractured rib, with a remarkable emphysema over moft part of the body. A man about fixty years of age, of a healthy conftitution, and lax fibres, on the 18th of May, 1762, fell with violence on the spiked points of a palifading. Externally, there appeared no wound, but a flight fcratch, with little or no tension or inflammation. On examining the part, one of the ribs of the left fide was found fractured; and, on preffing gently, a fmall emphysematous tumor was perceived upon the part, about the size of a crownpiece. On the leaft motion, he breathed with pain and difficulty. He was immediately bled pretty freely. The part was embrocated with spirits and vinegar, and a plafter, compress, and bandage applied.-About fix o'clock the fame evening, the patient was in much pain, and the trunk of his body, with one fide of his face, much fwelled. The plafter and bandage were removed, and the emphysema was found to extend itself over both breafts, all along the left fide backward, to the fpine, down a as low as the os facrum and ilium, all along the neck and face, particularly on the fide on which he had lain, so that the right eye-lids were much inflated, and the eye intirely clofed up. On fuch unexceptionable authority, without farther hefitation, a longitudinal incifion was made of about an inch and a half, above the fracture, where the fwelling appeared most prominent. The air immediately rufhed out with noife and violence, and even a confiderable time afterwards, by ftroaking and preffing the parts all around, towards the opening, Dd 2 continued 2 404 Medical Obfervations and Enquiries. Kol Ill continued to pafs off, with a piping, crackling noife. He way very foon moft fenfibly relieved by the operation, and could breathe and swallow pretty freely, which he could not do before without pain and difficulty. stom on held zaw ed The fame gentle efforts were perfevered in for near an hour and half, by which the fwelling, in every part, was greatly reduced, and the right eye perfectly freed and opened. After dreffing the part fuperficially, a large comprefs, dipped in fpirits and vinegar, with a long flannel bandage, was applied pretty tight, round the whole trunk. At three or four o'clock next morning, he became very uneafy, the swelling increafed, and confequently the thorax became too much confined by the ftricture of the bandage, which being removed, and the parts again ftroked towards the orifice, a large quantity of air was evacuated. After this, he was again fenfibly relieved, and flept fome hours in a posture between fitting and lying, About ten the next morning, he was much cooler, his pulfe more moderate and regular, his thirft greatly abated, and his refpiration free. On removing the bandage, though the fwelling was not much increased on the injured part, yet it had extended itself all along the right fide, and down below the cubit of the right arm particularly, which, on preffing, made a confiderable crackling noise, fo that it might be heard all over the room. જી. સુરત છે. The next day, the emphysema had affected the groins, and the upper part of the fcrotum, but in every other place feemed at a stand. From this time, the emphysema gradually fubfided, in all parts of the body, fo that no more incifions were thought neceffary. Whenever he coughed, he could hear the air fly off, with a bubbling noise, from the orifice.' I In this article, there is the following Letter from Dr. Huxham to Mr. Leake, on emphysematous cafes, from internal causes. "Dear Sir, 3 The cafe of the emphysematous patient, which you have drawn up, and which, you know, I also examined, is very fimilar to that fo judiciously related by Dr. Hunter, in the fe3.cond volume of the Medical Observations and Inquiries.£t Indeed, an emphyfema doth not uncommonly happen on a 6 fracture of the ribs, and a laceration of a lobe of the lungs. But an emphysema of a large extent, without any kind of laceration of the lungs, or fracture of a rib, is not fo common, nor fo eafily accounted for. The following cafe is, I think, fomewhat fingular. • About • About three years ago, a 'full-bodied, middle aged, failor (Michael McCann, of the Modefte man of war) was feized with a putrid fever and fore throat. He was bled at the be ginning, but his blood appearing in a loofe, diffolving ftate, he was bled no more. A blifter was also applied between his fhoulders, which foon dried up. A1 andriw eTOT 2 About the 7th or 8th day of his disease, an emphysematous fwelling appeared in his face, neck, and all over his breast, tefpecially on the right fide. The fkin was very greatly stuffed -up, and smade a crackling noise under the fingers, when touched, as if you had handled a half-blown, dry bladder, gand the patient was exceeding ftiff, and uneafy with it. bolq -no Mr. Montagu Bacon, the chief furgeon of the navy-hofApital here, and the other furgeons attending, were defirous that I fhould be confulted, and fee it, as fomething very unviconmont which I accordingly did. I examined it with great beare, and found the tumor altogether flatulent, and a com pleat emphysema. I advised the fomenting it with fharp vineaigar and camphorated fpirit of wine, and, if that should not bfucceed, to fcarify it flightly. The tumor totally vanished in two or three days without any scarification; and he foon recoti vered from the fever; but he continued very weak for a long wotime, and remained very scorbutic, as he was before the fever, his gums being very fpongy, and bleeding on the flightest stouch, or rubbing. • Here the emphyfema was generated, merely by the pu Barefcence of the humours, as is frequently obferved, in a lefs be degree, in and about the incipient gangrænes of the limbs, &c. Tis certain, from numberless experiments, that putridity, 919both in vegetable and animal fubftances, generates air, or rather raises it from a fixed to an elastic state. • I am perfuaded this more frequently happens in putrid -X&malignant fevers, than is commonly imagined; and it is not improbable, that elastic air may be generated even in the arterial and venous system, and be productive of terrible fymptoms, vaft oppreffion, anxiety, palpitation, intermitting pulfe, deliquium, &c. which are too often obferved towards the close of putrid fevers.nudag b 394 21Hence, probably, the fudden fwellings, hæmorrhages, and putrefaction of bodies dying in fuch diftempers; the emphyfematous tumor of the whole habit of the beafts, feized with the & folate disease amongst the horned cattle, is well known; and it egnas noted in common cookery, that mutton, or beef, tainted, -398l and beginning to grow putrid, will not fink even in hot water, in the juices. as 143 nomthe putrefaction generating air dnik Izi-sian goiwallet cd? tuodA 3 Dd3 Tam, &c.' 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