pulse at the wrist small and weak. He was directed to live low, and the tumour was covered with a loose wet bandage. On the 10th the tumour was enlarged; the pulsation in it violent, that at the wrist weak, V.S. ad 3xij.-purgatives and antimony. The skin now became thinner and discoloured, and, as he was evidently getting worse, the artery was tied on the 13th. It is unnecessary to detail minutely the steps of the operation; suffice it to say, that the vessel was dissected for about two inches lower than the insertion of the deltoid-that every care was taken to avoid the median nerve, &c. that two ligatures were applied, and the artery divided between them, and that, immediately upon the tightening of the threads, the pulsation in the tumour ceased. The wound healed readily; the pulse at the wrist on the 25th was distinct; that in the tumour disappeared; the tumour itself decreased in size, and, on the 29th June, he was quite recovered. Dec. 2. He had been at sea and remained well. The swelling was no bigger than a hazel nut, and he could move his arm freely.

Case 2. This occurred lately at St. George's Hospital. The patient, James Rogers, æt. 42, a butler, was bled, on the 30th of August, by a surgeon, who wounded the brachial artery. The bleeding was checked by a very tight compress, and the tourniquet. On his admission, Sept. 1st, the limb was much swollen from the extravasated blood, it was very painful, and a large, ill-defined, pulsating tumour was seen at the bend of the arm.

At 1 o'clock, 36 hours after the accident, the brachial artery was tied by Mr. Brodie, both above and below the puncture, though with some difficulty, in consequence of the displacement of the biceps muscle, &c. by the blood extravasated around. As there was little chance of union by the first intention, the wound was kept open with lint. Next day there was a good deal of irritation, both of the wound and of the system in general. On removing the dressings, much yellowish matter was discharged, and the relief was immediate. The bowels were kept open by senna and jalap, and ten grains of pil. opii were given at bed-time.

On the 11th one of the ligatures came away, and, on the 13th, the other followed. Some degree of tumefaction and pain appeared at the inside of the arm, giving rise to the suspicion that matter was forming there these symptoms, however, in a few days disappeared. On the 26th an erysipelatous blush appeared on the arm, and spread to the fore-arm, attended with constitutional disturbance, and much pain in the direction of the radial artery at the wrist. By the 30th, however, this had quite gone off. The surface of the wound was granulating, though rather indolently-the hand was not numb, and he had some power over the fingers-there was no pulse at the wrist, nor, indeed, had there been any since the operation, and, as the patient was anxious to get into the country, he was dismissed the hospital.

Remarks. This case is one of diffused aneurism; if the case had run on, a sac would most probably have been formed by the cellular

membrane, and the aneurism would have become circumscribed. The treatment, both as to the operation itself and its sequela, we think highly judicious.

In the Lancet, for September the 9th, there is a report of a case of this kind, treated at the Westminster Hospital, and a curious report, in good truth, it is.

Case 3. A man, æt. 35, was bled, July 30th, by a druggist, who punctured the radial (?) artery. Hæmorrhage, more or less, occurred every day, and he was admitted into hospital on the 4th of August, when Mr. White "cut down upon the tumour," (what kind of tumour?)" and secured the radial artery above and below the puncture." Aug. 10th. Hæmorrhage from a vessel in the wound: this was secured, and the hæmorrhage ceased. The wound now became unhealthy, and the tendon of the biceps and edge of the pronator teres were exposed by ulceration. Aug. 22. Hæmorrhage, which, after the loss of thirty ounces, was stopped by the house-surgeon's compressing the brachial artery until the arrival of Mr. Lynn, Jun. who tied that vessel two inches above the upper edge of the old wound. Aug. 23. Pulse "a mere thread;" wound sloughy. A consultation was held between Mr. Guthrie, Mr. Lynn, Jun. and Sir A. Carlisle, who observed that, if the hæmorrhage returned, amputation must not be thought of, as the patient had lost so much blood that he would, in all probability, die upon the table! It was accordingly decided on tying the brachial artery higher up, or even the axillary, if the bleeding should return. Aug 24. Bleeding again. Mr. White then amputated the limb just above where Mr. Lynn had applied the ligature. The report leaves the man convalescing, but we learn that he has long since bid the world good night.

On dissecting the limb there was found a large trunk at the back of the arm; the profunda superior was found unusually large; so were its radial and ulnar branches, "affording an easy explanation of the cause of the repeated hæmorrhage, viz. the great supply of blood sent by these vessels into the anastomosing branches round the condyles." No high bifurcation mentioned.

Remarks. This is a good sample of a Lancet report. Our readers are, no doubt, aware that the consequences of wounding the artery in phlebotomy are fourfold, namely, diffused aneurism-circumscribed aneurism-aneurismal varyx, where the artery communicates directly with the vein-and varicose aneurism, where there is an intermediate sac between the artery and vein, which still communicate with each other. In the two last no operation is required, unless, indeed, in a rare case or two of the varicose aneurism, where the sac has so extended itself as to compress the vein, and form a common aneurismal tumour. Now which of these four accidents happened in this case? The reporter merely says, "Mr. White cut down upon the tumour;" but what kind of tumour that was, no one, from the description of the case, can possibly discover. To be sure the scribe, in his remarks (!) rates Mr. White

for cutting down upon a varicose aneurism," (which, elsewhere, he calls an aneurismal varyx, two different affections,) but we could almost stake our existence that he does not rightly know what a varicose aneurism is.t

Then, again, the case is introduced as an aneurism of the radial artery, but unless there was "a high division," (and not a syllable is said about that) how came the radial artery in the way? We suppose the brachial artery was meant; however, it matters not to him of the Lancet.

The account of the dissection is quite equal to that of the symptoms. Many surgeons, we believe, have an opinion, that, if a main arterial trunk be tied, it is not an uncommon thing for the collateral vessels to become, in a short time, very much enlarged. Our intelligent reporter, however, appears to be much struck by this singular circumstance, and ingeniously remarks, that it affords "an easy explanation of the cause of the repeated haemorrhages." An important piece of information this! After this, no one, of course, will think of reading the partial and inaccurate reports of the surgeons themselves; nor will any one be hardy enough to question the accuracy and talent displayed in the hospital cases of the Lancet. No wonder the latter is furious at the bare thought of "youths of 15 or 16" being obliged by "the tyrannical junto of Lincoln's Inn' to attend some lectures before they walk the hospitals. Why, certes, if this odious and absurd law were put in force, the publication in question would be robbed of half those happy illustrations of hospital surgery which now form such an ornament to its columns. No! let the youth of 15" walk the hospital, and furnish as many cases as he will to the Lancet, without being compelled to the iniquitous drudgery of previously learning something of the principles of the prac tice which he records.

66

Men of Lincoln's-Inn, look to this.

12. ON THE NATURAL CURE OF WOUNDS OF THE INTESTINES.*

M. Paillard, Member of the Athénée de Médecine, has read to that body a memoir on the natural cure of intestinal wounds, which may help to explain some of the anomalies which not unfrequently occur in practice.

He observes that the intestine may either be simply punctured, or it may receive a longitudinal or a transverse wound, varying, of course, in extent.

If it be a simple puncture, the muscular coat contracts, and the mucous membrane is puffed up, (boursoufflé) so as to prevent the escape of solid or liquid matters from the opening. Gas may get abroad into the abdominal cavity, but the puncture cicatrizes, and prevents the exit of more, whilst that which has escaped is soon absorbed. Cicatrization,

We have, since this was written, made enquiries on the subject, and we learn, what we expected, that the case was one of DIFFUSED ANEURISM!! *Hop. St. Louis.

then, is one mode of reparation, but another, and, we should say, a more. frequent one, is the supervention of inflammation, exudation of coagulable lymph, and adhesion of the punctured part to the peritoneum, epiploon or peritoneal covering of some neighbouring viscus. If it be a longitudinal wound, the same inflammatory action, and the same adhesion to the parts in contact with it, form the natural cure. If the longitudinal wound be very extensive, it often happens that the omentum falls upon it, gets between its edges, contracts adhesions, and thus forms a natural plug, preventing the effusion of the contents of the intestine, within the cavity of which it hangs, and is soon covered by an organized mucous membrane. It is thus, too, that the transverse wounds are closed. But if, as, alas! sometimes happen, the intestine be entirely divided, we dare not hope for this sanative process. In that case, the ends of the gut retract and contract, allowing, at first, only the issue of gas-but soon they relax, the matters they contain are discharged into the cavity of the abdomen, and death, of course, ensues.

One of the most characteristic signs of wounded intestine, whether it is cleft by a sabre, or ruptured by a blow, &c. is sudden tympanitis.

Our author adduces two cases in illustration, which occurred in the wards of the Hôpital Saint Louis.

Case 1. N. æt. 22, was thrown down by a voiture, the wheel of which passed over his belly. On being carried to the hospital, there was found no lesion of the walls of the abdomen-no pain-belly blown up, and sounding like a drum. He was bled several times, and numerous leeches and cataplasms applied to the abdomen. He convalesced quickly, but an unexpected hæmoptysis occurred, which carried him off two months after his admission.

Dissection. The small intestine, at one point, adhered to the peritoneum and last false rib, as well as to the omentum, which lay before it. On examining the interior of the gut, there was found a kind of loose plug, which proved to be the epiploon, inclosed in an opening, nearly four lines in diameter.

Case 2. N. æt. 50, was brought to the Hôpital Saint Louis, in consequence of a beam having fallen with violence on his belly. There was great tympanitis, but little pain. He died the same night.

Dissection 24 hours after Death. The small intestine was entirely divided; so was the mesentery, to the extent of about six lines. The two ends of the gut had separated, and were só contracted as scarcely to allow the introduction of the finger. Stercoraceous matter was found in the cavity of the abdomen.

Remarks. We have thus given a condensed account of M. Paillard's paper, and of his views;-views partly the result of experiments on animals, and partly of clinical observation in the Hôpital Saint Louis, of which he was an "éléve interne." The whole forms a sort of corollary to the work which Mr. Travers has published on "Wounds of

the Intestines." It appears in these, as in other cases, that the safety of the patient depends on the supervention of the adhesive inflammation, and this will account for the comparatively greater danger of small punctured, than larger incised wounds. In the former case, the immediate injury to the part is trifling, the call for the reparatory or inflammatory process, therefore, less urgent, and the consequence is, that adhesion often does not occur. In the latter case, an active inflammatory state is at once superinduced, and the chances of adhesion proportionately great.-N Bibliothèque, Juillet, 1826.

13. DR. HEWETT ON FEVER.

In our tenth Number, page 457, et seq. we gave some account of Dr. Hewett's paper on follicular ulceration. The present contribution contains a series of cases treated at St. George's Hospital, upon the principles laid down in his preceding papers. The treatment hinged almost entirely on local depletion, by leeches, from the abdomen, and the exhibition of aperient medicine, generally of the mercurial kind. Mercurial alteratives were also usually administered. When the patients entered the hospital, the period for active purgation (a practice much recommended by Dr. Hewett) had passed, and, therefore, lenient measures only could be employed.

In Dr. Hewett's second paper, in our contemporary, the ingenious author has endeavoured to ascertain the period of the fever, at which the follicular ulcerations become established; but this paper we are unable to analyze as fully as we could wish. His plan of treatment varies necessarily with the stages of the disease. These he divides into three-the first comprising the period between the incipient and the complete development of the mucous follicles, prior to any inflammation or erosion of the neighbouring membrane. The second, the period of the incipient and advancing ulceration of the mucous follicles, generally accompanied by some slight inflammation of the neighbouring exhalent surface. The third embraces the period of the separation, by sloughing, of the previously disorganized follicles, with their neighbouring structures, and the termination of the ulcers, either in cicatrization, or in the death of the patient. The plan of treatment for the first period is "the effective exhibition of calomel, combined with any other auxiliary purgative and sudorific." In three or four days of this treatment the abdomen generally becomes less hard and prominent; but the purgation should not be left off till the belly feels soft and supple. This system being followed up for five or six days, and the evacuations still continuing unhealthy, Dr. Hewett very judiciously advises the purgation to be slackened for a day or two, and a dose of castor oil given, "for the purpose of ascertaining whether the unhealthy character of the evacuations may not have been prolonged by the continued irritation of the purgatives." He has observed that castor oil, in such circumstances,

* Med. and Phys. Journal, Nov. 1826.