point of so much importance, before a ligature should be applied. The depth of the wound rendered it impossible to see to the bottom of it, accordingly, I kept the point of my left fore-finger on the vessel, and cautiously detached it from its connexions with the blunt extremity of a director; having then introduced the fore-finger of my right hand also into the wound, I succeeded in compressing the vessel between the ends of my fingers, when the pulsation of the tumour immediately ceased, returning when the pressure was discontinued. This expedient was conclusive, and, for obvious reasons, more satisfactory than that of pressing the artery downwards against the first rib. "From the unusual degree of displacement of the clavicle, it was expected that great difficulty would have arisen in the application of the ligature to the artery; I was therefore provided with the several instruments which have been recommended to facilitate this step of the operation, however none of these were employed, as the object was speedily effected with a common aneurism needle. At first I attempted to pass the needle in front of the artery, with the view of giving every security to the vein; to this the position of the clavicle constituted an insuperable obstacle; I therefore directed the needle along the margin of the scalenus, and then insinuated the point of it under the artery from behind, guarding the vein with the fore-finger of my left hand, until the point of the needle was sufficiently elevated. I was then enabled to seize the ligature with the extremities of my fore-fingers, which I had introduced into the wound, nearly in the same manner as when compressing the artery, and the needle being held by an assistant, one end of the ligature was drawn out anteriorly, and the needle was removed. "The artery then lay upon the ligature; and I requested that my assistants, and such other professional gentlemen as could conveniently approach the table, should convince themselves of this fact, by making the most accurate examination. The knot was now tied, and a sufficient tightness ensured by the ends of the ligature having been passed in the ordinary way through the serre-noeud. On the ligature being tightened, the pulsation of the tumour entirely subsi Dr. Rutherford's account of M. Dupuytren's unsuccessful operation at the Hotel Dieu, in Edin. Med. and Surg. Journal, No. 63. "An eminent English Surgeon, then on a professional tour, was present at M. Dupuytren's operation and dissection, and favoured me with an account of them, which corresponds with that given by Dr. Rutherford. In the same letter (dated June 21, 1819,) he states that, 'three days since a surgeon of great celebrity attempted this operation, on a most admirable subject, and in an early stage of axillary aneurism, but he could not even find the vessel, and abandoned the operation.' "Mr. Samuel Cooper informs us, that one of the cervical nerves may be mistaken for the subclavian artery, in consequence of the pulsation of this vessel being communicated to all the adjacent parts; and that he has seen a mistake of this kind actually made by very skilful surgeons. First Lines of the Practice of Surgery, vol. I. p. 319. ded; its tension was considerably diminished, and the patient felt an increased degree of numbness of the arm; the external wound was then dressed, and he was laid in bed with the limb supported on a pillow by his side." 9. The patient did not appear much exhausted, notwithstanding the loss of venous blood during the operation. At night an opiate was administered, and, for the first time, since his admission into the hospital, produced tranquil and refreshing sleep. On the following day, there were no alarming symptoms, and the tumour was obviously diminished. There was some dyspnoea towards the evening, which was relieved by venesection. These attacks of dyspnoea recurred frequently, and frequently required bleeding and digitalis, with aperient medicine. The symptomatic fever which succeeded to this painful operation, was inconsiderable. On the 14th of February the wound was dressed for the first time, and the sutures removed. On the 15th, several ligatures came away-the discharge being small and healthy. The cedema of the limb had greatly subsided-no pulsation could be distinguished in any of the arterial trunks-the temperature of the limb had continued at 96°-the pulse at 92°. We cannot pursue the diurnal reports. On the 3d of May, when the paper closes, the man's "amendment has been most satisfactory; -the tumour is still further reduced, and he is gradually regaining the power of the muscles which move the arm on the scapula. The joints of the wrist and fingers have lost much of the unnatural laxiity, and the integuments of the hand no longer possess the diseased appearances reported on the 20th of March." We need hardly say, that this operation exhibits one of the most splendid triumphs of modern over ancient surgery. It must be received as a strong testimony in favour of the expediency of tying the subclavian artery, even under circumstances of peculiar difficulty and danger. 5. Malignant Ulcer of the Prepuce. Mons. L. 23 years of age, came under M. Dubois's care, presenting the following symptoms: -the prepuce was much enlarged and indurated; and, on the inferior part, was a large, deep, and eroding ulcer, which penetrated to the glans penis, with rugged edges of a violet colour, and violent lancinating pains. The disease had resisted various antisyphilitic modes of treatment, including mercury taken by the mouth. The ulcer was dressed with anodyne applications, and although the patient was very weak, he was immediately put on a course of mercurial frictions. Bitters, the cinchona, and anti-scorbutics were administered internally. Between the 12th and 15th days, the salivation became established, and quickly became inordinate, his tongue, lips, and whole face being greatly swelled. The ulcer instantly put on a healthy appearance and was soon healed. The cure was complete. • M. Dubois. Annuaire Med. Chir. Our readers will recollect, that in our last Number, we mentioned a case of sloughing chancre arrested in its course by mercury. We have received several communications lately, corroborating the good effects of similar treatment. 6. Oil of Turpentine.* Dr. Gibney thinks, that this medicine has not been so liberally prescribed as it deserves. In his practice, at least, it has proved as efficacious in the ascarides, vermiculares, and lumbricoides, as in the tænia. In small doses, he thinks, the effects of the medicine will probably be felt, where they are least wished— in the kidneys or skin, for instance. A small quantity will rarely act on the bowels, and there is not so much to be dreaded from a large dose as people imagine. "There are few children of three years of age, who will not bear from one to three drachms, given at intervals. To those more advanced in years, we may order from three to six drachms. To adults, of course, it may be given on a still more extensive scale. It should, Dr. G. observes, be given as little combined with other medicines as possible, and always on an empty stomach, in doses repeated at short intervals. Our author's method is, to order a good dose early in the morning, and repeat it every hour for three or four hours, as the strength of the patient, or the presence of the disease may indicate. Although food of any kind should be prohibited at the time, yet it may be necessary to allow the patient to drink warm tea, or acidulated barley water, to allay his thirst. Should the medicine prove slow in its operation, a little castor oil, taken a few hours after, may be serviceable. author mixes the oil of turpentine with some mucilage, cinnamon water, and syrup. The addition of a few drops of some essential oil, or warm aromatic tincture will sometimes be useful. In some instances, the disease yields to a single dose of the remedy, and the stools assume a natural appearance—in others, a more prolonged course is necessary. "In all cases, however, it will be advisable to continue the medicine (observing an interval of three, four, or five days between the regular doses) for some time after we have reason to suppose the worms have been destroyed." The permanent healthy appearance of the alvine discharges will, he thinks, be a tolerably faithful index upon this point. Dr. Gibney illustrates the foregoing rules by a sufficient number of appropriate cases, selected from his practice. These we need not notice here. Our 7. Chronic Rheumatism.+ The datura stramonium grows very plentifully in almost every section of the United States. Dr. Z. has been in the habit of using this medicine, in the form of tincture and * Dr. Gibney. Ed. Journal, No. 72. + Dr. Zollickoffer. Amer. Med. Recorder, No. 17. ointment, in cases of chronic rheumatism, with (he says) much advantage. His formula run thus: TINCTURE. B. Sem: Daturæ Stram: 3j. Spir: Vini Tenuis Oss. Mix and macerate for seven days, then strain, filter, and add to it the following articles:-Ol. pulegii, gt. xx. ol. cinnam. 3ss. tinct: opii, 3j. spir. vini camph: 3ij. This compound tincture of stramonium, he says, will be found a most valuable stimulant and rubefacient application in a variety of cases, in which camphorated spirits and other liniments are employed externally. The ointment is made by simmering an ounce of the flowers of stramonium, with four ounces of lard, and an ounce of white wax. It is particularly in chronic rheumatism that our author has used the tincture, exhibiting it internally, morning and evening, commencing with about eight drops, which can safely be increased two or three drops occasionally, until the patient is sensible of its producing vertigo, when the medicine is to be suspended for a time, and, if thought necessary, recommenced again. The tincture and ointment may also be externally employed. Purgatives should be exhibited during the use of these medicines. 8. Congenital Dyspepsia.* The editor of one of those numerous periodicals which, in their turn, have strutted their hour upon the stage, and then retired-some with plaudits-some with hisses-but most of them in solemn silence, has again appeared to vindicate some antiquated claims in surgery and midwifery. With these we have no concern; but, an appendix is added, on the subject of what the writer denominates, "Congenital Dyspepsia," or, in other words, that idiosyncrasy of stomach, from which few are entirely free, and through the influence of which, we account for those antipathies to certain kinds of food, or the disagreement of certain articles with the stomach, however much they may be relished by the palate. By way of illustration, the writer first relates his own case. Till the age of twenty, he was much in the habit of using milk, once or twice a day, as an article of food. He was then often afflicted with acidities in the primæ viæ, pains in the stomach and bowels, flatulence, nidorous or greasy eructations, and other accompaniments of indigestion. In point of general health, however, he was very well. Experience at length taught him, that every alimentary article, into the composition of which, either milk, cheese, or egg, entered-nay, even poultry or young pigs, fed on milk and barley meal, had the effect of deranging the functions of his stomach and bowels. The idiosyncrasy ascertained, the cause of these symptoms was avoided, Medical and Surgical Spectator, additional, 1822. -and the effects altogether ceased. He can renew them-we were going to say, at pleasure-by taking a bit of cheese or a bason of milk, to this day. When dyspeptic patients are otherwise in good health, our author suspects that this congenital dyspepsia or idiosyncrasy is at the bottom of the mischief; and unless the offending article be ascertained, all medicine will be unavailing. The author next introduces the case of a medical friend, and in the Doctor's own words. Of this case, which is not devoid of interest, we shall here present an outline. Dr., ætat. 35, subject to dyspepsia, and constipation of bowels, attended at times with considerable pain in the abdomen, complained in October, 1809, of almost constant pain in the lower part of the belly, with such an increase of the constipation, that laxatives, and even the bath-water injections, with difficulty cleared the bowels of hardened scybala. He continued in this state during the whole winter, with the exception of a week or two, after taking blue pill to affection of the mouth, during which short period, he also had regular stools. The complaint, however, returned, and the pilula hydrargyri had now no effect. Various remedies were tried in succession, but no relief was obtained. This was his state in November 1810, when, at the suggestion of the writer, be altered his diet, by substituting oatmeal gruel for milk, which last he had used freely for several years. He soon became free from pain; and although the bowels did not immediately perform their office properly, a very trifling laxative medicine was necessary. He now recollected that during the interval of ease which he enjoyed in the spring, he took whey at breakfast instead of milk. One person Congenital dyspepsy, our author observes, is not confined to milk, eggs, or cheese, for its cause. shall be rendered dyspeptic by eating corned beef, another by an apple and so forthevery individual has his peculiarity of temperament, and his gastric idiosyncrasy. We think these hints of the "Medical Spectator" not undeserving of professional attention, and we shall be glad to see another gazette extraordinary from the same source. 9. Hernia.* According to Mr. Lizars, all that we have learnt in the dissecting room respecting inguinal and crural hernia, "is of no avail," when we come to operate. This is a melancholy reflecWe tion; but we trust Mr. Lizars's assertion is not quite correct. know well indeed that living and dead anatomy are two very different things; but still we venture to affirm, that the knowledge gained in the dissecting room is useful in the operating room. If not, why does Mr. Lizars continue to lecture and demonstrate • Mr. Lizars, Ed. Journal, No. 72. |