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The ileum, cæcum, and colon, were injected with numerous blood vessels ; in some parts so as to acquire a dark colour, but the texture remained entire and firm. The appendiculæ pinguedinosæ were injected and covered with a viscid effusion, communicating the appearance of a mass of disease. The external and posterior portion of the bladder appeared also a little injected; its internal surface was perfectly natural. The stomach, duodenum, jejunum; the liver and spleen; the heart and lungs, appeared natural and uninflamed.
This case, which the author has endeavoured to describe with the utmost accuracy and succinctness, seems to have been a spasmodic affection, succeeded by inflammation of the large intestines, and perhaps, in a slight degree, of the bladder. Its prina cipal features were the following: At first, violent pain in the hypogastric region and lower part of the abdomen, inducing writhing of the body, and attended with strangury and constant desire to void urine. The operation of medicine was effectual, but induced the most violent pain. No vomiting. Pulse natural. Afterwards, there was violent fixed pain, referred to a particular spot, tender under pressure, without writhing of the body, but with an appearance of restlessness. Less strangury. Tenesmus ; the ready but painful operation of medicine on the bowels. Little or no vomiting. Pulse little affected until the appearance of cold sweat. A peculiar expression of countenance, induced by the action of the depressores angulorum oris.
Dr Willan, in the Diseases of London, has some excellent observations on the diagnosis of the affection in question. He observes, that “ mistakes arise respecting inflammation of the lower intestines, or of the colon about its connections with the cæcum or rectum. It does not, as in the case of inflammation of the ileum, or of any part of the smaller intestines, occasion, by 'excruciating pains, instant debility and depression, with vomiting, cold sweats, &c. There is at first a local but moderate pain, somewhat aggravated by pressure, and attended with thirst and general uneasiness. This pain seems afterwards to diffuse itself, producing strong contractions of the bowels and abdominal muscles, which recur from time to time, but have considerable intervals of ease and tranquillity. The disorder differs, however, from the colic, in this respect, that it is not attended with obstinate costiveness, and that after sufficient evacuations the pain is not mitigated. On the other hand, as the intestine is tender, and probably contracted about the seat of inflammation, a most severe pain is often excited by the operation of the mildest purgative. The pulse may at the beginning be hard and contracted, but it soon becomes weak, small, and perhaps irregular. There is a fur upon the tongue, somewhat thick, and of a whitish colour. The urine has a smooth, pink sediment, which, as the disorder advances, changes its colour, and resembles a rough cretaceous powder. Vomiting is not a constant symptom in this form of enteritis."-Diseases of London, pp. 164, et seq.
4. Notice of the beneficial effect of confinement to a warm and regulated temperature during the mercurial course, and in the treatment of syphilis.
The author has lately had occasion to observe very distinctly, in several cases of primary and secondary syphilis, the advantages of a warm and regulated temperature in their treatment. The mercurial course is at once more under the command of the physician ;-the remedy produces its effects with more certainty and safety ;--the malady yields more pointedly to its operation ;-and the several dangerous effects of incautious exposure to cold and damp are avoided, by conducting the treatment of syphilis in a warm and regulated temperature. On this subject an opportunity may occur of writing more at length; at present, it is the author's object simply to suggest and recommend the employment of this mode of conducting the mercurial course, particularly in the treatment of syphilitic affections. Mr Pearson (chap. xii.) and other authors have noticed the necessity of confining syphilitic patients to the house, and of avoiding exposure to a cold and damp atmosphere; but the full effects of confinement to an elevated and regulated temperature during the cure of syphilis, are, perhaps, still to be ascertained.
An analogical argument for the efficacy of this mode of treating lues may be drawn from the well-known greater facility with which this affection is cured in the warmer climates, compared with our own, which is so damp, cold, and variable.
Case of Reunion of a separated Portion of the Finger. By Mr
JAMES BRAID, Surgeon at Leadhills. Communicated by
CHARLES ANDERSON, M. D. Leith. ON N 13th June 1816, GEORGE Weir, æt. 63, by occupation
a miner, and occasionally a weaver, whilst using a hatchet cut off a portion of the fore-finger of the left hand in an oblique direction, carrying off all the nail, except a small portion of its root on the ulnar side, together with the soft parts on the anconal and radial aspect, to a little above the first joint. The bone was denuded, but not divided, from the finger having been lying on the radial aspect when the accident happened. He came to me from a considerable distance. Finding, on inquiry, that he had left the detached piece, I returned with him, and found it covered with dust. After having washed it with warm water, I applied and retained the divided part in its former situation by straps of adhesive plaster, and covered the whole with a piece of lint, and a pledget of common cerate.
On 17th, I undressed it for the first time, and, to my satis. faction, found adhesion bad taken place completely, except in the nail and cuticle, which last was very thick.
On 19th, I again dressed it, when the nail and skin were become discoloured, and beginning to separate from the subjacent parts.
On 20th, the nail and skin were quite loose, similar to the finger of a glove. I took away the adhesive plaster, and, by means of a pair of forceps and scissars, removed entirely the skin and nail. The subjacent parts appeared quite healthy, and the adhesion complete. He had the sense of feeling even from a small pointed instrument applied gently to the part which had been detached, which shewed plainly that he had the power of sensation in the part itself, and that it did not arise from mechanical pressure on the subjacent parts. From this time I dressed it with common cerate, and a gradual process of absorption of the old and deposition of new matter took place without any fissure between the new and old matter, until nearly the whole of the old substance had been taken away. After this, the absorption went on rather more rapidly than the new matter was deposited, and, of course, made a small fissure. I imagine the more rapid absorption of the old than deposition of new matter took place from some mechanical injury during sleep.
On 30th, I cut off the small portion of old substance, which adhered only by a very small neck. It bled freely, which shewed the connection of blood-vessels with it. I again dressed it with the common cerate. In a few days from this it was entirely covered with skin, and in a month from the time he met with the accident he was able to follow his work as a miner, and in five weeks could use his finger in tying threads whilst weaving. The nail has made considerable advance in growth already, and in a short time, when it has grown a little more, the difference from the original form of the finger will be hardly perceptible. Already it is as useful as ever to him, the motion of the joint being perfect.
A Cuse, disproving the Doctrine, that the Surfaces of a Wound in
a State of Suppuration will not Reunite by the first Intention.
By WILLIAM BALFOUR, M. D. Edinburgh. WILLIAM CUNNINGHAM, aged 18, a labourer, applied to
me, on the 30th July, with a severe wound in his left thumb, which he received eighteen days before from the tackle of a pulley, while working in a quarry. The whole of the nail was torn away, and the pulp or fleshy part of the thumb, as far back as the first joint, was separated from the bone, with the exception of a semicircular piece of about half an inch in ler and very thin, on the finger side. The lad, unfortunately for bim, applied immediately for medical aid, and, for upwards of a fortnight, the wound was kept open by the insertion of dressings to the bottom, with the view, I presume, of effecting a cure by the slow process of granulation.
When the patient came to me, which was eighteen days after the accident, there was a trace of adhesion having begun at one angle of the wound, but which now appeared completely at a stand ; there was no appearance of granulations in the bottom of the wound; the denucled parts had a peach-blossom colour; the pendulous surface a boneycomb appearance ; and the whole wound discharged a thin and very fætid matter.
I washed the parts with many successive ablutions of cold water, pressing the pendulous portion at times like a bit of sponge I now attempted to bring the surfaces into contact, as if the wound had been recently inflicted ; first, by a piece of rag applied circularly, and then by another longitudinally, or over the point of the thumb. Next day the discharge appeared through the dressings, which I removed, when the parts separated. The discharge was of a better colour and consistence; there was no fætor ; and the superior surface bled at many points without being touched. This circumstance encouraged me to another attempt. I bound up the wound, therefore, after washing it carefully, in the same way as the day before. On the third day the parts adhered. I did not remove the dressings again till the fifth, and then on account only of the great discharge that shewed itself, when I found my labour to be in vain. I now weighed deliberately every circumstance that might tend to defeat my purpose, and found that my anxiety to bring every point of the jagged edge of the pendulous portion
into perfect contact with the opposite, was the cause of my disappointment. I found that, at the third dressing, I had drawn the longitudinal strap, or that over the point of the thumb, too tight, which caused the parts farther back, or the pulp of the thumb, to recede from its opposite surface. I therefore now omitted that bandage, and contented myself with securing the apposition of the two surfaces by a bandage applied spirally. This plan succeeded to my. utmost wish. Next day adhesion had taken place to a degree sufficient to prevent the part that formerly hung down from separating as formerly from the thumb. This was proved by my being under the necessity of removing the dressings, on account of matter that continued to issue from the denuded parts of the thumb, and the irregular edge of the wound. I now considered my object as accomplished, for no farther discharge took place from the interior of the wound; the surfaces remained in perfect contact ; new skin began immediately to shoot across from both edges; and, in a week, the reunion was so firm and complete, that very considerable force would have been requisite to tear the parts asunder.
That the reunion in this case was by the first intention; that is, by a direct communication of vessels, without the intervention of granulations, there cannot be a shadow of doubt. It is not possible that granulations could have sprung up in twentyfour hours sufficient to close a wound in which the whole pulp, or fleshy part of the thumb, was separated from the bone, Healthy granulations are of slow growth; and there were none begun when the patient came under my care.
On the contrary, the wound was rapidly degenerating into a putrid state, It had been open eighteen days before I saw it; but when I succeeded in bringing and retaining the surfaces in perfect contact, adhesion took place immediately, as if the injury had been recently inflicted.
this case I have demonstrated, that the doctrine, so far as I know, universally held, of the surfaces of wounds being incapable of reunion by the first intention, after having passed into a state of suppuration, rests on no foundation: -- a discovery this, fraught with the most beneficial consequences to mankind; and in which the pathologist must observe, that the secretion of pus in a wound can be instantly suspended, and the action of the vessels producing it, changed.
I am aware, that, in the cure of wounds, the most approved practice is, to bring and to retain the parts as nearly in contact as possible. By these means, much less new matter is required for filling up the cavity, than if the sides were allowed to re