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29th.--Four copious stoole. Gripes gone. A good night, though the sleep is sometimes interrupted by the sciatica. Pulse 96 ; skin cool and soft ; tongue clean ; appetite good ; feels, as he says, 'strong and comfortable ;' discharge from the wound good, but copious; a sinus extends along the flank. Wound dressed twice a day, and a compress laid over the sinus, and retained by adhesive plaster.
To have chicken broth to dinner.
30th..Ligature came away to-day; wound clean, but soft ; and discharge copious, and rather thin,
April 1st - Continues easy. Pulse nearly natural, though ra. ther feeble; wound as last reported.
To have four or five glasses of claret daily, and some boiled chicken to dinner.
After this time the strength aud appetite gradually improved; and the healing of the wound was progressive, though slow, as it did not close till the month of June. The tumour in the
groin has disappeared ; only a small knot remains in its site. The circulation through the common femoral artery can be distinctly traced by the pulsation, and can be followed along the circumflex iliac artery. No pulsation can be felt in any part of the superficial femoral artery.
All that remains of the popliteal tumour is a degree of genea ral fulness along the ham, in which pulsation has been felt for about two months, but, notwithstanding of which, the fulness is gradually diminishing. The patient can use the limb with considerable freedom, but there is still a degree of stiffoess of the knee joint, and some inability to put his heel to the ground in walking ; but these are sensibly abating.
The muscles of the left limb have been considerably weaken ed, particularly those which are employed in the motion of the foot, but they are evidently recovering their power. In this limb he still experiences at times some degree of sciatic pain. His general health is perfectly good.
Professor Thomson had the goodness to continue to visit the patient daily for some weeks after the operation; a kindness which I owed not less to his friendship than to the interest which he takes in whatever relates to the science of surgery. Edinburgh, 18, St Andrew's Square,
December 12, 1815.
THE INQUIRER. No. XXV.
Medical Fragments. In what does the affection termed lumbago consist? Is it infistimátory, spasmodic, gouty, or rheumatic! It is sudden in its invasion and in its departure. The pain seems as if confined to a small spot, such as the centre of one of the lumbar vertebræ. The pain is excruciating on motion, but ceases almost entirely on rest. The affection is unattended with any pyrexia or general febrile condition. It disappears for a series of months, even years, and then makes its appearance in a moment, without the least previous warning: What is the bone or joint, ligament, muscle, or set of muscles, particularly concerned in it? A par ticular state of the weather seems to favour its attack. This ia probably a raw damp cold state of the air, such as prevails during easterly winds with sleet, or during an east wind that produces a thaw.
QUERY.- As the means of establishing a drain in discases of the spive and hip joint, has corrosive sublimate in powder ever been tried, or would it be advisable to try it in the manner pointed out by Mr Robertson of Kelso, in the 20th Number of this Journal? The present writer accomplished a perfect cure of a white swelling of the knee-joint, in the person of a young woman whose case was abandoned as hopeless, and no other rea source than amputation supposed to be left. The irritation produced is considerable, and in some degree perhaps peculiar: the discharge is most copious and long continued, and apparently of a quality and consistence very different from that produced by common caustics.
Mr Bryce's excellent Observations on the Fatal Liver lead directly to the important practical deduction, which has been elsewhere insisted on in this Journal, that the floating of the lungs of a new-born infant, where no putridity exists, proves incontestably the fact of the infant having breathed. His expres sion of the permanent dilatation of the lungs' is happily chosen. Indeed his whole hypothesis is plausible and satisfactory. On the subject of infanticide, it may be remarked, that, though the child hus breathed, the presumption is perhaps not a strong one, in any case, that the mother has murdered it. In the first place, the maternal tie has been wisely implanted by the Creator, as the strongest bond in human nature. It is not only maintained, sacred, but is augmented under every circumstance of difficulty and distress. The presumption is consequently against, rather than in favour of the breach of this tie ; and consequently a female has not only the benefit of the general maxim in law, of being held innocent until proved guilty, but there is this additional plea, arising out of the most irresistible feelings and sympathies of the human heart. Secondly, ignorance, agitation, and terror, may often be the means of occasioning the death of the new-born infant, without the least intention on the part of the mother to take away its life; though the dread of exposure may have induced her to conceal her shame to the latest moment. Instances must be familiar to accoucheurs of the birth of a living breathing child, where, from some untoward circumstance in the delivery, such as pressure in the passages, temporary strangulation by the umbilical cord and the like, the circulation of the blood has been so obstructed in the child as to produce congestion in some important organ; or the circulation between the mother and the fætus has been so interrupted as to bring the life of the infant into danger that could only be averted by the skill and promptitude of the accoucheur. Now, such an occurrence taking place where a young, ignorant, and inexperienced female delivers herself, without any assistance, and under the pressure of the most incapacitating circumstances, may cause the death of the child after it has breathed, and the permanent dilatation of the lungs' has been affected, without any design of the unfortunate mother, either premeditated or momentary, to destroy the fruit of her womb. She may have flattered herself with the hope of exposing it, which, though itself a horrible crime, is, in the eye of reason, humanity, and law, incomparably less heinous than murder. Or, probably, finding concealment to be no longer practicable after the offspring of illicit passion has seen the light, maternal affection may have asserted its paramount claims, and determined her to brave the sneers, and contempt of an unpitying world, at a moment when a fatal accident, such as has just been contemplated, may have prevented her. When that has actually happened, and when she perceives she can no longer preserve her offspring, then indeed concealment is the impulse of frail human nature; and, though a crime which no reasoning or sophistry can pardon, much may be said in palliation of it. It is needless here to point out the danger that may arise from unskilfulness in tying and cutting the umbilical cord, as it must be evident to every one. That the law, in its spirit and exercise, though not in its letter, leans to some merciful construction of the kind which has now been hinted at, is sufficiently evident from the practice of our courts of justice, both in England and Scotland; infanticide in either country being now seldom punished with death. The subject is alto gether deserving of the most serious consideration, and every one is interested in having it, if possible, unequivocally determined. August 1815,
QUERY.Is the floating of the lungs of a child recently born, and free from putrefaction, a sufficient proof that it has respired? Vide Edinburgh Medical and Surgical Journal, Vol. XI. p. 80. • Difference of opinion on any subject will ever be productive of benefit, by tending to lead to unprejudiced and careful investigation. In offering the following remarks to your notice, I do so with the hope that some one (having greater opportunity than myself) may be induced to give such attention to an investigation, as the importance of the question demands ;--question certainly of considerable magnitude, in as much as the life of an individual is at stake, and one upon which every practitioner may be called upon to give his opinion.
The floating or sinking of the feetal lungs appears to be a circumstance likely to guide the opinion, and consequently the verdict of the jury. The langs of the foetus before birth sink in water, containing no air. Their substance is redder than in a child that has breathed. Morbid and other circumstances may, however, occur, which (in my opinion) will make exceptions to these general rules, and thereby cause the floating test to be considered an uncertain one.
1st, Of the sinking of the lungs. Suppose we take a piece of the lungs, and throw it into water; it may sink, and yet the child may have been born alive, particularly if it is taken from a depending part. So it may happen if the lungs have been infamed ; a piece of inflamed lungs will sink immediately, like a piece of liver.
2d, Of the floating of the lungs. Suppose a woman to be delivered of a dead child, should she blow into its mouth and lungs, under an idea of bringing her child to life, the same appearance will take place as if the child had been born alive, viz. the lungs will assume a forid colour, and, containing air, will swim in water. When air has once entered, it always remains in some quantity. Thus an innocent mother might unintentionally be the cause of her own condemnation. In either case we may be deceived. Carlisle, June 16, 1815.
E. B. FLETCHER.
Note by the Editor. We feel obliged to our intelligent correspondent for his remarks, as they give us an opportunity of replying to both his objections.
Unquestionably a piece of inflamed lungs will sink in water, like a piece of liver ; but we doubt that such inflammation was ever observed in the lungs of a new-born infant, concerning wbich a question of its having been still-born could arise, and we leny the fact, that any portion of lungs which have breathed will ever be rendered specifically heavier than water, by the mere settling of the blood in the lower portions after death.
With regard to the second objection, we may observe, that the possibility of inflating the lungs of still-born children is denied by some able physiologists, but is established by others. Supposing the attempt to have succeeded perfectly, which it scarcely ever does, still it will neither produce that influx of blood into the lungs which is the necessary effect of respiration, nor alter the colour of the blood in the lungs. The absolute weight of the lungs of a ripe infant are about doubled by the act of respiration. In a still born infant they are about 1.70th of the weight of the whole body, in one which has breathed 1-35th. The colour of the lungs of a ripe still-born infant is very dark red, almost brown, and by artificial inflation they become of a bright and sometimes of a dull cinnabar red; the lungs of an infant which has breathed are of a clear pale red. If the inflation has only succeeded imperfectly, the differences are still greater. The thorax remains compressed and Ant, and the diaphragm strongly arched; the lungs are but partially distended, and do not in the thorax, or cover the heart; they do not crackle when divided, the air may be in a great measure pressed out of them, and portions of them sink in water,
Most of the objections to the hydrostatic proof are founded in an erroneous view of it. Reliance is only to be placed on it in cases to which it is adapted ; and it is not intended to supersede, but to be combined with, other modes of proof. It presupposes the lungs to be healthy, and tolerably free from putrefaction, and that the trial is performed with due circumspection.
A vessel at least a foot deep, and of a sufficient size, is to be provided, and filled with soft water, of 40° to 60° Fahr. After opening the thorax, the trachea is to be tied at its division, and. cut through above the ligature. Next, all the large blood-vessels are to be tied, both cavæ, the aorta below its arch, the pemonary arteries and veins. The whole contents of the thorax, lungs, heart, and thymus gland, are then to be taken out in connexion, cleaned, and laid gently upon the surface of the water. The experiment is then to be repeated, after the heart and thymus have been removed, upon the , lungs connected and separated, and cut in pieces:--their swimming or sinking entirely or partially, will commonly lead to positive conclusions.