prove how far the depleting and opiate plan may be carried, without injuring the constitution. The quantity of blood abstracted, and opium taken, really appears to be enormous; but it is evident to me, that, if this plan had not been persevered in to the extent mentioned, dissolution must certainly have been the consequence-most probably from too great a determination of blood to the head. I was fully aware, where spasm and pain existed, that opiates might be given in considerable quantities, without affecting the system in any other way than alleviating the misery the patient laboured under, as is conspicuous in this instance. Although my patient had taken 840 drops of the tincture, and 27 grains of the gum, the first day of the attack, it neither affected the head nor constipated the bowels, so long as the irritation remained; so soon as that was alleviated, it instantly operated on both. Opium, when taken where there is excessive irritation, does not produce that constipation, (that generally affects the bowels when the system is labouring under a disease where irritation does not exist); it operates as a specific stimulus, and generally destroys the excitement, without producing vertigo, or any other unpleasant affection. In this instance the quantity exceeded all I have ever seen or read of; but, as the case terminated favourably, it proves the plan may be extended much farther than is nerally pointed out on such occasions.

ge

On the 29th of the same month (June) I was desired to revisit the above patient. It was 11 A. M. and I found that premature labour was approaching from the dilatation of the os tincæ; pains coming on regularly, and at proper intervals; but as there was considerable rigidity in the uterus, the labour did not make much progress, and nothing could possibly be done except waiting for the operation of nature. At one o'clock, I could perceive the uterus had dilated considerably since I examined her before; and at three P. M. labour had advanced so far, that the head rested on the perinæum. Still a great rígidity remained, and a considerable disposition in the uterus. to contract. After remaining nine hours in this state, without making the least progress, and as her pains were in a great measure abated, the pulse sinking, I thought myself justified in using art to assist nature in her efforts; consequently, at midnight, I applied the forceps, and the head was delivered in about ten minutes. After this was effected, the pains began to return, from the stimulus the uterus had received, when I endeavoured to extract the body. I found it was utterly impracticable, owing to the violent contraction of the uterus on some part of the child. Still willing to give nature a chance to exert

her own powers, I waited three hours without using any extension, concluding the womb would relax and expel the fœtus. At the expiration of the above time, I gave her two grains of the gum. opii, with an intention of obtaining a relaxation of the uterus. Some hours after this was administered, I endeavoured to make a gentle extension, which proved to be fruitless. No doubt existed in my own mind but what this was an hour-glass contraction, so frequently spoken of by lecturers, and so seldom met with in practice. When the child was delivered, my idea proved correct, as the difficulty was from its contracting on the buttock of the child. As my patient's situation at this time was very precarious, and considerable weakness existed, I consulted with a medical neighbour. After sufficiently considering the case, he was of my opinion, that it was impossible to deliver at this time by extension, as the contraction remained with equal violence. Had we so proceeded, a laceration of the uterus would most probably have been the consequence; consequently I proposed to administer gtt. cl. of tinctura opii, which was given immediately, and suffered her to remain quiet. The effects of the opiate procured sleep, and after remaining in that state two hours, labour-pains returned, and instantly expelled the foetus. Nothing remarkable occurred after delivery. She was treated in the usual manner, and is now perfectly restored.

The power opium possesses over the uterus is really surprising. In a few hours it alleviated all the excitement, and rendered the labour manageable. Depletion would have been used in this instance, had it not been for the great quantity of blood abstracted in her former attack. The contraction in this case was more violent than I ever saw or met with in any of my medical researches. The disposition which the uterus evinced to contract at so early a period, struck me forcibly as indicating that the case would be difficult and laborious; and had it not been for the repeated depletion, in all probability it would have proved more obstinate, and of an unfavourable termination. July 12, 1815.

X.

Two Cases of Wounded Artery in Venesection cured by Compression. By C. K. CRAWFORD, Surgeon, R. N.

HILE I was surgeon of the Venerable, under Admiral Durham, two cases of puncture of the brachial artery in bleed.

ing at the bend of the arm occurred, which are to me the more remarkable, as they happened in my own hand, and are the only cases of the kind I have ever seen. They both healed by adhesion of the lips of the wound in the artery, without any communication betwixt the vein and artery being left, or obliteration of the cavity of the artery.

The first was William Robinson, a seaman, who had been shot in the head by a musket-ball in the action with the French frigate Alcmene. Wishing to take a quantity of blood from his arm by a large orifice, I took the lancet out of the hand of my assistant, and incautiously dilated a small opening which he had made in the vein. The surgeon of the naval hospital at Barbadoes, who was present, remarked that I had wounded the artery. I did not think I had done so at first, but was soon convinced it was the case, as well from the situation of the artery, as the two currents of different coloured blood that issued from the wound, that from the artery coming per saltum. The stream from the vein being stopped by pressing beneath the orifice, pressure on the superior part of the arm stopped the discharge from the artery.

The wound in the artery was oblique, and perhaps more than the sixth of an inch long. After the quantity of blood intended was taken away, the edges of the wound were brought together, and retained by the adhesive strap; a firm compress of four or five folds of calico, about two inches long, and less than half an inch broad, applied over the straps, as nearly in the direction of the course of the artery as possible, and a bandage put on with the necessary degree of tightness.

My intention in this, which seemed by the event to be fully answered, was to make such a degree of pressure on the upper side of the artery, as to bring it into the state of its greatest possible contraction, and prevent entirely its dilatation by the mo tion of the blood. By this means the side of the artery was prevented from moving, and rendered quiescent; and the lips of the wound kept in contact, and in a favourable state for union by adhesion, without the circulation in the arm being thereby materially injured. I ordered the arm to be kept quiet, suspended in a sling, and the bandage occasionally damped with cold water.

He complained of a little pain for a few days, from the tightness of the bandage, and a slight inflammation of the external lips of the cut. It healed in a short time without any farther trouble, or being attended with any bad consequence whatever. He is at present cook of the Palma frigate.

The second case is that of a black boy, betwixt 12 and 14 years of age, one of the Admiral's servants. He was very

much afraid of being bled; I had him so secured that he could not withdraw his arm from me. But, on feeling the lancet enter his skin, he started, and, pushing his arm forwards, caused me to make a larger and deeper wound than I intended.

The artery, which lay nearly underneath the vein, was wounded. This cut was also in an oblique direction, and, from the quantity of blood that issued out at a time, the orifice in the artery seemed to be much larger than in the former case.

The same precautions were taken in this as before. In a few days, when he was almost well of his original complaint, being of a very lively disposition, and not easily confined, he got playing about the decks, and making use of the arm, from which, together with the tightness of the bandage, his fore-arm and hand swelled, and became very hot, and painful.

By confining him more rigidly, using a saturnine lotion, and some other parts of the antiphlogistic regimen, this soon subsided. It was, however, near two weeks before I could suffer him to use his hand freely; and even after that, he said he felt it a little painful and weak, though the orifice was closed, without leaving any communication that I could ascertain, between the artery and vein, or any obliteration of the canal of the artery.

XI.

Appearances on Dissection, in a Case of Humoral Asthma. By C. K. CRAWFORD, Surgeon, Royal Navy.

TH HE following appearances on opening the trunk of a patient I had the misfortune to lose in humoral asthma, may be interesting, on account of the diseased appearances in that complaint being very little known.

The patient was a man of about fifty years of age, of a slender make, and narrow chest. He had been a long time at sea, and spent the best part of his life in the navy. He complained, shortly after I joined the Pique at Barbadoes, in the beginning of June 1814, of having been for about three weeks troubled with shortness of breath and cough, which came on by fits, and was then worse than it had lately been.

By being bled, and taking an emetic, he was relieved, and enabled to do his duty as a quarter-master. He did not again complain, except of the cough, which affected him at intervals,

and for which he took expectorating and mucilaginous medicines, until, after leaving Halifax in Nova Scotia, we were cruising about the banks on the coast of America, Newfoundland, &c. The weather being cold, and the atmosphere loaded with moisture, proved too much for his worn-out constitution. He died on the 11th September, notwithstanding every exertion we could make in his behalf.

He did not throughout the disease complain of much pain in his chest, but of a tightness; and his great complaint was, the difficulty he felt in fetching a full inspiration, and a sense of suffocation, attended with a whizzing noise. The fits mostly came on in the afternoon or night, and generally lasted a few hours, during which he could scarcely breathe, speak, or cough until he began to spit, and then he soon got relief. If he happened to be in bed at its commencement, he had to get up immediately, for fear of suffocation. In the latter part of his disease, when he had a blistering plaster on his breast, he made his water involuntarily. He was treated with bleeding while his blood appeared inflammatory; blisters on his breast kept almost constantly open; emetics, expectorants, antispasmodics, and the digitalis, were used for a short time, but without any benefit.

On opening the abdomen, the muscular parietes were thick and strong, for a man of his slender make. The fat in the adipose membrane not being nearly so much exhausted as his emaciated appearance seemed to indicate.

There was no fat in his omentum. His liver, stomach, and intestines, were in a sound state. The stomach and intestines distended with air. In the rectum there were some feces of a natural consistence. The spleen was of a pale colour, and firm texture. The bladder was thickened and contracted, containing a small quantity of high coloured urine. The kidneys were large, but healthy. The diaphragm was very concave towards the abdomen.

The cartilages of the four lower true ribs were ossified, and those of the upper of a very firm structure. The whole parietes of the thorax seemed very rigid, strong, and not well adapted for free motion. The heart was large, and of a pale colour. The right lung, except a small portion of the superior part of the upper lobe, adhered to the pleura costalis, and, from its texture, seemed to be entirely useless. There was neither air in its cells, nor blood in its vessels. It was of a pale grey colour, and collapsed into a small space.

The cavity of the right pleura seemed diminished by the great convexity of the diaphragm towards the thorax, and the mediastinum being pushed from its natural position more to