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in a book published by Mr. Freer, the first and best histories of this operation are given. But in the two following cases, the disease had proceeded to an extent to make the probability of success but small, and the result will show, that the operation may be successfully performed under the most adverse cir

cumstances.

William Cowles, aged 37, came to London from Beccles, in Suffolk, on account of an aneurism in the right groin, which he attributed to his having walked five miles with a heavy burden upon his back, six months ago, and a fortnight before the appearance of the aneurism. Journeying to London upon the top of a coach, a distance of more than one hundred miles, he fell asleep upon his face, and pressing upon the tumour, he observed its surface changed to a gangrenous colour. When he was admitted into Guy's Hospital, the skin was purple in some parts, red in others, and extremely thin. It was obvious no time was to be lost, and the operation was performed upon the day of his admission, viz. the 22d of June, 1808, two ligatures were made upon the iliac artery, and the vessel divided between them.

Nothing unusual occurred until the 30th of June, at ten o'clock at night, when a discharge of dark coloured blood took place from the aneurismal sac, and the swelling became quite flaccid. I ordered a sponge dipped in vinegar and water to be applied upon the swelling.

In the six following days, the skin from the surface of the sac sloughed, so that the aneurismal cavity was completely opened. July the 8th the upper ligature separated, and on the 9th the lower came away.

"The wound then looked well, the aneurismal sac granulated; but the man's health beginning to fail, it was necessary to remove him about a mile out of London, where he gradually recovered. This man, who now resides in the neighbourhood of Beccles, was in London this year, 1813, perfectly well.

CASE II.

April 30, 1813.

William Martin, aged 27, was admitted into Guy's Hospital under the care of Mr. Forster, for a fracture of the olecranon, and after having been in the hospital three weeks, he requested his dresser (Mr. Johnson) to examine a swelling in the left groin, which proved a femoral aneurism, seated at a small distance below Poupart's ligament, and the integument over it was in a mortified state, being of a dark colour, and having three vesicles upon its surface.

As it was thought that an operation was immediately necessary, and Mr. Forster was not at the hospital, I was requested to see him. The man said that the swelling had been growing nearly twelve months, and had a pulsation when he first observed it. He attributed its commencement to an attempt to raise 3 cwt. about three weeks before he first observed it.

The mortified state in which it was, he attributed to walking the distance of four miles, three days before it was shown to his dresser.

The tumour was as large as an orange; the pulsation in it very strong; its most projecting part was livid, and the surrounding parts of a deep red colour.

It appeared to me that no time was to be lost, and I immediately proceeded to tie the iliac artery. It may not be improper to remark, that the incision which I make for this purpose, is different from that usually advised: for I begin it just above the abdominal ring, and carry it half an inch above Poupart's ligament, in a semilunar direction, to one inch upon the inner side of the anterior and superior spinous process of the ilium.

Two ligatures were applied upon the artery, and the vessel divided between them.

The ligatures separated on the 17th day.

On the 23d day after the operation, an incision was made

into the aneurism, through the eschar, and the coagulated blood was discharged: the opening from the artery into the sac was very visible, but there was no bleeding from it.

The wound continued in a sloughy state for about three weeks, and then began to granulate; and although the restorative process went on slowly, the man was, after several weeks, discharged from the Hospital, completely cured, no lameness remaining.

Pathological Researches respecting the Diseases of Joints. By B. C. BRODIE, Esq. F. R. S. Assistant Surgeon to St. George's Hospital, and Lecturer on the Theory and Practice of Surgery.

[From the London Medico-Chirurgical Transactions for 1813]

As the articulations of the human body are composed of various parts, each possessing its own peculiar anatomical structure, we cannot but suppose that they are subject to a variety of diseases. It is also reasonable to conclude, that these diseases may differ with respect to their causes and progress; that they may be attended with different degrees of danger to the affected organ, and that for each there may be certain remedies better adapted than others for its relief. Remarks so obvious cannot be regarded as original, yet I am not aware that any one has undertaken to investigate the subject with a view to make a classification of the morbid affections to which the joints are liable, and still less has it been attempted to point out the diagnostic marks by which they may be distinguished, and the methods of treatment which they respectively require. The terms white swelling, scrophulous joints, carious joints, &c. have been employed almost indiscriminately, and I believe it will be found, that the same name has often been applied to different maladies, and that the same malady has been spoken of under different appellations.

Yet no part of chirurgical science appears to be much more worthy of attention. The diseases of joints are of very frequent occurrence: some of them go on towards an unfavourable termination, in spite of whatever remedies are adopted; others are capable of being materially relieved or completely cured: they are all formidable if neglected. It is very desirable that we should be capable of forming such a distinction of these diseases, as may enable us to determine in what case a cure may, or may not be expected; and in the former, what applications or medicines may be employed in preference, and with the fairest prospect of advantage.

Perhaps nothing has contributed in so great a degree to the modern improvements in surgery, as the practice of examining the changes of anatomical structure which disease produces, particularly in those cases where there has been an opportunity of witnessing the previous progress and symptoms of the complaint. There seems to be no better foundation for a scientific arrangement of diseases, or for acquiring a knowledge of the characters by which they are to be distinguished; and the having ascertained in what the deviations from the natural actions of the animal body consist, is at any rate an important step towards understanding the method, by which such deviations are to be corrected.

If a joint be examined in the most advanced stage of a disease, all the parts composing it are found blended into a confused mass, in which it is impossible to distinguish the original nature and seat of the morbid action. It is only where an opportunity presents itself of making the dissection at an earlier period, that we are likely to procure that kind of information which is calculated to throw light on this subject. But such opportunities are of comparatively rare occurrence, since the joints are not vital organs, and the affections to which they are liable seldom prove fatal, or even require amputation, until they have made considerable progress; and this circumstance is, in itself, sufficient to form a very material obstacle to the improvement of this branch of pathology.

VOL. V.

Y

No. 18:

It is only by the successive labours of many individuals, that any part of a science so difficult and so obscure as those of medicine and surgery can be brought to a state at all approaching perfection: but this, instead of operating in a contrary manner, should rather form an inducement to each person, who possesses the means of gaining experience, to lay the results of his experience before the public; to bring them into the common stock, and contribute, as far as it is in his power, to the general improvement of his profession. The observations, which I have now the honour of presenting to the Society, are, for the most part, drawn from cases which have come under my notice within the last few years, in one of the principal hospitals of this metropolis. They relate to the pathological history, and classification of the diseases of joints. Should this communication be favourably received, I may, on a future occasion, venture to offer some additional remarks on the diagnostic symptoms by which these diseases may be distinguished, and the different methods of treatment which they require for their relief.

II.-On the Inflammation of the Synovial Membranes.

The soft parts which, added to the bones and cartilages, constitute the structure of the joints, are the synovial membrane, by which the lubricating fluid is secreted; the ligaments, by which the bones are connected to each other; and the fatty substance, which occupies what, in certain positions, would otherwise be empty spaces. It is to be supposed that the adipose membrane belonging to the joints may be inflamed; that it may be the seat of abscesses and tumours, as well as that which is situated beneath the skin, or in the interstices of the muscles; and the ligaments cannot be regarded as more exempt from disease than the fibrous membranes, which they very nearly resemble in their texture. The ligaments and the fat of joints are sometimes inflamed in consequence of mechanical injury; and I cannot say that I have never seen a case where disease, independently of this cause, has originat

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