Imatges de pÓgina
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this malady, when it is stated that in 1804, six hundred and twenty one patients labouring under it, were admitted into a single hospital at Plymouth. In 1805, Sir Edward Pellew, commander in chief in India, stated to the Admiralty that, so destructive was the ship-ulcer in his squadron, and so intractable under every kind of medical and chiurgical treatment, that an apprehension was entertained of some of his sbips being depopulated. In 1804 and 1905 it had made destructive inroads upon the health of the fleets off Brest and Ferrol; but the greatest fatality occurred in 1806 on board the Salvador dil Mundo, then a receiving ship at the port of Plymouth. When in 1804 and 1805, Dr. ANDREW BAIRD, Inspector of naval hospitals, to whom the nation is indebted for rescuing her seamen from an enemy, against which no prudence could protect, no courage prevail, visited the fleet off Brest and the squadron at Ferrol, he found in many ships the progress of this disease truly awful. The representation of Sir Edward Pellew, on the state of his squadron, induced the Lords of the Admiralty to call upon Dr. Baird, in January 1806, to draw up a succinct account of his opinion on the cause and cure of this malady. The indefatigable attention to the avocations of his profession, the extent of his practical knowledge, and, above all, bis disposition *to feel no influence but that of duty, fully justified the choice of the Admiralty. There were two sources, Dr. Baird believed, in which the ship-ulcer originated: want of cleanliness in the ship, and negligent or improper management on the part of the surgeon. It is obvious that these causes may act separately; but the probability is, that when the Captain becomes careless of the state of the vessel, the Surgeon will be inattentive or slovenly in the discharge of his professional duty. In dirty ships, (a comprehensive term, including the actual impurities that may be suffered to accumulate in every part, the want of ventilation, and inattention of the crew to personal cleanli, ness), 'this disease was found most to prevail. Neglect on the

part of the Surgeon is specifically stated to be inatten, tion to slight hurts; not enjoining rest to patients be fore extensive inflammation, the precursor of gangrene, took place; and using the same sponge and water indiscriminately to all cases of ulcer. Under these circumstances it was, that blistered parts, punctured veins, recent wounds, and abraded surfaces, degenerated into malignant ulcer. The endeavour to rescue the navy from this calamity, was ne

cessarily cessarily divided into two branches; the prophylaris and therapeutica. The first was intimately connecied with the discipline of the ship, and not only became a means of prevention, but an able auxiliary in the cure. The detail of this comprehended a general attention to cleanliness; an enlargement of the sick, and an erection of a convalescent berth for the reception of all recent wounds and clean sores; and into which, all cases that had

gone

zbro' sphacelation, and had assumed a healthy appearance (the patient's person and clothing being, previously purified) were removed. No sponge, or any kind of dressiug used in the foul ulcer ward, was suffered to approach the conyalescent berth. Of the particular nature and quality of this ulcer, Dr. Baird expressed himself with a force and precision, that could only arise from extensive oba servation, and a conviction that his opinions were founded on truth. He contemplated it as a disease of increased action, and requiring a treatment in its early stage similar to other inflammatory affections, and calculated to render less destructive its subsequent progress. The inedical practitioner who is employed in those departments of civil life least liable to be influenced by impure air and sordid live ing, frequently encounters peculiar idiosyncracies, in popular but expressive language, called bad habits of body, where the smallest wound, or abrasion of surface, is followed by active inflammation, ulceration, and sometimes gangrene. In these cases, without being influenced by the prospect of future sphacelus to employ stimulants and tonics, the judicious practitioner looks only to the controul of the increased action, knowing that the ease or difliculty of the subsequent management will be proportioned to the extent of the inflammation. It seems that this peculiar idiosyncracy, or bad babit of body, prevails very extensively among seamen, ioduciog upon all external injury, an active inflammation, to be restrained only by the most powerful remedies.

Upon this principle was founded the successful practice of Dr. Baird. In the first, or inflammatory stage, early rest was enjoined; the inflamed part was covered with compresses kept constanıly wet with the vegeto-mineral water: the use of animal food and wine was strictly interdicted. Brisk

purgatives were exhibited every second day, and saline draughts taken in the intervening one, with the addition of opium every five or six hours to allay irritability, and to procure sleep an anodyne always at night. As soon as the in

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flammation was arrested, simple dressings were applied ; and if the disease rap into sphacelus, an employment of the fermenting cataplasm assisted in producing an early separation of destroyed parts. When the sphacelated parts were separated, the same simple dressing was again used, or adhesive straps if the bone was sound. By a moderate use of animal food, wine and bark, the strength was gradually restored. The propriety of this mode of treatment is established on its uniform success : “ for ulcers are now, where these doctrines

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almost extinguished from the service.” The once rapid spread of this ulcer through the fleets, and into the naval hospitals, seems principally to have been induced by a false theory. When a contagious or malignant property was only; looked to, stimulant and tonic remedies were exclusively employed internally, and irritating antisceptics applied to the ulceration. The inflammatory stage of the disease, and upon the conducting of which hung the final success, was either entirely overlooked, or its management so influenced by the idea of malignily, as to increase rather than abate its activity. Upin Auenced by hypothesis, Dr. Baird saw, that unless the inflammatory action could be kept within certain bounds, every remedial effort would be foiled: and it is to bis good sense and practical skill that the country is indebted for the lessening, if not extinction, of this disease.

The work of M. Richerande, in 4 vols. having been published at Paris, 1808,* hardly comes into the plan of: this Sketch: as it is, however, entirely practical, and professes, without any view to the historical progress of the art, to describe the scientific and operative part of modern Surgery, it becomes highly interesting to the English practitioner. The detail it gives of the state of surgery in France, affords the fair means of estimating whether in England or in that country, the science has made the greatest progress. But English surgeons will not subscribe to the decision of M. Richerande, when, on giving a comparative view of the art in different countries, he says,

“ 'L'Eclat dont brillait la chirurgie Française devint pour le reste de l'Europe un utile sujet d'emulation. En ces tems vécurent en Angleterre Cheselden, Douglas, les deux

Monro,

Second edit. enlarged and improved,

Monro, Sharp, Cowper, Alanson, Pott, Hawkins, Smellie, et les deux Hunter; en Italie, Molinelli, Bertrandi, Moscati; en Hollande, Albinus, Deventer, Camper ; en. Allemagne, et dans le norde de l'Europe, Heister, Platner, Ræderer, Stein, Bilguer, Acrell, Callisen, Brambilla, Thedan, et Richter. Tous ces hommes célèbres s'accoutumènent à regarder l'Académie de Chirurgie comme le centre commun des lumières dont toutes les parties de l'art se trouvaient éclairées; la supériorité de la chirurgie Française fut généralement reconnue, et noblement avouée par la plupart d'entr'eux. Cet hommage ne lui fut pas rendu peut-être d'une manière unanime chez une nation rivale, qui, fière de ses Bacon, de ses Loke, et de ses Newlon, aspire vainement a une supériorité trop universelle. Si les suffrages de l'Europe n'avoient pas fait justice de ces prétentions, el si d'ailleurs l'espace ne manquait à notre zèle, nous nous plairions, dans un parallèle des chirurgies Française et Anglaise, a comparer, et même à opposer Wiseman à Paré, Cheselden à J. L. Petit, Jean Hunter à Desault: dans cette espèce de lutte établie entre les chirurgiens des deux peuples, il n'est pas difficile de prévoir de quel côté resterait l'avantage.'

The truth is, that each country has excelled the other in some particular points; and we sincerely regret that the evils of war prevent a participation of their peculiar ime provements. If M. Richerand had been better acquainted with the state of English surgery, his work, as a view of the present state of the art, would have been more perfect; and his opinion of French surgeons might, perhaps, have come to a modester standard. On the operations for aneurism in particular, the French might receive much instruction. For, notwithstanding M. Richerand's opinion to the contrary, tying the external iliac, the ca.. rotid and subclavian arteries, may be effected without any extraordinary difficulty, and with great prospect of success. The year 1809 has produced cases of this kind. Mr. Abernethy, in his remarks on aneurisın, attached to the “ Observations, &c.” relates three cases of tying the external iliac, two of which were completely successo ful; and Mr. Astley Cooper, in the Medico Chirurgical Transactions, gives the histories of two cases of tying the carotid artery. A correct knowledge of the anatomy is too obvious to be mentioned as an indispensable qualification in the operator; but it seems of great importance to urge an early employment of the operation, and before the aneurismal tunour has injured, in any great No. 137.)

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degree, the surrounding parts; or become, from its extent and diseased state, the source of morbid irritations, which may themselves destroy the patient. While these bold operations receive their sanction from success, we feel it a duty to state, that the experience of this year seems to have fully determined, that one much more simple cannot be performed without putting life into extreme hazard. In certain varicose states of the vena saphena, it has been proposed to tie that vessel in a way that has some analogy to the operation for aneurism. This has several times been done, and the result has commonly been severe inflammation, which, in several instances, has ended in death.

The frequency of herniæ, the alarming symptoms that casionally arise from them, as well as the hitherto unavailing efforts of art to discover any means of radical cure, must be an apology for noticing the following statement in a work entitled, “ Cochlioperie; Recuiel d'Experiences tres-curieuses, sur les Ilelices terrestres, ou Escarjot, &c. 8vo. Paris, 1808.” M. Tarenne asserts that he has discovered a radical cure for hernia. Having observed, he says, that the slimy juice of the snail had been long used with success in disorders of the breast, and noticing its astringency, and the singular reproductive quality, which the animal itself possesses; be was led to conjecture that this juice, when applied upon the skin would

readily penetrate, and spread ita. self to the diseased parts beneath. Upon this principle he applied this agglutinating fluid to hernial apertures; and he further asserts, that he succeeded in radically curing the disease. Though there is no rational expectation that a cure can be thus effected, yet the positive manner in which M. Tarenne relates his cases, will induce some, possibly, to give his method a trial. To enable those who may be thus disposed, M. Tarende's process is here inserted from a reputable periodical work. The common spring truss, when employed in this process, has its convex cushion made concave, for the purpose of receiving a china or glass cup, which cup is to bave a diameter equal to the herniak aperture. This eup, intended to be kept upon the opening through which the intestine escapes, by the pressure of the elastic truss, is filled with wool imbued with the li. quor flowing from the snail. Being provided with this apparatus, the patient is directed to proceed in the following manner: three or four hundred snails are to be procured in the spring, and kept in a place where they may have. nutriment, as only from two to eight are to be used daily. The patient every day before he rises, and after he is in

bed,

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