Imatges de pÓgina
PDF
EPUB

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 motion 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 blocd 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

wards that side. The remainder of the cavity that was not occupied by the lung was filled with cellular substance.

The whole of the left lung, and small portion of the right mentioned above, were of a dark liver colour, without adhesion. On cutting into their substance, a great quantity of frothy phlegm, intermixed with a dark-coloured blood, issued out. Their whole substance seemed to be as completely filled with this fluid as a sponge well soaked in water, and it ran out in a stream, without pressure, on merely making an incision with the knife.

The pleura costalis, except at the place of adhesion, was natural, nor was there any water in the cavities of the thorax.

The trachea appeared very vascular, and on its anterior side, within the thorax, there were, betwixt its cartilage rings, portions of imperfect rings of extravasated blood in the state of coagulation.

MEDICAL EXTRACTS.

No. IX.

An Analysis of the Mineral Waters of Dunblane and Pitcaithly; with general Observations on the Analysis of Mineral, and the Composition of Bath Water and some others. By JOHN MURRAY, M. D. F. R. S. Edinburgh.

(See Transactions of the Royal Society of Edinburgh, Vol. VII. Part II. p. 411.)

T HE essay of Dr Murray deserves to be very generally studied by professional men; but very few of them can have an opportunity of reading it in the philosophical work in which it is published. We therefore feel a pleasure in being able to give it greater publicity; and only regret that its great length obliges us to omit some parts, and abridge others.

Dr Murray was led to these considerations in consequence of analysing the mineral waters of Dunblane and Pitcaithly, both in Perthshire. The very ingenious method of performing these analyses, and the curious chemical views stated in regard to the methods of analysing mineral waters in general, are highly interesting to the chemical student; but we must content ourselves with extracting the results obtained from a pint.

[blocks in formation]

"It is a question not unequivocally determined, and perhaps not capable of being determined, in what state the saline ingredients of a mineral water exist,-whether the acids and bases are in those binary combinations which constitute the different neutral salts, or whether they exist in simultaneous combination, the whole acids being neutralized by the whole bases. If the former, which is the more common, and perhaps the more probable opinion, be adopted, it is at least certain, that the state of combination may be modified by the analytic operations, and that the binary combinations obtained by these may not be precisely those. which existed in the water. In the case of the Dunblane water, for example, the ingredients obtained are muriate of sola, muriate of lime, and sulphate of lime. Now, it is possible that the sulphate of lime may be a product of the operation, not an original ingredient. The sulphuric acid may exist rather in the state of sulphate of soda, and when, in the progress of the evaporation, the liquor becomes concentrated, this salt may act on a portion of the muriate of lime, and, by mutual decomposition, form corresponding portions of muriate of soda, and sulphate of lime.

"A question of this kind is not merely one of speculation, but the solution of it may sometimes throw light on the properties of mineral waters, particularly on their powers of affecting the living system. The present affords a very good example of this. Sulphate of lime is a substance apparently inert." If it exist, therefore, as such in water, it can contribute nothing to its efficacy. But in the other state of combination which is supposed, both the quantity of the muriate of lime, the more active ingredient, will be greater, and the presence of sulphate of soda will in part account for the purgative operation which the water exerts.

"There is no very direct, and perhaps no decisive experiment, by which this question may be determined; for any method which would cause the separation of either substance as a binary compound, may also be conceived to operate by causing its formation.”

Dr Murray then gives some arguments in favour of his opinion.

"These results do not absolutely establish the conclusion, that VOL. XII, No. 47.

« AnteriorContinua »