16th the patient imprudently rode out, without permission, the wound being perfectly healed. On the 30th April, he was in complete health. The leg was not of its full size, nor so strong as the other-he was free from pain. On the 20th May, he came 25 miles to show himself in New York. The remains of the aneurismal tumour had disappeared -the epigastric artery was found much enlarged, and beating strongly, and there was a feeble pulsation in the femoral artery.

When we compare this operation with

the one performed some months ago by Mr. Wardrop, and reflect that in a case like Crane's, the operation ultra aneurismam would have been applicable, according to the doctrines recently maintained, we must admit that the interests of surgery and of humanity demanded a full and speedy exposition of the newly revived doctrine of Dessault, and the data on which it is grounded. The facts which we have here put upon record speak for themselves; and we shall not add a single

comment.

DISEASE OF THE HEARt.

We shall present to our readers a short statement of this case (from the Medical Gazette) before we make any comment.

A young soldier (aged 23) was received into hospital on the 17th of November, for feverishness and constipation, which seemed to give way in three days. On the 26th he had a fresh attack. On the 1st of December Mr. Maynard saw him. "He appeared very feverish, anxious, and irritable; had a pulse of very unusual and remarkable strength; it was not only visible at the wrist, but in the fleshy parts of the thighs and belly; his skin hot, with great thirst." He was bled to ten ounces from the arm, without any relief, or any sensible effect on the pulse. From this time till the 10th December he varied much; but, at the latter period, complained of pains in his knees, breast, shoulders, and bowels. On the 25d the fever was renewed, and calomel and opium were given at night, without benefit. A troublesome cough is now added to the other symptoms. There was still no suspicion of disease of the heart.

"On the 25th, however, there was something in the stroke of the pulse which it is impossible to describe, what I never myself felt before, combined with a thrill, almost a hiss, under the finger, more like the vibration of a harp-string; it was very remarkable in the right wrist, but still more so in the left. The heart was felt to be beating short, quick, and vio

cation of the finger to the space between the second and third rib, a something between a crepitus of air in cellular membrane, and the thrill at the wrist could be discerned at every pulsation, that showed us pretty clearly the real complaint. The stethoscope was applied, and the preternatural rushing sounds very clearly heard. About 16 ounces of blood were taken from the arm; it was cupped, but not much, for the coagula were not firm, nor was the buff very marked, being grey rather than the usual yellow. I felt his pulse that night while he slept, and it was comparatively quiet and soft, having lost all that hard jerking vibration it had in the morning. 26th and 27th-Much the same, pulse less violent, and No. 122. On the 28th all the bad symptoms increased; he was restless, anxious, and evidently weaker; had no sleep, felt pain, expressed a wish for nourishment, but complained he could not eat; his pulse was regular and less strong, but had the same remarkable jerk and thrill. Towards the morning of the next day he asked for the close-stool; he refused the bed-pan, and got out of his bed and used it. In half an hour after he had laid himself down again, he died without any struggle.

"On the 31st we examined the body. On raising the sternum, the heart lay more exposed to view than usual, less enveloped in the lungs, of enormous size, and occupying a more horizontal position in the chest. There was no blood whatever in the cavities of the chest or pericardium, but the serous fluid in the peri

cardium was in double quantity. On looking attentively at the heart as it lay, there appeared, between the origin of the pulmonary artery and the arch of the aorta, a small tumour, of livid colour, having a surface of pericardium, but evidently going into ulceration. It felt solid, but not hard. The right ventricle was very thin and flabby, the left as remarkably thick and firm and muscular, The vessels were all in their natural state, neither larger nor smaller nor discoloured. The interior of the right ventricle was natural. At the upper part of the septum ventriculorum, just where the edges of the semilunar valves mark the origin of the aorta, an orifice appeared, through which was escaping grey flakes of coagulated lymph, which were followed by clots of black blood, and some in a fluid state. This tumour, when emptied, would contain a pigeon's egg; the orifice was ragged, and the interior surface rough and fibrous, like the cut surface of the heart; it was not thin, nor pervious to blood in any part. Two of the semilunar valves were destroyed, one was entire. Quære. What was the cause of death in this case ?"*

The foregoing case offers food for much reflexion. We would ask Mr. Maynard, in the first place, how it was that the state of the vascular system, on the 29th November, did not excite his attention to the state of the central organ of the cir culation? He examined the patient's abdomen, and found the pulse visible there -yet he did not examine the chest. Secondly, was the detraction of ten ounces of blood from a young grenadier, with the above-mentioned phenomena, a sufficient depletion? Thirdly, when he says, on the 25th, that a something between a crepitus and thrill felt in one of the intercostal spaces, "showed pretty clearly the real complaint;" we would ask him what was the real complaint then, and how it was known by the foregoing phenomena, as we are not aware that the said phenomena afford any data for a fixed diagnosis? We do not ask these questions from any captious or hypercritical motives; but to show Mr. Maynard and the public, that auscultation is not sufficiently attended to. The complaint, in this case, was not suspected

* Med. Gazette, No. 6, p. 163.

till within three days of the patient's death, and even then, we question whether a proper diagnosis was formed. The extent over which the heart beat-the impulsion--the difference of impulsion in the two sides of the heart, were not investigated, (at least there is no mention of them,) yet on them would chiefly have rested the diagnosis, even on the first day the patient entered the hospital. In respect to the query at the end of the casewe conceive that there can be very little difficulty in concluding that immense hypertrophy of the left side of the heartdilatation of the right chambers-valvular disease-and a tumour of the heart going into "ulceration," were quite enough to destroy the life of even a grenadier of the guards. In respect to the nature of this tumour, we have no doubt that it was a false aneurism, or aneurismal pouch going off from between the heart and aorta, such as we have described, in several instances, in the 15th number of this Journal. Considering the obloquy which has been attempted to be thrown on auscultation, of late, we have deemed it necessary to comment on the foregoing case, in order to show the value of the auscultic diagnosis, and the danger of neg. lecting it.

2. ST. GEORGE'S HOSPITAL.

BLEEDING IN ERYSIPELAS.*

The patient, a soldier, æt, 38, was admitted Nov. 24th, 1827, in consequence of a lacerated wound on the left side of the forehead, and contusion behind the ear, which he had met with four days previously. There was a good deal of action in the system, with head-ach and costive bowels, for which he was bled to 3xxx. and took cal. grs. ij. p. jal. grs. vj. 4tis horis. On the next day, he was bled again to ten ounces, and ordered salines with sulphate of magnesia. On the 26th, he had much pain in the head-general excitement-pupils sluggish, and an erysipelatous blush appeared upon the forehead. Lot. spt. fronti. V. S. ad 3xv. The ery sipelas extended with thirst, head-ach, hard pulse, and he was again bled to twenty ounces on the 27th. Next day the erysipelas had extended over the right

* Med. Gazette. No. 6. Jan. 12.

POPLITEAL ANEURISM IN BOTH LEGS

SECONDARY HÆMORRHAGE.*

This case, we understand, excited much interest at the time, and furnished food for no little misrepresentation and vituperation in a certain quarter.

The patient was a carrier, æt. 53, admitted August 1st, with a large aneurism in the left ham, which had commenced twelve months previously. The tumour had made considerable progress, and was in one part exceedingly near the surface, but not the least discolouration of the integument was present. His health had been always good, until the commencement of the disease, at which time he was much harrassed in body and mind by a trial at law, since which he has been very nervous and irritable. On his admission, he was labouring under a good deal of fever, with great action in the pulse and vascular system generally. On inspecting the other ham, a distinct aneurismal tumour was discovered pulsating with extreme violence, and on the right side of the neck the carotid was seen beating very forcibly. Of the existence of the second aneurism the patient was not aware, and he was accordingly left in ignorance of it. He was kept quiet and bled until the 9th, when the operation was performed in the usual manner.

*Medical Gazette, No. 7.

The ligature separated on the 23d, (fourteen days after its application,) and at this time the wound was little disposed to heal, and the thigh was much swollen. On the 6th September, (thirteen days after the separation of the ligature,) secondary hemorrhage took place from the wound-the bleeding could not be entirely checked by the tourniquet, &c. and on the morning of the 8th, Mr. Brodie tied the artery at the groin. This ligature remained until the 29th, (twenty-one days,) and on the 11th October, (twelve days subsequently,) secondary hæmorrhage, to the extent of a pint and a half, patient was now in that state of irritatook place from the upper wound. The bility and excitement, that any further and, indeed, he positively declared that operation was almost out of the question, he would undergo no more. Accordingly, pressure, by means of properly adapted trusses, pads, &c. was carefully employed, but only with temporary effect, for on the 30th bleeding took place, and, from that time until the 2d November, when he died, blood was continually oozing from beneath the compresses, although gentlemen were constantly sitting by the poor fellow's side, day and night. The immediate cause of death was mortification, or rather a condition more nearly approaching to "dry gangrene" of the limb.

On dissection, it was found that the ligature in the groin had been applied on the superficial femoral, immediately below the giving off of the profunda. The artery at this point was entirely destroyed by ulceration, so that no clot or adhessions were discovered, and from this spot to the site of the original operation both artery and vein were converted into a ligamentous undistinguishable mass. The aneurismal tumour in the ham was solid, no larger than an orange, and the vessels passing to and from it obliterated. In the other ham was a good sample of incipient, aneurism.

We could make some remarks upon this case did our limits permit. As it is, we shall content ourselves with copying from the Gazette, with a slight alteration or two, the contradictions of the erroneous statements which have gone forth. Lancet.-"Tumour remarkably tense and solid."

The fact.-It was soft, and could be almost entirely emptied by pressure.

The fact.-Not even a speck of discolouration had appeared. Lancet.-"The man was kept at least a

fortnight in the hospital before the artery was tied."

The fact. He was admitted on the 1st, and the operation was performed on the 9th. It was not done sooner, because the patient had much fever, and required repeated blood-letting and purging. Lancet." The operation should have been performed immediately on the patient's admission."

The fact. It should not. Lancel." Mr. Brodie attempts to pass a straight probe by main force under, for we cannot call it round the artery."

The fact.-Mr. Brodie attempts to do no such thing. He uses the eyeprobe, simply because it is more flexible than the common aneurismal needle, and admits of any curve required. The operation was performed with great facility.

Now if this hospital report of the Lancet's be not a tissue of the most palpable blunders, we know not what is. We have one or two cases by us at the present moment, which will teach the Lancet what sort of stuff the "surgical capability" of its reporters is made up of.

3. MIDDLESEX HOSPITAL.
SECONDARY HEMORRHAGE.*

J. Willmott, æt. 37, prompter of Drurylane Theatre, had his left leg removed, by amputation above the knee, for caries of the tarsus, on the 10th October. The case apparently did well, the ligatures came away on the 20th, and the stump had healed, save that two small sinuses remained leading towards the bone. He left the hospital on the 18th November,

* London Med. Gazette, No. 6, Jan. 12.

and resumed his employment at the theatre, one sinus still remaining open, and the bone appearing likely to exfoliate. On the 16th December, the stump swelled, and grew more painful, and on the 19th, a violent hæmorrhage took place, which was arrested by a ligature on the limb. He was again brought to the hospital, when Mr. Mayo tied the common femoral artery, distinctly above the origin of the profunda. On tying the ligature, the lower part of the artery continued to pulsate, though not so strongly as before. Mr. Mayo, thinking that the knot might have slipped, applied a second ligature, but still the pulsation remained. On removing the bandages from the stump, there existed a sinus in the direction of the femoral artery, and a second opposite the bone, and through them the blood must have issued. more hæmorrhage ensued, but it was necessary to remove some dead bone, and on the 1st January, the ligature had not separated from the vessel.

No

T. Bailly, æt. 58, had his right leg amputated above the knee, for ulcer and caries of the bone, on the 13th November, by Mr. Mayo. The vessels bled furiously, and sixteen were tied, but in the evening secondary hæmorrhage came on, and it was necessary to secure three more. Next day there was great nervous irritation, twitchings of the stump, &c. from which he rallied for a time, but sank on the 1st January. One ligature, in the direction of the main artery, had not separated, and from this spot hæmorrhage had occurred which was restrained once by pressure, and on its recurrence by the actual cautery. Upon examination, the bleeding was found to have proceeded from a small artery upon the vastus internus, the femoral being firmly closed, and containing a clot, au inch in length. The plugging up of the vessel was found to have depended on the adhesion of the outer coat only, the inner coat not having entered into the cicatrix in the manner described by Dr. Jones. This appearance is very well shown in a wood-cut.

Between these two cases, though simi. lar in some respects, there is yet an obvious difference. In the first, there was no particular hæmorrhagic tendency at the time, and all went on favourably enough, save that from weakness of constitutional power, or other cause, a sinus remained, and the ulceration sub

sequently extended to the artery. In the second case, the hæmorrhagic disposition was marked, and the patient seems to have sunk more from the effects of what took place on the day of operation, than from the trifling bleeding which occurred subsequently, though this, no doubt, was the cause of great irritation to the system. We have heard a comparison drawn between Mr. Mayo's first case, and that related above from St. George's Hospital, but, to our minds, a most inappropriate and unfair one. In the one case, there was disease of the artery in a decidedly aneurismal habit-in the other there was nothing of the kind.

4. ST. THOMAS'S HOSPITAL.

FRACTURE OF THE SEVENTH CERVICAL VERTEBRA.*

Cases of fractured spine used to be considered as something uncommon in the pages of a journal, but now, thanks to the "gentlemen connected with the press," as Sir Richard Birnie has it, they are becoming plenty as black-berries.

H. C. æt. 35, received an injury to the spine, on the 1st of December, from a sack of flour falling from a height of 10 feet upon his shoulders. He was stunned by the blow, and lost the use of his lower extremities, but did not enter the hospital until the 5th. The lower extremities, at this time, were quite paralyzed, but he could raise his arms to a certain extent -breathing diaphragmatic-no priapism -pain on attempting to move his head. No displacement of vertebræ could be discovered, so that Mr. Green was disposed to consider the symptoms as dependent on effusion. Cupping-injections, and the catheter three times a day, were employed, but the urine in a few days became decidedly ammoniacal and offensive, sloughs formed on the nates and sacrum, and on the morning of the 23rd the poor fellow died.

Dissection. The arch of the 7th cervical

there was a coagulum of blood, whilst the membrane here was vascular and distended. On exposing the medulla, much serous fluid escaped, and the marrow itself opposite the last cervical vertebra was of the consistence of cream.

This softening of the medulla Mr. Green, in his clinical lecture, very properly considered as dependent on the injury (and consequent inflammation) of its substance, rather than on any pressure exercised by the bone. Mr Green also observed that, on the 8th day after the patient's admission there were signs of returning sensation in the lower extremities, the patient being able to distinguish which foot was touched; but on the following day these good symptoms bad disappeared. This, Mr. Green was disposed to attribute to the setting up of inflammatory action, which induced a temporary excitement in the spinal marrow, and temporary return of sensibility in consequence. The reporter, whilst he appears to be struck by this " ingenious explanation" of Mr. Green's, (an expla nation, by the bye, which was given long ago by Mr. Charles Bell, in his celebrated controversy with Sir Astley Cooper,) declares pretty plainly, that Mr. G. laboured under an "illusion" as to the fact of the amendment having taken place on the day mentioned. The reporter examined the man soon after Mr. G. and found, "to his complete satisfaction, that there was no return of sensibility." the shock to Mr. Green's nervous system must be very severe indeed upon reading this, the reporter has very judiciously and humanely endeavoured to allay the constitutional irritation, by declaring that what he did, was only "with a view of establishing truth," and preventing the dissemination of so dangerous a doctrine, as that H. C. could tell which toe was pinched upon the eighth day!

5. ST. BARTHOLOMEW'S.

NOSE.

As

on the theca beneath the first dorsal arch

*Lancet, No. 228, Jan. 12.

An interesting case of this terrible disease is detailed in No. 6 of the Gazette. We must refer our readers for the details, which are exceedingly well given, to the journal in question; but we may just