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LECTURESON SOME

PRACTICAL POINTS OF SURGERY,DELIVERED TO THE

Students of the late Borough Dispensary,By MR. ALCOCK.

LECTURE XII.

On the Mechanical Extraction of Poisonsfrom the Stnmach; and on the treatmentof Suspended Animation.

Gentlemen,IN the preceding lecture, I alluded to

the use of the stethoscope, as a mode ofarriving at accuracy in the diagnosis offractures ; that practice in the use of theinstrument is essentially necessary to ar-rive at any thing like certainty you mustbe well aware, and that the occasions ofacquiring this experimental knowledgecannot be derived from the living body bythe numerous students of an hospital,unless by subjecting patients to a muchmore protracted examination than can becompatible with their welfare; the know.ledge may, however, be acquired in thedissecting-room, and a single subject bemade to serve for the instrnction of anentire class. This is an exercise which Iam fully persuaded will repay the labourand attention you may levote to it; writethe results of your ex&.nination of eachfracture that you may be enabled to cor-rect or verify your conclusions by the sub-sequent anatomical investigation of theparts on which the experiments have beenmade. It is to be regretted that the va-luable memoir of M. Lisfranc, on thisnew application of the stethoscope tosurgical pnrposes, has not appeared in anEnglish dress.In a former lectnre, I mentioned the

error of binding the chest too tightlywhen the ribs were fractured ; since thattime I have met with a preparation illus-trative of its bad effects ; (this was sub-sequently submitted to the examination ofthe students ;) several of the ribs hadbeen fractured, and the ends of three ofthem had been forced past each other,and had united in that position, so as toproject in a very irregular manner intothe chest ; great mischief had taken placein the lung opposite the place of frac-ture.The mechanical treatment of poisons is

a subject of considerable importance ; butthere is a period to which its usefulness islimited, namely, whilst the poison remainsin the stomach; for it is in vain to expectrelief from the extraction of the remain-der after a sufficient quantity to destroy

life may have passed the pylorus, or havebeen carried into the circulation.There is another circumstance of which

yon should be aware, that whilst thestomach retains its irritability, the poisonmay be as effectually and as speedily eva-cuated by vomiting as by the use of apump ; and if such emetics as the snt-

phate of zinc, which in sufficient doseacts almost instantaneously, be timelyadministered, the occasions for the use ofmechanical means will be found to bemuch less frequent than has been supposedto be necessary.Should you however, be convinced that

the welfare of your patient requires thestomach to be emptied mechanically, themeans may be both simple and efficient.The complications of instruments, whichI doubt not may have been profitableenough to the vendors at the enormousprices at which they have been furnishedto the profession, afford, I fear, no veryfavourable indication of the general sci-entific attainments of those members ofit who might have the opportunity of ex.amining these wonder-working machinesbefore they purchase them. They areinferior to a simple well constructed sy-ringe with a flexible tube; the complexityof valves or sliding orifices may serve toamuse ; but these contrivances are morelikely to be clogged with half-digestedsubstances, than a direct communication,every part of which shall be of sufficientdiameter to allow of the free passage ofwhatever can have entered at the orificeof the flexible tube. Even the syringemay be dispensed with, unless it be de-sired to inject fluid forcibly into the

stomach ; for the tube alone, if of properdimensions, when passed down into thestomach is sufficient to evacuate its con-tents. either bv being used as a svphon,or by a very moderate pressure yof thehand upon the region of the stomach;you may readily verify the practicabilityof this mode by experiment upon a

living animal ; but it does not rest uponexperiments on the lower animals ; forMr. Evans, surgeon, of Belper, used itsuccessfully in the case of a female, inthe year 1820, the management of whichdoes credit to his skill and common sense.In injecting the stomach previously to

withdrawing its contents, there is oneprecaution which must not be omitted,should the patient be in a state of insen-sibility, and be supported with the headand shoulders raised, as is the mostconvenient position for the operator. Ifthe injection be continued beyond whatthe stomach can contain, instead of thefliiid flowing out by the lower orifice ofthe stomach, it is apt to rise by the side

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of the tube, aud if the head be inclinedbackwards, to fill the fauces, so as to en-danger suffocation.The passing of the tube presents little

mechanical difficulty to any one acquaint-ed with the relative position of the parts,except what may arise from the sensa-tion of sickness, by the tube coming incontact with the fauces, pharynx, &c. Ifthe tube be very soft, a piece of whalebone,similar to the handle of a probang, maybe inserted within the tube, when it isintroduced, to give it firmness and elas-ticity, withdrawing the whalebone whenthe tube is fully introduced.

If the simple syringe be used, it maybe half filled with tepid water, and whenjoined to the tube, the liquid may be in-jected ; by raising the handle of the sy-ringe, so as to fill the syringe, double thequantity of the fluid injected may be with-drawn from the stomach; and this pro-cess may be repeated as often as neces-sary, tilIthe stomach be perfectly washed,and its contents evacuated.There is a danger in the use of either

syringe or pump, in awkward hands,which may be productive of distress and I

injury to the patient, it is the drawing ofthe coats of the stomach forcibly withinthe tube; and when it is considered thatthe surface thus drawn in may be sub- Ijected to a force equal to the pressure ofthe atmosphere, it forms a strong groundfor the preference of more simple means,in the use of which a want of dexteritydoes not endanger the patient. By eitherusing the flexible tube as a syphon, or bya very moderate degree of pressure withthe hand upon the region of the stomach,the fluid contents of the stomach may bemade to flow through the tube in a fullstream, and the application of a greaterforce, when the lesser is fully adequate,is, to say the least, unnecessary and use-less.

[The injecting of the stomach, and with-drawing its fluid contents, was demon-strated upon a living dog, using the sy-ringe in the first instance, and then show-ing that the evacuation of the contents ofthe stomach was practicable by the tubealone, used as a syphon, or by very mo-derate pressure on the abdomen.]

Should you wish to trace the history ofthe invention, you will find, in the firstvolume of Tij LANCET, (Dec. 1823,) " Onthe immediate treatment of persons poi-soned," a list of authors, whose worksand communications you may refer to,that you may examine the facts and dates

impanially, and determine for yourselves.Sn.epended animation may arise from va-

rions causes, as from drowning, hanging,sutfocation by noxious vapours ; practi.

cally considered, these may be lookedupon as mere modifications of suffocation,by which that change in the blood effect-ed by respiration, which is essential to

the preservation of life, is interrupted orprevented. The effect is the same whe-ther respiration be rendered mechani-cally impracticable, or whether the air

respired be deprived of its oxygen, (orvital air,) on which its property of sus-taining life by respiration depends. Indrowning, the abstraction of heat fromthe body by the water, is more rapidthan when the body is surrounded by air,consequently, in our attempts to restoreanimation to those who have been sub-mersed, more immediate attention is re-quired to restore the warmth of the body,than in suffocation from other causes.You are aware that the dark blood

which circulates in the veins is incapableof sustaining life, when it occupies theplace of the florid blood, which circulatesthrough the arterial system of the body ;and to the condition of venous blood isthe whole circulating mass speedily re-duced, when its renovation by respirationceases. Hence, therefore, you will infer,that the essential part of the treatment ofthe apparently dead from drowning, con-sists in preserving or restoring the warmthof the body, and in effecting artificial re-spiration till (when the vital spark is notextinct) natural respiration again takesplace.When accidents occur which require

the treatment adapted to restore anima-tion, it unfortunately often happens thatthe best means of carrying the remedialintentions into effect, cannot be imme-diately, if at all, obtained ; it thereforebecomes imperatively the duty of the me-dical man to consider well how far thetreatment may be simplified, and insteadof confusion and dismay, because a boxof tools, consisting of bellows and otherimplements, cannot be obtained, to satisfyhimself, by previous experiment, that themeans with which nature has providedevery individual, when judiciously em-

ployed, may be rendered effectual 811b.stitutes for the more complicated re-

sources of art.The application of warmth to the body,

(the wet clothes, if any, having beenspeedily removed,) may be effected whenhot water can be obtained, by the fre-quently renewed application of woollenor other cloths wrnng from the hot water,and immediately applied to the surfaceof the body. When artificial heat can-not be hsd, the surrounding of the bodywith dry woollen clothing, such as a

blanket, which, being a bad conriuctor ofheat, prevents in a great measure fte

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further loss of heat, and if there be in-dividuals present whose services be nototherways required, the warmth of theliving body may be made by contact toafford it in some degree to the unfortn-nate object of solicitude, or the bodyfay be placed upon a bed. By a spiritlamp and a blanket, quilt, or sheet, awarm atmosphere may be speedily madeto surround the body of the sufferer ; andif the treatment be carried on in a house,there are few habitations which cannotafford a cup or saucer with a little spirit,which may be lighted, and the hlanht heheld by assistants, or hyacotd, leavinga space between it and the bady, closedat the sidps and ends, so as to retain theheated air fiirnished by the burning ofthe spirit. The body, and not the ftce,

should be thus exposed to the warm air;as the air thus heated is not sufficientlypure for breathing, and further, the me-dical attendant should be employed in

effecting artificial respiration, at the sametime that others attend to the warming ofthe body. ’1 tie warmth may be regulatedby making the apertures at the euds ofthe blanket more or less open, and its de-gree may be ascertained by the arm of anassistant placed between the blanket andthe body of the patient. I may seem tobe too minute in thus dwelling upon par-ticuld) s; but next to artificial respiration,you %%ill find the proper application ofwarmth to the body of the greatest valuein the treatment of suspended animationfrom drowning.

In this rude sketch, the botly is represented as extended upon a table, t headand shoulders being gently raised.

Fig. I.-A The spirit lamp, or cup or saucer containing spidt which has beelllighted.

L,

B B A cord held, or otherways fastened, to support the blanket.C C The blanket, which should extend over each side of the table, and be

pinned, so as nearly to close the ends.

Fig. 2.-Tube for inflating the lungs.A The end to which the month of the assistant is applied.11 The end which is inserted into the nostril of the patient, and is slightly bul-

bous externally, to prevent it from slipping.

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Artificial respiration is the most im-

portant of all the means employed in thetreatment of persons apparently dead,from any of the causes of suffocation.-The apparatus of the Royal Humane So-ciety, which consists of bellows. varioustubes, an elastic bottle for administeringcordials and glysters, a scaipel for per-forming the operation of tracheotomy,&c., is very complete, when at hand andunder judicious management; the formeris rarely the case, and the latter-may notbe found although the instruments be inreadiness.Respecting the operation of tracheotomy

as a mode of facilitating the inflation ofthe lungs, were it not known that patientswho have been rescuscitated have died inconsequence of this operation, by theblood from the wound flowing into the Iwindpipe and producing suffocation, Ishould still object to it as one of thosebarbarisms which sets common sense atdefiance. The passages which nature hasmade for the transmission of air duringthe life of the individual, are quite suffi-cient for the purpose of artificial respira-tien ; for the parts, in the stillness of ap-parent death, are passive, and the talesof spasm preventing the admission of airmay pass with the vulgar, but will notimpose on the understanding of any onewho lias dared to examine the subjectand to think for himself.In a case of snspension, from the his-

tory of which there was every reason toanticipate that resuscitation might be ef-fected, the surgeon first called determin-ed to perform the operation of tracheo-tomy ; the patient was corpulent, and the ’’

blood filled the wound repeatedly beforethe trachea was exposed; when it was

opened the blood continued to ooze ra-pidly, and the opening was so jagged andirregular that the utmost efforts of theoperator did not succeed in adapting thebellows to it so as to effect a single dis-tension of the chest in imitation of natu-ral inspiration.

In performing this operation, if theartificial aperture be less than that of thetrachea itself, any tube inserted into thelesser opening allows the air to escapeby its side along the trachea, and if thegap be made large enough to admit thenozzle of a pair of bellows, the difficultyof fitting it accurately, so as to preventthe escape of the air, is much greaterthan in applying the tube to the mouthor nostril.In effecting artificial respiration by the

natural passages there is a precautionrequired, which if neglected is apt to de-feat the attempts of the operator. If a a

person uninstructed attempt to inflate the

lungs he will blow up the belly, and. ifhe persist, the abdomen may be so greatlydistended as to press the diaphragm soforcibly upwards into the chest as to ren-der the subsequent distension of the

lungs almost impracticable ; I have knowr.this circumstance to happen in attemptsto restore suspended animation, with whatsuccess I need not inform you ; the reasonis obvious, the air is forced down theoesophagus with a slighter decree of pres-sure than is necessary to raise the chest,in the absence of muscular action, con-sequently, it becomes necessary to pressthe firm upper part of the windpipe (thatprojecting part knon by the commonappellation of Adam’s apple) upon thegiillet, which passes behind it, which effec-tually prevents the air from passing intothe stomach : a very moderate degree ofpressure is sufficient when applied at theproper place.The uslual mode of inflating the lungs

is to insert a short tube iuto one nostril;the pipe of a pair ot’ bellows is insertedinto the tube, the other nostril and themouth are closed by an assistant, whoshould also make the pressure abovealluded to on the wind-pipe ; the air tsthen gently forced from the bellows tillthe chest is distended, when the pipe iswithdrawn and the chest pressed to forcethe air out, and this process is repeatedagain and again, so long as the artificialrespiration is continued.This mode, you will perce’ve, is com-

plicated, and cannot be carried into effectby one individual. If the apparatus oi-the Humane Society be not at hand, the

adaptation of common bellows is a call

upon the ingenuity of the bystanders,which few are able to meet; hence muchvaluable time is wasted in fruitless efforts.It therefore is of importance, that youshould know how to obviate the difficulty,or to substitute such means as may bemore manageable and yet efficient.

Although pure atmospheric air is to beprefeued to that wltich has been partlyrespired, we know that air, deprived ofa part of its full proportion of oxygen, isstill capable of sustaining life. Suppose,by way of illustration, that- two cubicinches of oxygen be absorbed at eachrespiration, and that in a state of healththe inspirations and expirations take placefifteen times in a minute. Suppose, onthe other hund, that the air be deprivedof one half of its proportion of oxygen,so that the quantity inhaled at each in-

spiration, instead of affording two cubicinches of oxygen, affllrd one only; but ifthe respiration be c.onbttd in frequency,so that instead of fifteen it should take

place thirty times in the minute, you may

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readily conceive the effect should be thesame, that in each instance thirty cubicinches of oxygen would be consumed inone minute.

Carrying this principle into effect, Ishould have no hesitation whatever in

performing artificial respiration, in a caseof suspended animation, by air which hasbeen partly respired, unless complete ap-paratus were at hand, that the inflationof the lungs could be carried into effectwithout delay. I am aware that somepersons are of opinion that nothing canbe done without the bellows, but in nu-merous instances (when I was engaged ingeneral practice) I have used successfullythe simple mode, before alluded to, of

inflating the lungs ofstill-born infants, byusing the air which I had hastily respiredfor the purpose of inflation, without anyother apparatus than the simple tube(fig.2) which forms apart of my pocketcase of instruments. I have succeeded inrescuscitating (using external warmth atthe same time) in instances which, fromthe long cessation of the heart’s action,have been considered hopeless, and whenthe slightest indication of returning lifedid not make its appearance until afterlong-continued and unremitting artificialrespiration. I have traced the change ofcolour in the lips, &c., from the darklivid hue till it became nearly of the natu-ral florid tint, before a single act of na-tural respiration had taken place, andI have also traced the return of the lividhue in a very short space of time whenthe artificial respiration was suspended.Again, on renewing respiration, the floridhue of the lips has returned, and after res-piration had been kept up a considerabletime, I have had the pleasure to witnessthe first inspiration by the muscular ac-tion of the infant. Till the natural respira.-tion has been fully established, the inspi-rations have been at intervals more or lessconsiderable, and each has rather resem-bled a convulsive gasp than an ordinaryinspiration, the countenance at the sametime being strongly affected. Wheneverthe heart’s action has been suspended fora few minutes only, the rescuscitation hasbeen slow I have persevered for a fullhour before the first unaided inspirationhas taken place, and yet have had thegratification of witnessing the establish.ment of breathing life and the recoveryof the infant.By applying my mouth to the straight

end of the tube A, and by inserting thebulbous end of the tube B into the nostrilof one side, and compressing the oppositenostril with that in which the tube wasinserted so as to make it fit closely, takingthe precaution to close the month and

press the larynx upon the pharynx withthe other hand, I have never experiencedany difficulty in inflating the lungs of anadult before the muscles had becomerigid, and after that period no rationalexpectation of rescnscitatition could beentertained.Even in the absence of all apparatus,

artificial respiration may be effected in acase of suspended animation, but notwithout a disagreeable office on the partof the operator, which might be sparedby the slender foresight of being providedwith a tube : accidents requiring its useare fortunately of rare occurrence ; butone life saved would amply repay anysupposed inconvenience of being at alltimes prepared for the more sudden andurgent duties of that profession, whosehumble glory is to do good to others. Inthe absence of all apparatus, the inflationcan be performed by the operator placinghis mouth in contact with that of thesufferer, interposing a thin handkerchiefif it be sufficiently open to allow of thefree transmission of the air, compressingthe nostrils and pressing the larynx uponthe pharynx, forcing the air into the lungs,then removing the mouth; the same pro-cess must be renewed as often as the dis-tension of the lungs may be deemednecessarv.

Friction, stimulants, bleedings, &c.have been recommended ; unless circula-tion be previously restored, they are use.less, and when circulation and respirationare again established, the danger is ge-nerally past, unless under particular cir-cumstances of ignorance or mismanage-ment.

I have, however, known death to occurmore than 40 hours after animation hadbeen restored, after an attempt to com-mit suicide by hanging. The sufferingsof the patient were dreadful,

In suspended animation from noxiousvapours, it has been recommended to

affuse cold water freely over the body,before proceeding to artificial respiration.In France, M. Labarraqne has used thechloluret of lime with effect so so) prisingas almost to appear magical, in cases ofsuspended animation produced by me-

phitic vapours from cess pools, drains, &c.In suspended animation from exposureto extreme cold, the restoring of the na-tural temperature must be extremelyguarded and gradual.Genttemen, in concluding these lec-tures, let me advise yon to perseveresteadily and regnlarly in yonr professionalstndies. Nevei- let any one day passwithout advancing some step—withoutacquiring some fresh knowledge ; let thosestudies which more immediately quality

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you for the important duties of your pro-fession, be fairly advanced before youspare much time for ornamental pursuits ;be not depressed should your worldly suc.cess fall short of your just expectation;whilst some early attain extensive prac-tice, few rise to eminence as improvers.of the science of. surgery ; but it is in thepower of every one, by persevering ap-plication and undeviating integrity, todeserve success, and to enjoy that tran-quillity of mind which results from thebest exertion of his talents to alleviatethe sufferings of his fellow creatures.

ANATOMY AND SURGERY

CONSIDERED IN

Relation to the other Branches of Learning.

THOSE sciences which are institutedfor the general utility and immediate bene-fit of mankind claim the highest rank inour estimation.As the necessities of men are more nr-

gent than their pleasures, and as the en-joyment of pleasure depends primarily on ithe full accomplishment of their wants,so in proportion that which is usefut inthe common affairs of life demands as.cendancy over the mere gratifications ofthe mind. It is the natural propensity of

. man to stndy his comforts. Brutes areendowed with a certain degree of instinct,sufficient for the provision of their food,and, according to their species, are armedwith forces necessary for their protec-tion. This animal possesses fleetness toescape its pursuer, but the. cunning of itsenemy will often supersede its speed; inshort, every naturalist is acquainted withthe wise and just laws which nature hasordained throughout creation. Yet bruteshave no power to extend this faculty ; alltheir enjoyments are enclosed in the nar-row compass of satisfying their neces-sities. But man, in the full perfectionof his reasoning faculties, is not satisfiedwith mere animal existence ; he exertshis invention for new delights; he wan-ders, as it were, over the garden of theworld to gather its products ; he selectsthis flower for its beauty, and that for itsfragrance; he cultivates this plant for theindulgence of his appetite, and that forits specific virtues.

If we study the history of man fromthe earliest ages, we shall find that, ac-

cording to the gradual deveiopment of

knowledge, the wants of man increased,but the means of satisfying them werefortunately exhibited in the same pro-portion. Society, which had hithertobeen as a republic, became divided intodifferent classes, distinguished by theirdifferent pursuits. As learning openedher various sources, each man, as thebent of his inclination led him, followedthat most adapted to it. The adven-turous spirit sought the fruits of otherclimes, encouraged by the support whichnovelty inspired ; the painter and thepoet presented the beauties of nature,embellished by their imaginations ; thesculptor carved from the rude block theimage of humanity ; but the anatomist,not satisfied with the external man, ven-tured to examine the component parts,and to survey the operations which na-ture effected, with beautiful simplicity,in the regular adaptation she presentsone part relatively with another, and inthe grand conformity of the whole.As in society there exists a mutual de-

pendence, one class with another, so inscience there is a corresponding connex-ion. How evident is the Utustration !-The rich man, riding in his carriage witharistocratic elegance, is indebted to thetradesman for this provision, as thetradesman is obligated to him for his pa-tronage. Thus in science, the artist con-fesses the benefit of the anatomist, andthe physician courts the aid of chymicart to adjust his remedies to the pecu-liarities of disease. This brings me tothe consideration-in what position, re-latively with the other sciences, oughtwe to rank the study of the human frame?It is not my intention to enter into thehistory of the rise and progress of the

study of medicine and surgery, bnt merelyto refer to such matters as bear imme.diate relation to the subject.

It is a well authenticated truth, that thefirst promoters of medical knowledge en-countered many obstacles to the advance-ment of their pursuits. Superstition sogenerally pervaded the mass of mankind,that the skill of the operator was ascribedto witchcraft, and the secrets of the ci-rative art could only be learnt, by the vul-gar, by leaguing with the devil. Withthese difficulties presented by the simplecredulity of the people, and the conse-quent dangers attending the practice ofthe art, we cannot wonder at the slowprogress this knowledge made in the darkerages. Fortnnately, however, for the inter-ests of mankind, the original professorswere men of undaunted intrepidity, whofearlessly opposed every danger, in de-fiance of the menace of a bigoted priest-hoo d ; and who, with the zeal of martyrs,