48

had been kept up the greater part of the preceding day, and hadproduced, as before, tingling, numbness, pricking and burning ;the limb is also somewhat swollen, especially about the knee;the temperature is very little reduced, as the lower part of theleg is invested in a flannel stocking. It being rather tiring forthe man to hold the cylinder, a cradle has been put over theleg, and the weight fastened to it by means of a piece of tape;in this way it is fixed over the artery, and can be constantlypressing over it. Go on with the mixture.Fourth day.-The tumour is certainly somewhat firmer, but

it is found difficult to keep a constantly-applied degree ofpressure sufficient to control the flow of blood through the sac.The patient appears to have a very small femur, but the softparts and adipose tissue are very abundant, the thigh being thusvery flabby ; hence the necessity of a great degree of pressure,such as the patient can with difficulty endure, even for a shortperiod; otherwise the clamp shifts, and but very slight effectis produced. The parts subjected to compression are to besprinkled with oxide of zinc, and the patient is to continuethe mixture.

Seventh day.-The pressure has been continued more or lesssince the 22nd; the general health continues good; the mansimply complains of feeling stiff and tired from lying so long.He has not exceeded a pint of fluid a day since he came in,but has had a full allowance of mutton and vegetables. The

pressure renders the skin very tender, red, painful, and

vesicated ; when these phenomena occur, the instruments areshifted, and the skin soon recovers. As regards the tumour,it is decidedly firmer to the touch, and not so large, althoughthe improvement cannot be called great; there is no pain inthe sac, and the integuments around it are healthy. Go-on with the medicine.

Fifteenth day.-The cure seems to be greatly impeded bythe peculiar characters of the thigh, as, owing to a small femurand flabby soft parts, (as stated above,) there is not sufficientresistance to the pressure made, unless it is exercised to suchan extent as to be intolerable. It was suggested that the legshould be swung in a cradle as a fractured limb, so that

greater resistance might perhaps be obtained. This was tried,but failed; it was found better to let the leg lie on the bed, theknee bent, and the toes everted.

Eighteenth day.-Bowels open by medicine. The clampwas taken away, that the posterior pad might be made larger,and thus encompass the back part of the thigh; but thecylinder was to be kept constantly pressing in the groin.

Twenty-first day.-The clamp has been returned, but theinteguments of the thigh are in a very unsound condition, thewhole space over which the pressure of the clamp has beenmade being quite raw. Vesications had formed, they hadbroken, and left the part quite denuded; the clamp cannottherefore be borne at present. The cylinder remains con-tinually applied during the day, but whilst the patient is asleep,it probably gets shifted off the artery. The tumour is, however,becoming much firmer, and the pulsations, although still strong,have decidedly diminished. Omit the medicine.

Twenty-ninth day. -The soreness of the thigh still continues,although the skin is better; there has been, the last two nights,an occasional acute pain at the left ankle, (just between theinternal malleolus and the tuberosity of the calcaneum,) lastingfor two or three minutes; the tumour is still more diminishedin size and increased in firmness; the pulsating force hasabated.

Thirty-second day.-This morning the pulsations haveentirely ceased, the condition of the tumour being as follows :-Quite firm, resisting, free from pain on manipulation, no heator redness round or near it, and of the size of a greengage i

plum; an artery of considerable calibre, crossing the middleof the sac, may be felt pulsating. The posterior tibial arterycannot be made out at the ankle, the temperature of theaffected limb is not perceptibly lower than that of theother, and there is no oedema, though the leg looks a littleelongated.The only pressure that has been made on the artery since

the twenty-fourth day, was by means of the cylinder, the sore-ness of the thigh forbidding the application of the clamp. Thesame amount of pressure is still to be continued, and thepatient is to keep his bed for a few days longer.The pressure was continued, during waking hours, up to the

forty-second day, the man improving considerably in generalhealth, and his delight being great at seeing the consolidationof the tumour, which is now the size of a walnut.On the forty-second day, (Aug. 31st, 1853,) the leg was well

bandaged with a flannel roller, over which an ordinary cottonone was placed, and the patient allowed to move about on

crutches, the limb swung on a broad piece of list fastenedround the neck.

Forty-eighth day.-*.Since the last report the patient has beenwalking about on crutches, occasionally bearing his weight onthe affected leg; this has given him no inconvenience. To-day he leaves the hospital, the leg being still bandaged.

Reviews and Notices of Books.

Anatomical and Physiological Observations. By JOHN STRU-THERS, M.D., Fellow of the Royal College of Surgeons ofEdinburgh, Lecturer on Anatomy. Part I. Edinburgh.1854.

THIS work consists chiefly of reprints of various papers bythe author which have appeared in medical journals, to whichnotes are now appended.Now-a-days we rarely see works of this kind, from the well-

known fact that original memoirs rarely ever pay the authorthe price of publication; the saleable medical works beingchiefly compilations, manuals, &c. Neither, we believe, dosuch works, except with a taking title, procure for theirauthors emolument in the shape of practice; while the pro-fessorships, and such like posts, which can hold out a bait forthe scientific cultivation of the science of medicine, are so few,that we often wonder at the spirit of our professional brethren,which leads to the production of even so many admirable and.truly scientific monographs. Doubtless "Fame is the spur thatthe clear spirit doth raise." The work before us contains severaltruly admirable memoirs, written without pretension and withgreat perspicuity. As it is impossible to notice them in detail,we shall select the inquiry into the " Mode of Action of LocalBloodletting in Affections of the Internal Viscera."

In applying leeches nigh to an affected part, or in cupping, theobject of course is to afford relief, by derivation, to the diseasedpart, and the general idea seems to be that the bleeding in thiscase is a local and not a general one. He then proceeds toinquire how far, in most cases, this idea is well founded, pre-mising,-" 1. That the relief in local bloodletting is throughthe bloodvessels or vascular system, and not through nervousagency; and,-2. That as blood can come from one part tanother only by bloodvessels, there can be no more specialrelief by local bloodletting, unless the bloodvessels of the onecommunicate or anastomose with the bloodvessels of the other."There is a wide difference between the local bleedings prac-

tised by surgeons to relieve local affections, and those practisedby physicians to remove internal disease. The connexionbetween the vessels from which the blood is drawn and thoseof the affected part is clear in the former case; in the latter itis not; and the object Dr. Struthers has in view is to investi-gate how far, in a case, say of inflammation of the bowels, theeffect of leeches applied to the abdomen is due to local or

general depletion. He shows, we think very satisfactorily,from the mode in which the abdominal organs are suppliedwith blood, that they can only be depleted through the generalcirculation, and that local depletion cannot affect the internalabdominal organs more than it would affect the hands or feet.In the chest the only contents that we could expect, fromanatomical grounds, to affect from local bleeding would be thepleurae, and these only to a slight extent. The case is differentwith the head. The direct communications by the parietaland mastoid foramina afford means of operating directly uponthe circulation in the brain by local bleeding; and by leechingthe scalp, " especially behind the ear, the sinuses of the dura.mater and veins of the brain may be relieved, and that asdirectly, though not so rapidly, as by the method of openingthe external jugular vein at the root of the neck." "

Agreeing, however, as we do with Dr. Struthers in his viewsdrawn from anatomy, we cannot entirely acquiesce in the firstproposition which he lays down-viz., that the relief in localblood-letting is through the bloodvessels, entirely, and not in

49

the least through nervous agency. The question amounts tothis,-Is the effect of counter-irritation entirely that of a deri-vative of the circulation, or is there not also an action on thenervous system? For both in leeching and cupping we haveconsiderable local irritation. It is clear that this questionwould lead to most extensive discussion. At present we shallcontent ourselves with remarking that in inflammatory affec-tions of the abdomen, where general bleeding is sometimesfollowed by a very great amount of depression and the occur-rence of typhoid symptoms, we have often seen most beneficialresults from leeching, where, in our opinion, general depletioncould not be risked, and have been inclined to refer this partlyto the effect produced by counter irritation, independent of thewithdrawal of blood.

This work of Dr. Struthers is highly to his credit as ananatomist and physiologist, and calculated to enhance his re-putation as a teacher.

Correspondence.

AMENDED VACCINATION ACT.

" Audi alteram partem:’

To the Editor of THE LANCET.SiE,—You have commented with proper severity on the pro-

visions of this Bill, which gives the fee of one shilling for theduty of sending the certificates to the registrar, when thevaccination is done by a medical man not appointed by theguardians. But this is not all: this fee (according to the Bill)is to be paid Mt the same way," and by the same authorities,as the other fees-that is, by the guardians. The course to bepursued before the shilling is received will be as follows :-Thecertificates must be given to the parent and the registrar. Abill for this will then have to be sent to the guardians, who, ifthey are satisfied that the duties to which it refers have been pro-perly pe1formed, will pay it when they are again called upon.How they are to be satisfied (as they have no official connexionswith the registrar or the parent) the Bill does not enlightenus. Why not make a provision, that the authority we sendthe certificate to should pay for it at once.The defects in this measure could only have been avoided by

a reference to persons practically engaged in its working. Like

you I give every praise to the benevolent motives of itsoriginator; and I cannot but admire the industry with whichhe has taken it through all its stages in both Houses. Wouldthat this quality were practised in a similar degree by themovers of our medical Bills.

Your very obedient servant,July, 1854, M. R. C. S.

ABUSES AT THE MANCHESTER ROYALINFIRMARY.

To the Editor of THE LANCET.SIR,-I was exceedingly gratified on perusing your impression

of Saturday last to ascertain that one of my fellow-studentshad at length summoned courage to complain of the very un-systematic manner in which the surgical practice of the Man-chester Royal Infirmary is conducted. Your correspondent’scommunication does not contain exaggerated statements, but,on the contrary, assertions which are so just and undeniable,that all the students of this institution ought to feel sincerelyobliged for his timely interference.There is another grievance which my friend omitted to men-

tion-viz., the irregular attendance of the surgeons. I havebeen comiected with this infirmary for twenty months, andduring the whole of this period I may, with correctness, assertthat I have seldom derived any information from the remarksoffered by them at the bedsides of the patients, which are theonly places where we can acquire a practical acquaintance withdisease. How effectually might this evil be removed had thesurgeons a stated time for visiting the hospital; and if, insteadof passing from ward to ward, without uttering a word, exceptto give instructions to the nurses, they were, as they walkedfrom bed to bed, to endeavour to unravel the intricaciesattendant upon the different forms of disease continually sur-rounding them. By this means the surgeons would not only I

have the satisfaction of having discharged their duty, butwould with pleasure witness the marked respect and unre-mitting attention which the students would ever manifesttowards their elucidation of the different diseases which wouldfall under their notice.

I trust I shall not exceed the license which you generouslygrant the profession in your valuable journal, by soliciting thefavour of your inserting this letter in your next, in the hopethat it may plead successfully with the surgical staff of theManchester Royal Infirmary, and that they will ere longeradicate the abuses which have for so long a period been prac-tised by them.

1 remain, Sir, yours truly,Manchester, July, 1854. EXPOSITOR.

THE LONDON GAS.

W. R. BOWDITCH.

H. LETHEBY.

To the Editor of THE LANCET.SIR,-Two articles in THE LANCET upon the subject of impu-

rities in London gas, seem to indicate that the enormous influenceof your journal is to be directed to this amongst other great socialevils. If so, I think it but right to inform you that a remedyhas been discovered for very much, if not the whole, of the evil, inthe use of Nature’s great natural purifying substance-clay. I

could, of course, enter at length upon my own researches in con-nexion with this subject, but prefer merely to send you a copy ofa letter of Dr. Letheby, who has investigated the matter withreference to the efficiency of clay for the proposed purpose. Theletter is entirely at your service.

I have the honour to be, Sir, your faithful servant,W. R. BOWDITCH.

Parsonage, St. Andrews, Wakefield, July, 1854.

(COPY.)Laboratory, London Hospital, July 7th, 1854.

DEAR SIR,-The result of my experiment with your process ofpurifying coal gas, by means of moist clay and lime, is on thewhole satisfactory and encouraging ; for I find that the clay whichhas been used in the purification of raw gas is charged with fourvery important impurities, viz., ammonia, sulphurettedhydrogen,tar, and a sulphur compound, which is, I believe, bisulphuret ofcarbon. The absorption of this last impurity, let it be what itmay, is of the highest interest ; in fact I regard it as of so muchpractical importance that I consider it necessary to describe theprocess which I adopted in the management of the experiment.The raw gas was taken from the pipe immediately before it entersthe lime purifiers, and it was passed through a series of threevessels containing lime, clay, and lime. The flow of gas wasallowed to go on for forty-eight hours ; at the expiration of whichtime the contents of each of the vessels were much discoloured.The clay had acquired an inky appearance from the formation ofsulphuret of iron. It absorbed abundance of ammonia ; and, in-deed, it had the offensive appearance and odour of the soil whichlies in juxta-position with the pipes in the public roads. The claywas drenched with its own bulk of rectified spirit sof wine, thentreated with a small quantity of powdered acetate of lead andfiltered, lastly it was saturated with ammonia and againfiltered. The clear solution thus obtained was introduced into aclean spirit lamp and burnt under a platinum rosette in such amanner that all the products of combustion were collected. Aparallel experiment was made with the same quantity of the samespirit, treated in exactly the same way. In the former case Iobtained a liquid which gave an abundant precipitate, with acidnitrate of baryta ; and in the latter the results were of a negativecharacter. It is clear from this that a soluble sulphur compoundwas removed from the gas by the clay, and this compound couldnot have been either sulphuretted hydrogen, sulphurous acid,sulphuric acid, or sulpho-cyanogen, for all these would have beenremoved by the acetate of lead. I conclude, therefore, that thecompound is, in all probability, bisulphuret of carbon ; but beforeI decide on this point, I will make an experiment on a muchlarger scale, and will subject the clay to distillation ; by whichmeans I hope to obtain sufficient material to enable me to separatethe sulphur compound.

I will communicate with you as soon as I have prosecuted theinquiry as far as I consider it necessary.

I remain, &c.,Rev. W. R. Bowditch. H. LETHEBY.

CONDITION OF THE RUSSIAN ARMY.CONDITION OF THE RUSSIAN ARMY.-Disease of everydescription is committing frightful havoc in the Russian Army.