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Page 1: Reviews and Notices of Books

128

very low state, and it was deemed expedient to cut down andsecure the bleeding vessel. This was performed by Dr. Holtonby- laying open the cicatrix for about three inches on the faceof the stump. On separating the edges of the wound, a clotabout the size of a large egg was found, and the haemorrhageevidently proceeded from the trunk main artery, which appearedhealthy. The clot was turned out, and a ligature applied tothe bleeding mouth of the artery. Notwithstanding the lowstate to which he was reduced, his pulse being scarcely per-ceptible, under the judicious use of stimulants he rallied, andthe stump healed without any return of the bleeding.

CASE 3.-(Repol’ted by Staff Assistant-Surgeon D. CAMPBELLTAYLOR. )-Henry White was admitted into hospital June26th, 1855, with a gun-shot wound of the groin, received inaction on the 18th. The ball entered a little below Poupart’sligament, externally to the pubis, passed downwards and out-wards, through the interior femoral and gluteal region, andescaped posteriorly. On admission there was profuse dischargefrom the wound, numbness along the inside of the thigh, butthe limb can be used without difficulty.

July 4th.-Aperture of entrance much smaller; dischargeless in quantity and healthy. On the evening of the 1st therewas slight haemorrhage.8th.-Wound improving fast; no more haemorrhage.15th.-A piece of cloth was extracted yesterday through the

anterior aperture. Still in hospital, but doing well.CASE 4.-(Reported by Staff Assistant-Surgeon HINDE.)-

Sergeant Geo. Anderson, 34th Regiment, aged twenty-seven,was wounded, on the 18th of June, in the left arm and leg.The ball entered the arm at about the junction of the middlewith the lower third, passed downwards, backwards, andinwards, and came out about three inches above the elbow-joint. He lay on the field from four o’clock in the morninguntil six in the evening, when he was conveyed direct on boardship, where he remained for two days. On the passage downto Scutari, haemorrhage took place from the wound in the arm,and the tourniquet was applied immediately, which controlledthe bleeding. He was admitted into the Barrack Hospital, onthe morning of the 24th, under the care of Dr. Bird, (CivilMedical Staff.) He appeared very low and weak, and lookedas if he had lost a considerable quantity of blood. He com-

plained of great pain, which was accounted for by the swellingand oedema of the arm, supposed to be probably the consequenceof. the necessary pressure by the tourniquet. After he hadbeen in the ward some time, pressure was cautiously andgradually diminished, and no blood appeared. About fouro’clock on the morning of the 25th, haemorrhage to the amountof about half an ounce took place, and the tourniquet wasagain tightened. About eleven A.M., as he complained of ex-cessive pain, the instrument was made slack. He then appearedvery easy, and slept until three o’clock. While Mr. Hindewas in the ward, he suddenly called out that it was bleedingagain. It was stopped by pressure in three or four minutes,but not before he had lost nearly a pint and a half of blood.This made him very faint, his face was blauched, and his pulseimperceptible at the wrist. He was a little revived by the useof stimulants, which he could only take in very small quantitiesat a time, owing to the excessive irritability of his stomach.As there was now no doubt that the brachial artery waswounded, Dr. Bird determined upon a ligature on that vesselat the seat of the injury. Accordingly, he cut down on thevessel at the course of the wound, and applied ligatures uponthe vessel above and below the opening in it. There was notan ounce of blood lost during the operation. The edges of thewound were brought together in the usual manner. He nevermade the slightest attempt to rally, and died about an hourafter the operation was performed. ,

A post-mortem examination was made of the injured arm,and it was found that the median and internal cutaneousnerves had been divided by the ball. The two venae comiteswere also completely divided, the biceps muscle was torn, andthere was a considerable amount of blood effused into thelimb. The brachial artery had been wounded about an inchand a half above its bifurcation. The ligatures had beenapplied properly above and below the wound in the artery.Remarks.-Oase 1 is, I think, interesting, as showing the

possibility of a ball splitting, as ignorance of this fact hasmisled surgeons. It is also interesting as showing the possi-bility of recovery from such serious consequences as must resultfrom the lodgment of a foreign body, such as a bullet, in orupon the brain. No doubt the symptoms might have beenthose of compression by the pieces of bone afterwards extracted,but there is every reason to believe that there is a portion ofthe bullet somewhere within the cranium. Mr. Guthrie seemsto think that persons seldom recover, with a ball lodged in the

anterior portion of the brain, and cites cases in which thepatients, having apparently completely recovered from theeffect of such an injury, afterwards died suddenly. It wouldbe interesting to watch this case.

Case 2 involves a point of practice, as to whether, in suchcases, the course to be adopted should be ligature of the arteryhigh up, or cutting down upon the face of the stump, andtying the vessel there. First-class Staff-surgeon Delange, whohas had considerable experience in gun-shot wounds, informsme, that in those cases in which the femoral artery has beentied in Scarpa’s angle, in case of secondary haemorrhage fromthe stump after amputation of the thigh, sloughing of the stumphas frequently occurred, from the supply of blood by anasto-mosis being cut off.

Case 3 is an instance of the manner in which arteries appearoften to be pushed aside by a ball; otherwise, in this case, howdid the internal circumflex artery and the large anastomosingbranches of the circumflex and sciatic, at the back of the thigh,escape ?

Case 4.-Even if the patient had lived, the limb couldscarcely have been saved : judging from the amount of injurydone to the veins and nerves, gangrene would most likely haveset in. In such cases, where heamorrhage occurs more thanonce, and there is a suspicion of the main artery being theinjured vessel, I believe the safest practice would be to cut downupon it at once, and tie it at the seat of injury.

Reviews and Notices of Books.Histoire de la D&couverte de la Circulation du Sa7zg. Par P.

FLOURENS, Secretaire Perp6tuel de 1’Academie des Sciences,&c.&c. Paris.

Tnis is one of an interesting series of books, by which M.Flourens, the worthy successor of Buffon, of Cuvier, &c., at theInstitute of France, has recently adorned the literature of

physiological and physical science.M. Flourens has made himself the generous and truthful

defender of the honour and fame of Harvey, in a " History ofthe Discovery of the Circulation of the Blood," which reads,in his beautiful style, like a biography of surpassing interest.

Before we can judge of the merits of this discovery, we mustinform ourselves with regard to the previous condition ofmedical opinion relative to the arteries, veins, and blood; forthe mere existence of all these was, of course, well known.On a cursory view of the internal tissues, two kinds of vessels

would present themselves to the observation of the physiologist.One of these is firm, a little opaque, and apparently nearlyempty, or containing air; the other is slighter, transparent,and replete with dark-coloured blood. How natural was it to,

regard the former as arteries or air-tubes, and the latter asblood-vessels !But in one part of the economy, another series of tubes

exists,.larger and more distinctly aÍ1--tubes; the trachea, orarteria-trachea, or r01lgh air-tube, subdividing itself, like the

arteries, into minor tubes or bronchia.It would be very natural to regard these two kinds of tubes,

so similar in the dead animal, as parts of the same system.The very designation of artery or air-tube, was calculated toperpetuate the error-the first error in regard to the circu-lation, or that of Erasistratus.

According to this ancient author, the air respired passedalong the trachea and the bronchia into the lungs, and thenceinto the heart and arteries.There were then arteries and veins, an arterial or air-

system, and a venous or blood-system; that is, two systems ofvessels, of which one conveyed air, and the other blood, to theremote parts of the body.

Galen punctured an artery, but blood and not air escapedfrom the orifice. It was the discovery of the method of in-vestigation by expaimel1t.

It was evident from this experiment, that the arteries donot contain air but blood; and they conveyed this blood,according to Galen, to the remoter parts of the system.. But

Page 2: Reviews and Notices of Books

129

the veins also were supposed to convey blood to the distantparts of the body. The blood of the arteries was designatedspirituous, that of the veins venous; for it was soon seen thatthere were two kinds of blood. The liver was especiallyobserved to abound in veins and venous blood. It was con-sidered to be the organ of sanguification..

Such was the condition of physiology until about the middle Iof the seventeenth century. I

Yet during the whole of this period, an event continuallypresented itself to the eyes of the physician, calculated toraise the veil of ignorance, or rather of miseonception, if itwere an easy thing to observe and interpret the plainest pheno-menu. Every day a ligature was applied to the arm, to pre-pare it for bloodletting; every day the veins were seen totumefy beyond the ligature; and yet these veins were stillbelieved to convey the blood from the central organs to thedistant parts ! 1Well has M. Biot observed, that there is nothing so clear

and obvious as the discovery of yesterday: nothing so obscureas that of to-morrow. ‘

Such is the fact of every discovery. Facts which ought toreveal the truth, are seen daily, and yet the truth remainshidden as before. Apples fall, veins swell beyond the liga-ture, every milkmaid knows that the cow-pox prevents thesmall-pox, and yet the principle of gravitation, the circulation,and vaccination remain undiscovered.

It is very difficult to fix an especial attention on an event ofdaily occurrence.

In 1574, Fabricius of Aquapendente discovered the exist-ence of valves in the veins. This was the hieroglyphic of thecirculation ! It was a hieroglyphic which Fabricius could notdecipher. The task was reserved for our own immortal

Harvey.Before the period of the discovery of Fabricius, several

authors had approached that of the circulation. Servetus-the

unhappy Servetus, burned as a heretic by the bigot Calvin-had stated that the blood sent forth from the right side of theheart, pursued a " marvellous" course through the vencc arte-riosa (the pulmonary artery), through the lungs, into thearte1’iae venosae (the pulmonary vein), to the left side of theheart. Servetus discovered the pulmonary are of the circu-lation !

Several anatomists-Columbus, Fallopius, Vesalius, Csesal-

pinus-arrived at the same point of knowledge. The last even

caught a glimpse of the systemic circulation, and used the veryterm ci1"culation.Then came Fabricius. And then-Harvey; and we might

quote on the occasion the words of Csesar.Nothing can be more beautiful, nothing more perfect and

complete, than the work of Harvey. It is in this fulness and

completeness of view, not less than in the mere fact of priority,that Harvey is the discoverer of the circulation of the blood.Here we must close our brief remarks. We recommend to

all our readers who wish to know the French language in itsbeauty, who wish to read a classic writer in physiology, andwho wish to become acquainted with the history of the circu-lation of the blood, this admirable little work. Would thatM. Flourens would so write the history of physiological dis-covery in general, and make us forget, and more than forget,the loss we have sustained in the unfinished work of Cuvier.

THE COMMITTEE OF INQUIRY ON THEADULTERATION OF FOOD, DRUGS, &c.

AT the meeting on Friday, the 3rd instant, Mr. SCHOLEFIELDin the chair,

Dr. THOMSON said, the first remark he had to make withreference to water was the inferiority of London in this respectcompared with other parts of the country. The quantity offoreign matter in Thames water varied with the season andthe locality. In September, 1854, the water supplied by theSouthwark and Vauxhall Company contained 72’66 grains per

gallon of solid matter. The water on March 15th, 1855, con-tained 23-8; on the 7th of May, 32’2; on the 7th of June,41’88; and on the 7th of July, 84’94 grains per gallon of solidmatter. The water was taken from the locality of St. Thomas’sHospital. The reason of this was explained by reference tothe diagrams produced, the first of which represented the com-parative impurity of the water supplied by the different com-panies ; the second, the degree of hardness ; and the third, thedegree of organic matter present in the water. At Vauxhall,the mechanical impurity of the water was 60 ’50; organicmatter, 5’28; inorganic, 36’64; total, 102-42. At Hunger-ford, mechanical impurity, 64’64; organic matter, 5’80; in-organic, 45’24; total, 115’68. At the south end of London-bridge, mechanical impurity, 63’44; organic matter, 4’72; in-organic, 45’08; total, 113’24 grains per gallon. The specimenswere Þ ken at the same hour of the same day, and about thetime of high water. At low water at Vauxhall, the mechanicalimpurity was 10’26; organic matter, 4’34; inorganic, 12’54; ;total, 27’14. At Hungerford, mechanical impurity, 16’80;organic matter, 8’40 ; inorganic, 23’64 ; total, 48’84. At thesouth end of London-bridge, mechanical impurity, 3 ’52; organicmatter, 7’36; inorganic, 21’20; total, 3208 grains per gallon;and at Greenwich on the same day, the mechanical impuritywas 2’07; organic matter, 19’44; inorganic, 72-52; making atotal of 95 ’68 grains per gallon. Dr. Thomson explained thatby mechanical impurity he intended matter which is diffusedthrough the water and can be removed by filtration; organicmatter, that which remains in solution, and is not removableby filtration; and by inorgauic matter, that which is not de-structible by heat, and is also held in solution. The " low-water" specimens were taken on the 2nd of September, 1854,and the " high-water" on the 8th of December, and after somecontinuance of dry weather. A specimen of water taken fromalongside the D)-eadnought hospital-ship at Greenwich con-tained sea-water, 9’04; organic matter, 21’28; silica and clay,69 ’68 in 100 parts. The difference between the water takenfrom the Thames at different places was due to the greater orless amount of sewage matter and sea-water. The water takenfrom cisterns supplied by the various companies contained car-bonate of lime in- the following proportions :-Lambeth Com-pany, 10’144; West Middlesex, 9’190; Chelsea, 9 -550; South-wark and Vauxhall, 10 ’070; New River, 11’985; East London,11’997; Kent, 10’540 grains per gallon. The presence of thecarbonate of lime necessitates the employment of a largerquantity of soap, and destroys the " caffeine" and " theine" intea and coffee, and materially interferes with the process ofdyeing.By Mr. ViLLIERS.-At present the water obtained from the

Thames was all more or less impure, but it would not be im-possible to obtain a pure water supply; the great difficultywas in an engineering point of view. It could not, however,be from any pecuniary profit that the companies supplied it ofan injurious quality. They might soften the water.By Mr. OTwAY.-The water in London was inferior to that

supplied in other large towns, and even after filtration con-tained sewage matters. Shallow wells were often very in-jurious. He (Dr. Thomson) had found the water containammonia and nitric acid, and in many cases urine.By Mr. VILLIERs.-On one occasion some water had been

sent to him from a house on the south side of the river, whichwas supplied by a shallow well. The children of the familycomplained of fever, and the water, being suspected, wasexamined, and found to contain nitrate of ammonia and nitricacid. The well was shut up, and the illness ceased. He wasconvinced, from the result of his examinations, that choleraprevailed to a greater or less extent according to the impurityor purity of the water supplied to a particular district., By Mr. MoFFAT.-The water in many places had improvedlately. There was no water in the world without some im-

purity, except distilled water. He accounted for the greateramount of impurity in the water at high tide from the fact ofthe presence of sea-water mingling with it. The water sup-plied to the metropolis might be improved by the applicationof lime, and he (Dr. Thomson) had been told by engineers whohad purified water in large quantities upon what was called"Dr. Clarke’s principle," that it was perfectly practicable toany extent. Boiling the water discharged a large quantity cifthe carbonate of lime, but not the magnesia. Filtration bycharcoal had been employed on a large scale.By the CHAIRMAN.-Was aware that by an Act passed in

1852 all the companies were required to filter their water aftera certain date (December, 1856).By Viscount EBRIN&TON. —Had some doubts whether filtra-

tion through charcoal would remove the organic as well as theI mechanical impurities. It would remove the colouring matter.


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