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examination, it was clear that the patient had lost a consider-able quantity of blood, and that the thigh was in some degreedistended with that fluid; the artery could be traced, violentlypulsating, above the cicatrix, as far as Poupart’s ligament.Signorini’s tourniquet had been very judiciously applied by.ATr. Ball, the house-surgeon. Mr. Adams now held a consul-tation with his colleagues, and it was determined that thewound should be laid open in order to seek for the spotwhence the haemorrhage came. A large quantity of coagulumwas found distending the thigh, in the direction of the sarto-rius muscle, which latter was distinctly visible; and a sinus,big enough to contain two fingers, ran upwards in the course ofthe femoral artery, and downwards along the inner edge ofthe sartorius, (this being the track of the abscess.) At the

upper part of this sinus the femoral artery could be distinctlyfelt, pulsating violently.After a careful examination, a coagulum was visible in con-

nexion with the artery, and on removing this, the source ofthe hemorrhage became at once apparent by the escape of aquantity of arterial blood. The forefinger was immediatelyapplied to the end of the vessel, and at once stopped thebleeding; the wound was now enlarged in the course of theartery, with a view to secure it, but the parts were so thick-ened around it, that Mr. Adams deemed it advisable at onceto apply a

Ligature on the External Iliac Artery.Mr. Adams accomplished this operation with no great diffi- ’,

culty, and all haemorrhage ceased immediately. The man was ’’

sent to bed, ordered thirty drops of laudanum, and the originalwound lightly brought together. ’

Mr. Adams observed, in a clinical lecture which he gave onthis case, that it was one replete with high interest. He hadcongratulated himself on the complete closure of the wound,and never dreaded that secondary haemorrhage could, undersuch circumstances, occur. Yet seven weeks after the firstoperation, and two after the closure of the wound, ulcera-tion occurred in the cicatrix, and great arterial bleedingcame on. He (Mr. Adams) need scarcely observe that thisulceration of the cicatrix is consequent on the haemorrhagewhich must have been going on previously. There are caseson record of secondary haemorrhage occurring a long timeafter the separation of the ligature, but he did not know ofany where this happened after cicatrization had taken place.In South’s edition of Chelius, a case is reported, which occurredin Air. Green’s practice, where secondary haemorrhage tookplace nine weeks after a ligature had been placed on the sub-clavian artery for axillary aneurism; but here a small sinushad remained open all the time. In the present case thewound had cicatrized at least a fortnight before the bleeding:this shows that we ought not to be too sanguine under themost favourable circumstances. He confessed that there hadalways been something about this man of an unfavourablecharacter. His countenance had an anxious expression, whichhe (Mr. Adams) could not account for. The patient hadnumerous attacks of erysipelas, accompanied with nausea andvomiting, and by looking at his ticket, it would be found thathis diet, medicine, and stimulants were repeatedly changed;this would show that he was not progressing quite favourably,still he (Mr. Adams) never anticipated haemorrhage after com-plete cicatrization. Two questions naturally suggested them-selves,-What was the source of haemorrhage ? and what wasthe practice to be pursued ? The haemorrhage may arise fromthe artery above, or from the artery below; it may come fromthe giving way of numerous small vessels, or it may comefrom the vein. The gush of arterial blood which took placein this case indicated its arterial source, the end of the arteryhad ulcerated, and this at once pointed to the necessity ofdoing something to prevent a repetition of the bleeding, whichwould be almost of necessity fatal. Having most able assist-ance at hand, Mr. Adams had determined to lay open thewound to find the source of the haemorrhage, and the resulthad been as above stated. If no large vessel had been dis-covered, he would have been contented with plugging thewound, and trusting to pressure. Now having found the endof the artery, was it best to secure it at the part affected, orwas it not preferable to tie the artery at some distance above,and where the vessel was more likely to be healthy ? Mr.Adams decidedly thought that in this case the latter alter-native alone could have been adopted with a fair prospect ofsuccess. To get at the vessel in the original wound was cer-tainly not difficult, as he had it under his finger; but it wouldhave been no easy matter to have isolated it from the veinwithout so disturbing its investments as to jeopardize its

vitality, and as in this case there was an obvious tendency todisease in the coats of the artery, there would have beengreater risk of subsequent ulceration than where the ligatureis applied at a spot remote from the disease.Mr. Adams had a few remarks to make about the operation.

It was one which had been performed a great many times,and the result of ligature on the external iliac is most en-couraging. Although there are various modifications of theoperation, the leading principles are the same: first, tomake a free incision through the integuments, -fascia, ten-don, muscle, and fascia transversalis, so that the operatormay not be embarrassed by too little space; secondly, to makethe incision to fall as nearly over the artery as possible.;thirdly, to be careful to divide the fascia transversalis, andpush the peritonaeum out of the way; and lastly, in passingthe needle, to disturb the coverings of the artery as little as

possible. With these principles in view, and with a correctknowledge of the anatomy of the parts, gained by dissection,there is little to fear as to the satisfactory accomplishment ofthe operation.

On the third day after the latter, the patient was progress-ing favourably, and the wounds were looking healthy. Therewas, however, a slight erysipelatous blush over the knee, andsome tendency to nausea. The bowels had acted, but in atrifling manner. He was ordered saline mixture with lauda-num, and he takes four ounces of wine daily, with beef-tea, &c.On the tenth day after the operation the patient was doing

well. Mr. Adams was allowing him a generous diet, and re-marked that it was not judicious to reduce the patient toomuch in cases of this kind, as thereby a cachectic state un-favourable to the speedy union of the artery might supervene.Eighteen days after the external iliac artery was tied, fresh

haemorrhage, to the extent of at least six ounces, took placefrom the wound made for the ligature of the external iliac.The wound itself, however, was healed, with the exception ofthe spot through which the ligature is coming out. The

haemorrhage was arrested by pressure, which was maintainedfor some days.On the 9th of April, twenty-seven days after the operation

upon the external iliac, the patient was very weak, the pulsefeeble and quick, and the countenance anxious. Pus could bepressed out of the abdominal, almost cicatrized wound, butthis pressure gave the patient exquisite pain. The ligaturehad not come awav.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, MARCH 23, 1850.—PROFESSOR MURPHY, PRESIDENT.

DR. CORMACK read an elaborate paper, entitled,THE ENTRANCE OF AIR BY THE OPEN MOUTHS OF THE UTERINE

VEINS CONSIDERED AS A CAUSE OF DANGER AND DEATH AFTER

PARTURITION.

The paper consisted of three parts:-1. The various effectscaused by the entrance of air into the veins, and the appear-ances found on dissection. 2. Statement of facts proving thatthe entrance of air by the open mouths of the uterine veinsmay cause dangerous symptoms, and even death. 3. Sugges-tions as to the prevention and treatment of such accidentsafter parturition; with remarks upon the precautions requiredin injecting the uterus after delivery for uterine haemorrhage.The opinion, that the entrance of air into the uterine veinsmight be a source of danger and death after parturition, hadbeen enunciated by Legallois in 1829, and subsequently byOllivier; it had likewise been supported by Dr. Cormack inhis " Graduation Thesis," published at Edinburgh in 1837.Dr. Cormack had attended cases in which air had been drawninto the womb after delivery by the sudden relaxation of theorgan, and occurrences of this kind he supposed must befrequent. Dr. Cormack quoted Dr. Meig’s very graphic de-scription of the way in which air was often drawn in and thenexpelled with noise by the womb after delivery. Dr. Cormackwished to prove that if any impediment existed to prevent theexit of the air which had been drawn in, it must, when theuterus acted, be thrown into the large orifices of the uterineveins, provided they were not secured by coagula or by theapposition of their parietes from contraction of the organ.He also showed, by anatomical facts, and by referring to theexperiments made by Dance, that the communication betweenthe cavity of the womb and the current of blood in the venacava inferior was direct and easy, and that air once introducedinto the uterine veins must soon be carried to the rightauricle of the heart; there-if in sufficient quantity-to cause

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frothing of blood, aeriform distention of the right side of theheart, obstruction of the pulmonary artery, and congestion ofthe pulmonary capillaries. Cases of this kind had actuallytaken place. One had been published by Lionet, and anotherby Wintrich. A case had also been published by Dr. Bessems,in which air had been thrown accidentally into the uterineveins when injecting the uterus to arrest haamorrhage. Thewoman died suddenly with symptoms of suffocation, and theright side of the heart was found distended by air. Dr. Cormackshowed, by a detail of experiments which he had performed,andalso by cases, that the entrance of air into the veins, even inconsiderable quantity, was not necessarily fatal. A case com-municated by Sir B. C. Brodie to Dr. Cormack illustrated thisfact. The general treatment for uterine haemorrhage, by in-ducing contraction of the uterus, also the plugging, would bethe means by which the entrance of air into the uterine veinswould be prevented. Should the accident occur, and the cir-culation and respiration become affected,and asphyxia be immi-nent, it would be necessary to unload the heart and pulmonary ’,

capillaries, by taking blood, following up the advantage so ’,gained by aspersion of the face with cold water, the applica-tion of stimulating embrocations, sinapisms, &c., and the in-ternal use of various stimuli. Dr. Cormack stated that in acase which he had watched for hours after the accidental en-trance of a large quantity of air into one of the veins of theneck, no advantage was got from stimuli till the heart wassomewhat relieved by venesection. This is the case whichoccurred at Barnes in 1848, and an account of the inquest onwhich appeared at the time in THE LANCET. In some cases,little or no treatment might be required. If the air was insmall quantity, it would be absorbed, if the patient surviveda sufficient time, and no bad consequences might ensue. Atthe same time, in some animals experimented on, Dr. Cormackfound that though they recovered from the immediate danger,they ultimately died from pneumonia. The cases mentionedby Dr. Simpson, in a communication to the late Dr. John Reid,and published in his collected Memoirs, were examined, andstated to belong to a different class from those of Bessems,Lionet, and Wintrich.

Letters were read from Dr. Collins, of Dublin, and from Dr.Lever, of London, to Dr. Cormack. The former knew of no casesof death from air entering the uterine veins ; the latter had

- seen three.In the discussion which followed, several fellows took part.

PATHOLOGICAL SOCIETY OF LONDON.MONDAY, MARCH 18, 1850.—DR. LATHAM, PRESIDENT.

(Communicated by Mr. POLLOCK.)

MR. FERGUSSON exhibited-

I. SPECIMENS OF ENCHONDROMA ON THE METACARPAL BONE AND

FIRST PHALANX OF THE MIDDLE FINGER, REMOVED FROM THEHAND OF A MIDDLE-AGED FEMALE.

The disease had been present about three years, and hadcaused exquisite suffering; pain was so constant and severeas to render the hand useless. Before operation the swel-lings (one about the size of a chesnut, the other about thatof a hazel-nut) seemed to involve the bones; but on exami-nation afterwards, each growth seemed to spring from theperiosteum; the smallest tumour (that from the phalanx)sprung from the periosteum in front of the bone, and in-volved the front part of the sheath of the flexor tendons;there were none of the digital nerves involved in thesegrowths. He referred to them as being rare examples ofsuch tumours being painful. Various casts and other prepa-rations, showing the ordinary appearances of tumours con-nected with the metacarpal bones and phalanges, were alsoexhibited.II. THE ARTICULAR EXTREMITIES OF THE BONES OF THE ELBOW,

SHOWING THE CONDITION REQUIRING EXCISION.

This operation had been performed a fortnight before. Theolecranon and coronoid process of the ulna, the head andcervix of the radius, and about one inch of the humerus, hadbeen removed. Other preparations were exhibited, showingsimilar diseases. In some of these excision had also beenperformed; in others, amputation had been resorted to.Mr. ToYNBEE produced an extensive series ofPREPARATIONS OF THE DISEASES OF THE MEMBRANA TYMPANI.

He remarked that time would not allow him to do more thanindicate briefly the principal pathological conditions to which.his structure is liable. In the first place, he would point out

the diseases to which each of the component structures ofthe membrana tympani is liable, independently of the others;and in the second place, describe those in which all its struc-tures are implicated. The external or epidermoid layer ofthe membrana tympani is found in two diseased states: thefirst is hypertrophy, in which it becomes many times thickerthan natural, and forms a. dense laminated mass, which ad-heres to the outer fibrous layer; the second diseased state iswhere it is slightly thicker than natural, its surface beingstudded by numerous small, round masses, and in this state itadheres to the fibrous layer much more firmly than natural.Before referring to the diseased conditions of the fibrous

laminaæ, it is requisite to observe, that it not only consists oftwo sets of fibres, the radiating and circular, but these sets offibres form two distinct layers, easily separated from eachother, and subject to diseases wholly independent of eachother. Thus it will be often found that the outer or radiatingfibrous layer is thicker, whiter, and more dense than natural;while the internal circular, fibrous layer is perfectly healthy;in other cases the internal layer is much thickened, whilethe outer layer is translucent and healthy. The externalsurface of the outer layer is frequently the seat ofchronic inflammation, when it becomes very thick and vas-cular, and is covered by granulations of a deep red colour;polypi are also developed from it. Chronic inflammation ofthe outer layer of the membrana tympani frequently inducesulceration, by which process portions of one, often of both ofthe fibrous laminae are destroyed, while the mucous mem-brane remains entire. In cases where only a small portion ofeach of the fibrous laminæ has thus been removed by ulcera-tion, a deep depression exists, caused by the mucous mem-brane bulging inwards. Where much of the fibrous coatshave been destroyed the mucous membrane falls inwards,towards the ossicula and promontory, and becomes adherentto them. The fibrous layers are also the seat of calcareousdeposit. The internal mucous laminæ of the membrana tym-pani, which in its natural state is so thin that it is frequentlydifficult to detect its presence, becomes thickened by chronicinflammation, and sometimes is so much hypertrophled, thatits inner surface is in contact with the promontory. In acute

inflammation, lymph is effused from this mucous layer, andbands of adhesion are formed, which connect it to the ossicula,or to the inner wall of the tympanum. The diseases of themembrana tympani, in which all its component structures areat the same time effected, are the following:-1. Hypertrophy,where the epidermoid, fibrous, and mucous layers are

thickened. This not unfrequently proceeds to so great an ex-tent, that the membrana tympani is ten or even twenty timesits natural thickness, and it becomes opaque, hard, and dense,like a piece of cartilage.-2. Ulceration, where all the layersare destroyed, wholly, or only in one part, so as to cause aperforation: 3. An increase of the external concavity, so thatits internal surface is in contact with the promontory withwhich it is frequently firmly adherent.-4. An absence of theexternal concavity, in place of which it is perfectly flat.-5. Scrofulous degeneration, in which all the layers lose theirnatural structure.-6. Calcareous degeneration, in which thereis often not a vestige of healthy structure in any of the layers.7. An increased degree of tenseness; this state is most fre-quently accompanied by the presence of membranous bands,which connect its inner surface to the promontory stapes, orother parts of the inner wall of the tympanum.-8. Sometimesthe whole of both fibrous coats are destroyed by ulceration, andthe mucous layer remaining entire, falls inwards, and coversthe surface of the promontory, and the inner wall of the tym-panum.-9. Sometimes one half of the membrana tympani isdestroyed, and the border of the remaining half becomes ad-herent to the inner wall of the tympanum, forming a closedcavity.-10. The entire substance of the membrana tympaniis sometimes ruptured. The part most subject to rupture isthat between the posterior margin and the handle of themalleus.

(To be continued.)

DEATH of DR. PROUT, F.R.S.-This distinguishedmember of the medical profession expired at his residence,Sackville-street, Piccadilly, on the 9th inst., at an advancedage. Dr. Prout was deservedly well known for his variouscontributions to medical science, particularly by his Bridge-water Treatise on Chemistry, Meteorology, and the Functionof Dizestion considered with reference to Natural Theology.The lamented deceased had also contributed many valuablepapers to the Philosophical Transactions.