say, more common. Among the welleducated members of our profession, they are daily met with. They are the symbols of the new order of things, for a new order of things there is. Such, as lago says, we do profess ourselves, and to make more and more men in the profession such, we have worked, and, please God, we will work still.

This brings us to the point we aimed at. Is practical information of the description we have mentioned to be obtained by indulgence in disquisitions on abstractions-or in the plain study of plain facts? Suppose a man wishes to become practically conversant with surgery. If he possesses good sound sense, he does not lock himself up in his chamber, and devote night and day to the reading of Rhazes, and Albucasis, and Celsus, and Paré, and Benjamin Bell. No, he goes to the dissectingroom, and he learns anatomy thorough ly, and he also learns the elements of surgery and physic and materia medica, and being thus acquainted with the leading and established facts, he proceeds to the hospital ward and the hospital dead-house. He accurately notes the cases that prosent themselves, and the symptoms they exhibit. If the patient dies, he reads in the dead body the language of symptoms-if he recovers, he has observed the effects of medicine. This is the course of study which turns out a good surgeon.Journals should be conducted with a view to the same substantial results. They should collect the facts too widely scattered for individual observationand they should present those facts, those simple facts, for general perusal and consideration. This is our notion of what a practical journal should attempt, and for these reasons we usually select those cases which can be resolved into useful lessons for the man of much or of little experience. We leave to others the insatiate thirst for novelty, which sometimes gratifies but too often disappoints, and we content ourselves with endeavouring to point out what we think is sound philosophy-close observation, and rigorous reasoning.

The paper we are now to notice is by Dr. Browne, one of the surgeons of

Saint Mark's Hospital, and formerly surgeon to the County of Meath Infirmary. It is offered with a view to the elucidation of the surgical pathology and treatment of aneurism. He observes that in both parts of this subject there is still much difference of opinion, and he presents the following facts in order that they may tend, so far as they can, to increase our stock of knowledge. The cases are four in number, and occupy twenty-eight pages of our contemporary. They admit, we trust, of much compression.

CASE 1. Aneurism of the Posterior Tibial Artery - Scarpa's OperationDeath from Sinuses in the course of the Sartorius Muscle.

A man, æt. 27, admitted into the Infirmary, Aug. 27th, 1817. On examination, there was found an aneurism of the posterior tibial artery. A round tumor, resembling an orange in size and shape, existed in the centre of the upper and back part of the calf. It was deep seated, lying apparently beneath or in front of the belly of the gastrocnemius muscle; its upper edge was placed nearly three inches inferior to the lower margin of the popliteal space, and it extended downwards and laterally more than two inches in each direction. Pressure on the femoral and popliteal arteries arrested the pulsation, and diminished the size of this tumor. The disease had existed for two months. There was no disturbance of the health, of any consequence.

On the 1st of September, Dr. Browne performed the operation of tying the femoral artery, immediately above the sartorius. Some difficulty was experienced in finding the superior border of that muscle, and it was necessary to turn it outwards. Two ligatures were applied to the artery, on tying which the pulsation in the tumor ceased.

On the 2d day there was such symptomatic fever that twenty ounces of blood were abstracted, and purgatives, &c. were given. On the 3d day the bleeding was repeated On the 10th day, the lower ligature separated, the upper having come away on the 9th. Slight lividity of the integuments covering the

outer ankle, and superficial ulceration between the toes now occurred. The aneurismal tumor was reduced to a small hard substance of the size of half a nutmeg. An abscess now formed in the course of the artery upwards, and a sinus communicated with the wound. The patient got hectic with diarrhoea. On the 36th day an opening was made in the groin. The probe was now found to pass nearly its entire length on the inner side of the sartorius muscle, and deep in the flesh of the thigh; the discharge was very considerable. The hectic symptoms increased, and on the 41st day, the patient died, having previously evinced some features of thoracic inflammation.

Dr. Browne's remarks may be easily summed up. He inquires into the cause of the fatal sinuses beneath the sartorius. He thinks that they depended on an original want of vis vitæ and he furthermore thinks that the patient's death was occasioned by an aortic aneurism. The reasons for the latter extraordinary conclusion are, that the patient had a vibratory pulse, and that he had pain under the sternum with lividity of countenance the day before he died.

The latter supposition is so unsupported, that it is not worth while arguing it. But we would make this one observation on the cause of the collections of matter. We are not surprised at their occurrence, considering that the muscle was a good deal disturbed during the operation, and that the patient lost forty ounces of blood from the arm within two or three days after it. The two circumstances taken together will present a tolerably satisfactory ground of conjecture to most practical surgeons.

CASE 2. Diffused false Aneurism of the Popliteal Artery, from Wound by the Sequestrum of a necrosed FemurOperation-Death.

A young man, æt. 25, who had laboured under necrosis of the lower third of the right femur for some years, and in whom two fistulous openings discharged moderately, one on each side of the thigh a little above the joint,

was induced to dance at a wedding. In the midst of the glee, he felt sudden uneasiness in the thigh, and bleeding took place from each fistulous opening. Some compression was resorted to, but more or less hæmorrhage occurred for eight days, when he was received in the Meath Infirmary, under the care of Dr. Byron.

This gentleman finding that compression on the femoral artery arrested the bleeding, with great promptitude, decided upon tying that vessel in the upper third of the thigh: which operation was performed at the moment, without difficulty, and with the effect of putting an immediate stop to the hæmorrhage. The vis vita, however, had been previously too far exhausted to allow of salutary reaction, and the limb passed rapidly into gangrene,which quickly extended to the groin, and carried him off in a few hours.

The post mortem examination discovered a longitudinal slit nearly onefourth of an inch long, in the front of the popliteal artery, close to which lay a jagged portion of sequestrum; this was thin and sharp, and formed a part of half of the circumference of the cylinder of the old bone, the greater portion of which was firmly incased in the

new one.

Dr. Browne refers to two similar cases, one related by Dr. Jacob, and the other by Mr. Porter. In Dr. Jacob's case, amputation was performed, and the patient recovered. In Mr. Porter's the operation could not be performed, and the patient died. From various considerations, Dr. Brown considers amputation preferable to the ligature of the femoral artery in such cases, and most surgeons, we think, will feel inclined to agree with him.

CASE 3. Circumscribed false Aneurism of the Brachial Artery; a high Bifurcation; both Branches tied; the Aneurismal Sac opened; Recovery.

P. G. æt. 32, a shoemaker, admitted into the Infirmary, Dec. 28, 1824. Four days previously he had forcibly wounded the brachial artery with his knife. Great bleeding occurred at the

"On examination he was found to have received an incised wound on the inner side of the arm, two inches above the inner condyle, and one inch superior to the bend of the joint. This wound was an inch and a half long, and extended obliquely upwards and outwards; its surface was foul, but partially united, and its edges had been closed by four continuous sutures. To the outside of the wound was situated an aneurism half the size of a pigeon's egg, pulsating strongly and synchronously with the artery at the wrist; and the arm and forearm were swelled to at least twice their usual size, particularly on the fore and inner parts.'

It

By appropriate means the wound was healed, but the aneurism remained. Gentle pressure on it was tried. caused such irritation of the skin that the latter sloughed, and on the separation of the slough, hæmorrhage ensued. The following was the condition of the parts. The cavity of the aneurismal sac was exposed by an opening the size of a shilling, the sac itself being apparently as large as a common sized poppy head; there was considerable hardness and thickening of parts in the line of the brachial artery, extending up the arm for one hand's breadth above the sac; no pulsation was discoverable at the wrist, and the limb retained its natural temperature. The brachial artery was now tied above the tumor. Hæmorrhage issued from the latter on slackening the tourniquet; there was a high bifurcation. The second arterial trunk was tied; this did not stop the hæmorrhage. The following particulars are deserving of extraction without mutilation.

"The discharge of arterial blood having been altogether uninfluenced by these measures, it was determined to incise below the sac, and endeavour to tie one or both branches of the bifurcation, as might be found necessary. Accordingly, an oblique incision was made on the inner side of the arm, immediately below the sac, carried outwards two inches, and subsequently

made angular, by giving it a direction towards the biceps tendon. The veins and nerves were exposed, and the artery sought for without success, and in the course of these efforts the sac was opened below.

During the continuance of the recent operation, the tourniquet had been occasionally loosened, as the size of the opening in the sac enabled the thumb, assisted by a compress of lint, to command the bleeding; it was then, however, tightened, and the finger passed into the sac. That cavity was found to be of an extent considerably larger than had been supposed; it extended two inches in the direction of the external hardness, and three inches to the outside of the biceps tendon; altogether it might contain four ounces of coagula.

As the sac had been exposed, and the second opening made into it, and as there seemed no prospect of finding the wounded vessel below, it was deemed right to throw both wounds into one by a suitable incision. This having been done, the brachial artery was discovered lying at the bottom and middle part of the sac, and in the centre was an opening or slit, half an inch in length, extending longitudinally, from which blood issued with the same freedom as before on the tourniquet being relaxed.

The artery was considerably enlarged, nearly to twice the usual size, and its coats much thickened, particularly superior to the opening which had been made into it: inferior to this aperture its condition was more healthy, and one inch below it its state was altogether normal. At that point, therefore, (a little dissection being previously required to bring it into view,) a double ligature was applied upon it.

This measure, though it materially checked, did not arrest the hæmorrhage, for an oozing of florid blood still continued from the opening in the artery on relaxing the tourniquet. It was deemed prudent, therefore, to include the thickened portion of the vessel lying in the sac in a ligature, which was accordingly done, two inches superior to the opening in it, and then only did the bleeding cease.

The sac did not extend quite an inch below the wound in the artery, although it reached more than three inches above it; its orifice was lightly filled with charpie, and the other wounds were brought together by adhesive plaster. Compresses of lint and tow, with a flannel roller, were applied over all, after which he was put to bed, and got thirty drops of tincture of opium, being directed to keep quiet and live low.”

After this all went on well. On the fifth day, the surface of the exposed sac was granulating. On the eighth day there was feeble pulsation in the right radial artery in the wrist. On the 12th day all the ligatures came away; the cavity of the sac appeared obliterated. On the 15th day, slight pulsation in the right ulnar artery. On the 43rd day, the wounds were all healed, and on the 47th day the patient was dismissed. He then possessed nearly the full use of the limb. A strong pulsation was discovered in the profunda superior artery.

case.

This is undoubtedly an interesting In aneurism at the bend of the arm, from puncture of the brachial artery, or of the radial or the ulnar, supposing a high bifurcation, two operations are open to the surgeon. Either he may perform the Hunterian opertion for aneurism, and tie the artery above the tumour, or he may adopt the old operation-cut into the sac, expose the orifice of the vessels, and secure the latter above it and below it. Some authorities are in favour of the one, some advocate the other operation. We conceive that the rule of practice is clear. If pressure on the brachial artery, or on either or both of its branches, in the case of a high bifurcation, satisfactorily arrests the pulsation in the trunk, the surgeon should give his patient the chance of the ligature of the vessel in the arm. We have the experience of Mr. Colles in favour of this rational and moderate practice. With him, it has been highly successful. If, however, pressure in the artery in the arm does not sufficiently control the pulsation, &c. in the aneurism, or if the operation we have mentioned fails, then the surgeon must cut into the aneuris

mal tumor, and proceed in the ancient

manner.

The case before us was complicated. It is not impossible, nor, indeed, improbable, that if the operation of tying the artery in the arm had been performed, instead of using pressure, and producing an opening by sloughing into the aneurismal sac, it is not, we say, improbable, that a cure might have been effected. For the sac having partially sloughed, the case became analogous to one of wound, rather than to one of aneurism. In an aneurism, the simple retardation of the current of blood appears to be equal to effecting coagulation in the sac: but, in a wound, that would be quite insufficient to arrest the hæmorrhage from a large artery. We can, therefore, readily understand, that tying the artery above the tumor would cure traumatic aneurism, under ordinary circumstances, at the elbow, but would fail to cure it if the aneurismak sac was laid open. The case, we repeat, is one very worthy of the atten tion of practical surgeons.

CASE 4.-Aneurismal Varix at the Bend of the Arm-Cure by a Bandage.

A healthy labourer was admitted into St. Mark's Hospital, March 29th, 1830, for aneurismal varix of the left arm.

"The median basilic vein was dilated to about the same extent as we observe it to be when ordinary venesection is going to be performed; and the pulsations of the artery beneath it, accompanied by the peculiar thrilling sensation, resembling the noise produced by the wheel of a watermill, were distinctly and strongly perceptible both to the ear and to the touch. This thrill extended for at least an inch all round the site of the original puncture, and could be removed by moderate pressure on the vein, without the pulse at the wrist being interrupted.

Slight hardness existed in the situation of the wound in the artery, particularly towards its outer side, accompanied by yellowness of the skin along the inside of the arm; and the forearm could not be flexed peyond a right angle, nor extended perfectly."

He had been bled six days previously.

The blood flowed "per saltum," but was easily checked. Next day there was much ecchymosis, and a small pulsating tumor was observed under the orifice. In three days the orifice healed. Under the direction of Dr. Browne, a compress of lint, wet with lotio plumbi acetatis, was applied over the tumor, which was kept in its place by a roller, carried around the forearm and elbow; and some ordinary purgatives were directed. Digitalis was added afterwards. The compression and the latter remedy together effected so complete a cure, that, on the 12th of April, the patient was discharged cured. The arm was in a natural state, the vein of its usual size, and the artery felt beating beneath it, without increased strength in its pulsations, or any surrounding hardness.

We subjoin the following remarks.

"Aneurismal varix, at the bend of the arm, according to the opinions of the most approved authors, usually progresses in three several ways, viz. 1st. in the majority of instances the tumor, after attaining a certain moderate size, remains stationary, and, with ordinary care, and the avoidance of unusual exertion of the member, continues to be free from either danger or inconvenience during the rest of life. 2dly. Either from over-exertion or improper treatment, the cicatrix formed between the wounded artery and vein gives way, blood is effused into the intermediate and surrounding cellular tissue, and a varicose aneurism is eventually produced. 3dly. By careful and gradual compression,more particularly in young subjects, adhesive inflammation may be excited, by which the orifice of communication between the artery and vein becomes closed, the varicose swelling removed, and one or both of these vessels obliterated at the place; most usually the vein, but often both vein and artery.

Few surgical practitioners, however, are aware, I believe, of the fact, that an aneurismal varix may be radically and perfectly removed, all the tissues concerned in its production being restored to their original integrity, as oc

curred in the case which I have detailed.

But a termination so favourable must be deemed a rare event, and to account for it we must presume, that just so much lymph was effused as sufficed to agglutinate the lips of the wound in the artery, without being secreted in a quantity great enough to endanger the obliteration of its canal.

That the gentle pressure of the roller contributed to this effect is probable; but we must not forget that such an agent has been reprobated by authors, as giving rise, on several occasions, to the second termination of the disease which I have noticed, namely the formation of a varicose aneurism; it should, therefore, be used cautiously, ane its effects carefully watched."

The preceding cases merit the perusal of our readers.

ST. THOMAS'S HOSPITAL.

SYPHILITIC ERUPTIONS TREATED WITH HYDRIODATE OF POTASS.

Our readers are aware that the experiment of treating several forms of syphilitic secondary symptoms, by preparations of iodine, has been lately made. We have noticed the observations on this subject that have been, from time to time presented to the public, and we have watched with some small degree of curiosity, the amount of faith placed in the medicine. In the reports of St. Thomas's Hospital, edited by Mr. South, we find five cases of secondary eruptions, treated with bydriodate of potass. These cases we shall notice separately.