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British Medical Journals.
205 11 an With regard to the large arteries of the extremities, I have liberty already applied torsion, in sixty-five cases, after amputaexcito-motory" action, tions and disarticulations,principallyperformed in the Clinique, mechanically and some in private practice. Although the operation in Dr. OLDHAM thought the contracted state of the os uteri &c. ’interfered with the secretion of the menses, by impairing the these cases has not succeeded so fully and securely as in the functions of the organ, and that these wererestored to a healthy preceding, yet in the majority it has answered. For the arteries of the forearm and leg, radial, ulnar, tibial, interosseal, action by its dilatation. Mr. SAFFORD LEE, (a visitor,) in reply to a question from torsion, either simple or after separation of the end of the Dr. Oldham, said that he had seen advantage from Dr. Rigby’s artery, has constantly succeeded, except in two cases, in one practice of injecting the 11 blue ointment" (in a liquid form) I of which, the anterior tibial, and in the other, posterior tibial, into the womb, for the relief of fibrous tumours’of that organ. gave way, and the ligature was required. On the brachial it He had known slight symptoms of peritonitis follow this prac- has always succeeded; and of twenty-three operations on the tice, but doubted whether the fluid ever passed up the Fallo- femoral and popliteal, it has failed in four cases, two already mentioned, the twisted portion having given way, and ligature pian tubes. Dr. OLDHAM thought that these symptoms might arise occa- being necessary. I know that with some surgeons of my sionally from air being forced along these tubes into the acquaintance, laceration and haemorrhage have been more peritonseal cavity during the use of injections. frequent; but that may depend upon error in method or Dr. inBENNETT thought that the application of nitrate of management. Fricke has enjoyed very good fortune, having silver, its solid form, to the vagina, in the cases alluded to, only one case of haemorrhage in thirteen torsions of the would be calculated occasionally to produce very great irrita- brachial, femoral, popliteal, and tibial arteries. He, however, has no bounds to his enthusiasm, and prefers the new operation, and was objectionable on that account.
organs to
a
r‘
by proper performance of their functions at or
by setting
the secretion
Dr. OLDHAM had never used it in acute cases. The President said that he was in the frequent habit of using the nitrate of silver, in its solid form, in the acute conjunctivitis of children, and had never seen any harm arise from it. According to the freedom with which it was applied, it might be made either a powerfully or a moderately stimulating application. He thought it would be a perfectly safe remedy in the cases alluded to. Dr. OLDHAM spoke of the great advantage arising from the use of the " potassa fusa" as a caustic in certain diseases of the uterus, and asked the experience of Mr. Safford Lee on this subject. Mr. SAFFORD LEE said, that in chronic inflammation, with enlargement and thickening of the cervix uteri, he had found this application very useful. In such cases, the effect seemed to be, that when the slough produced by this caustic was thrown off, a softening of the surrounding texture took place, very favourable to the case. Great care was, however, necessary in the application of this caustic, as, if any of it got upon the mucous membrane of the vagina, it produced intense irritation. He was in the habit of using the caustic protected by a stick of wax, and of passing up the vagina a piece of wool or cotton, well oiled, previous to its use, and of allowing a portion of this to remain at tint upper part of the passage, near the cervix uteri, so as to receive any drop that might fall. Adiourned.
British Medical
Journals.
tion in all cases, and twists with success even ossified arteries, which are not susceptible of torsion. On the other hand, the cases of Delpech and Textor are inconclusive, and of no more weight against this operation than the first unfortunate trials of the Hunterian operation in France by Desault and Des-
champs.’
"The author goes on to argue, that ill success is more frebe attributed to incapacity in the operator than to the condition of the vessel. If not twisted enough, the current of blood will reopen it; if too much, the coats give way. He continues:’The results of practical surgery correspond with, and are even more favourable than, the results of zootomy.’ " The conclusions are, that in wounds of arteries only can torsion take the place of the ligature; and as it is perfectly safe and secure when practised on the smaller arteries, it ought to be performed when those arteries are divided. The question with regard to the larger arteries is not yet settled; but it would appear that although torsion answers in the majority of cases, still the ligature affords greater security against
quently to
secondary h2emorrhage:’
THE CONTENTS OF THE F(ETAL STOMACH.
In the Edznburgh Monthly Journal, Dr. G. ROBINSON details a series of experiments performed on different animals, which appear, so far as can be judged without repeating them, to support the following conclusions:" 1. That the stomach of the foetus, during the latter period of its uterine existence, invariably contains a peculiar substance, differing from the liquor amnii, and generally of a nutritious nature. " 2. That in its physical and chemical properties, this substance varies very much in different animals, being in no two species precisely similar. " 3. That in each foetal animal, the contents of the stomach vary much at different periods; in the earlier stages of its development consisting chiefly of liquor amnii, to which the other peculiar matters are gradually added. "4. That the liquor amnii continues to be swallowed by the foetus up to the time of birth; and, consequently, after the formation of those matters,and their appearance in the stomach. " 5. That the mixture of this more solid and nutritious substance with the liquor amnii constitutes the material submitted to the process of chymification in the foetal intestines. The opinion that the foetal chyle is principally formed from these matters, however, by no means implies a supposition that the nutrition of the foetus is thus accomplished. For the actions which proceed in the chylopoietic viscera of the foetus are, I imagine, chiefly useful from their gradually preparing the different organs for the important functions assigned to them in the economy of the mature animal ; whereas the nutrition of the foetus is undoubtedly effected by its placental vessels, the venous capillaries of which (or, to speak more correctly, the streams traversing them) possess an absorbing power precisely similar to that of the mesenteric veins. And as a. portion of the foetal blood, charged with the albuminous substance there absorbed, after passing through the umbilical vein, circulates in the bloodvessels of the liver, the presence of an albuminous fluid in the hepatic duct, as noticed by Drs. Lee and Prout, is by no means inexplicable. Viewed in this light, the umbilical vein of the foetus will answer to the mesenteric veins of the adult, while the ramifications of the hepatic duct, in addition to their ordinary function, may be considered as, to a certain extent, representing the lacteals. -
A late number of the British and Foreign Review contains lengthened analysis of a work by M. PORTA on the
a
LIGATURE AND TORSION OF ARTERIES.
interesting facts are those which relate to the successful application of torsion, particularly in cases of divided arteries. The results are far moresatisfactory than they have been found by other surgeons; indeed, so favourable, as to justify a substitution of this process for that of the ligature, more particularly in cases where the smaller arteries have been divided, and the securing which is a source of painful delay in operations. " ’ From the beginning I kept an exact register to the number of four hundred; then I neglected to record the daily cases in hospital and private practice, in which torsion was applied, except in cases of amputation. It was applied to the occipitals, temporals, maxillary, superior thyroids, some branches of the subclavian, the thoracic, external pudic, spermatic, &c., and to the digitals, so that there is no artery of the fourth or fifth order upon the surface of the human body that has not been repeatedly twisted, after accidental wounds or cutting operations; and the result of so much practice, during nine years, has been fortunate beyond every expectation. I well remember, in some cases, to have been obliged to repeat the twisting two or three times; but I do not remember that the ligature was ever necessary on account , of torsion having failed. Thus I have ceased to employ the ligature for wounded arteries of moderate size, and now employ torsion only, as to the advantages of simplicity and celerity it - -tanites others, as it may be done without assistance, and does uot leave foreign bodies in the wound. The most
organs to
a
r‘
by proper performance of their functions at or
by setting
the secretion
Dr. OLDHAM had never used it in acute cases. The President said that he was in the frequent habit of using the nitrate of silver, in its solid form, in the acute conjunctivitis of children, and had never seen any harm arise from it. According to the freedom with which it was applied, it might be made either a powerfully or a moderately stimulating application. He thought it would be a perfectly safe remedy in the cases alluded to. Dr. OLDHAM spoke of the great advantage arising from the use of the " potassa fusa" as a caustic in certain diseases of the uterus, and asked the experience of Mr. Safford Lee on this subject. Mr. SAFFORD LEE said, that in chronic inflammation, with enlargement and thickening of the cervix uteri, he had found this application very useful. In such cases, the effect seemed to be, that when the slough produced by this caustic was thrown off, a softening of the surrounding texture took place, very favourable to the case. Great care was, however, necessary in the application of this caustic, as, if any of it got upon the mucous membrane of the vagina, it produced intense irritation. He was in the habit of using the caustic protected by a stick of wax, and of passing up the vagina a piece of wool or cotton, well oiled, previous to its use, and of allowing a portion of this to remain at tint upper part of the passage, near the cervix uteri, so as to receive any drop that might fall. Adiourned.
British Medical
Journals.
tion in all cases, and twists with success even ossified arteries, which are not susceptible of torsion. On the other hand, the cases of Delpech and Textor are inconclusive, and of no more weight against this operation than the first unfortunate trials of the Hunterian operation in France by Desault and Des-
champs.’
"The author goes on to argue, that ill success is more frebe attributed to incapacity in the operator than to the condition of the vessel. If not twisted enough, the current of blood will reopen it; if too much, the coats give way. He continues:’The results of practical surgery correspond with, and are even more favourable than, the results of zootomy.’ " The conclusions are, that in wounds of arteries only can torsion take the place of the ligature; and as it is perfectly safe and secure when practised on the smaller arteries, it ought to be performed when those arteries are divided. The question with regard to the larger arteries is not yet settled; but it would appear that although torsion answers in the majority of cases, still the ligature affords greater security against
quently to
secondary h2emorrhage:’
THE CONTENTS OF THE F(ETAL STOMACH.
In the Edznburgh Monthly Journal, Dr. G. ROBINSON details a series of experiments performed on different animals, which appear, so far as can be judged without repeating them, to support the following conclusions:" 1. That the stomach of the foetus, during the latter period of its uterine existence, invariably contains a peculiar substance, differing from the liquor amnii, and generally of a nutritious nature. " 2. That in its physical and chemical properties, this substance varies very much in different animals, being in no two species precisely similar. " 3. That in each foetal animal, the contents of the stomach vary much at different periods; in the earlier stages of its development consisting chiefly of liquor amnii, to which the other peculiar matters are gradually added. "4. That the liquor amnii continues to be swallowed by the foetus up to the time of birth; and, consequently, after the formation of those matters,and their appearance in the stomach. " 5. That the mixture of this more solid and nutritious substance with the liquor amnii constitutes the material submitted to the process of chymification in the foetal intestines. The opinion that the foetal chyle is principally formed from these matters, however, by no means implies a supposition that the nutrition of the foetus is thus accomplished. For the actions which proceed in the chylopoietic viscera of the foetus are, I imagine, chiefly useful from their gradually preparing the different organs for the important functions assigned to them in the economy of the mature animal ; whereas the nutrition of the foetus is undoubtedly effected by its placental vessels, the venous capillaries of which (or, to speak more correctly, the streams traversing them) possess an absorbing power precisely similar to that of the mesenteric veins. And as a. portion of the foetal blood, charged with the albuminous substance there absorbed, after passing through the umbilical vein, circulates in the bloodvessels of the liver, the presence of an albuminous fluid in the hepatic duct, as noticed by Drs. Lee and Prout, is by no means inexplicable. Viewed in this light, the umbilical vein of the foetus will answer to the mesenteric veins of the adult, while the ramifications of the hepatic duct, in addition to their ordinary function, may be considered as, to a certain extent, representing the lacteals. -
A late number of the British and Foreign Review contains lengthened analysis of a work by M. PORTA on the
a
LIGATURE AND TORSION OF ARTERIES.
interesting facts are those which relate to the successful application of torsion, particularly in cases of divided arteries. The results are far moresatisfactory than they have been found by other surgeons; indeed, so favourable, as to justify a substitution of this process for that of the ligature, more particularly in cases where the smaller arteries have been divided, and the securing which is a source of painful delay in operations. " ’ From the beginning I kept an exact register to the number of four hundred; then I neglected to record the daily cases in hospital and private practice, in which torsion was applied, except in cases of amputation. It was applied to the occipitals, temporals, maxillary, superior thyroids, some branches of the subclavian, the thoracic, external pudic, spermatic, &c., and to the digitals, so that there is no artery of the fourth or fifth order upon the surface of the human body that has not been repeatedly twisted, after accidental wounds or cutting operations; and the result of so much practice, during nine years, has been fortunate beyond every expectation. I well remember, in some cases, to have been obliged to repeat the twisting two or three times; but I do not remember that the ligature was ever necessary on account , of torsion having failed. Thus I have ceased to employ the ligature for wounded arteries of moderate size, and now employ torsion only, as to the advantages of simplicity and celerity it - -tanites others, as it may be done without assistance, and does uot leave foreign bodies in the wound. The most