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ROYAL MEDICAL & CHIRURGICAL SOCIETY. TUESDAY, JULY 1ST.
37 had had an attack of diarrhoM., which was not wholly arrested, but as she was suffering so much pain, he thought it wiser to the forearm at once. which was done at its upper third, under chloroform, on the 10th June. As was anticipated, the carpal joint was generally destroyed, the cartilage being removed, the bones exposed, and pus present. These disorganized joints, Mr. Erichsen further observed, were not common in advanced life, and when they do occur in old people, are generallythe result of long-continued rheumatic disease. In the present instance there was no rheumatism, but the mischief was the result of old standing disease. The progress of this patient subsequently was most satisfactory, the stump healingkindly.
Medical Societies.
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ROYAL MEDICAL &
CHIRURGICAL SOCIETY.
TUESDAY,
JULY 1ST.
DR. BABINGTON, PRESIDENT,
IN THE
CHAIR.
REPORT OF THE COMMITTEE APP01XTED TO INVESTIGATE THE SUBJECT OF SUSPENDED ANIMATION.
THE
inquiry was conductedBy means of experiments upon living animals; By means of experiments upon the dead human body. SIAPHYLORAPHY COMPLICATED WITH ENLARGED In investigating anew the subject of apnœa by means f TONSILS. periments on the lower animals, it seemed expedient to observe, THE operation of staphyloraphy is one so frequently practised in the first place, the principal phenomena of apnœa, in itsleasi form-namely, when produced by simply depriv. by Mr. Fergusson at Kind’s College Hospital, and we may say complicated the animal of air. invariably with success, that we have not usually drawn atten ingThe principal facts to which attention was directed during tion to it unless there was something special or unusual tc notice in the individual cases. On the 16th of June, a girl was the progress of the apnœa thus induced wereThe duration of the respiratory movements; submitted to the operation, with fissure through the soft palate, The duration of the heatt’s action. and a partial one through the hard. The parts were not abunThe duration of the heart’s action was observeddant, but yet 8ufficien ly fleshy to be favourable for the opera(n) In relation to the duration of the respiratory movements. which was the There was tion, satisfactorily accomplished. (b) In relation to the time after the stoppage of the breath. disadvantage, however, as Mr. Fergusson remarked, of enlargement of the tonsils, and patients will seldom submit to their ing. From the experiments performed it appeared that in the dog removal before the other operation. He thought the cases do not heal so kindly when the tonsils are enlarged. The patient the average duration of the respiratory movements after the in the present instance was at first refractory; but she calmed animal has been deprived of air is 4 min. 5 sec., the extremes 3min. 30 sec. and 4 min. 40 sec. The average duration down, and the operation was done with facility. It occupied being the heart’s action is 7 min, 11 sec., the extremes being from first to last but. twelve minutes-a very short time indeed, 6ofmin. 40 sec. and 7 rnin. 45 sec. Mr. Fergusson observed, particularly since four stitches were I these experiments it appears that on an average the From introduced.
action continues for 3 min. 15 sec. after the animal has ceased to make respiratory efforts, the extremes being 2 min. REMOVAL OF A USELESS LEG. and 4 min. respectively. ON the 21st ntt. Mr. Paget amputated the leg of a man in Rabbits on an average ceased to malte respiratory efforts in about thirty, who was the 3 min. 25 sec. Their heart’s action stopped in 7 min. 10 sec.; St. Bartholomew’s Hospital, subject of an ulcer at its lower and middle part of many years’ consequently the interval between the last respiratory effort standing, which rendered the limb perfectly useless for pro- and the cessation of the heart’s action was 3 min. 45 sec. The next question investigated was-the period after the gression, and his life most miserable. Last year he was a patient in the hospital and subsequently again for some months, with- simple deprivation of air at which recovery is possible, under out benefit. He had been in other hospitals as well. On his natural circumstances, without the aid of any artificial means present admission, he entreated Mr. Paget to remove his leg, of resuscitation. but that gentleman at first hesitated to do so, as the health The experiments performed led to the conclusion that a dog of the patient was indifferent. The latter, however, preferred may be deprived of air during 3 min. 50see., and afterwards risking his life to retaiuing his limb. Hitherto the result has recover without the application of artificial means ; that a dog been satisfactory. is not likely to recover, if left to itself, after having been deprived of air during 4 min. 10 sec. The force of the inspiratory efforts during apncea was obCURVED-HORN TOE NAIL. SOME months back, Mr. Erichsen removed from a woman, in served in the experiments to be so great that it was determined ro measure then). They were found to be capable, in the dog, University College Hospital, the great toe nail of the right of raising a column of four inches. It appeared, morefoot, which had been enlarged and growing in a curved horn- over, that their force increases up to a certain period. of manner for the It was shaped period twenty years. upwards In other experiments, plaster of Paris, and even mercury,. of two inches long. The neighbouring toes were becoming were thus drawn upward- into the minute bronchial tubes. somewhat similarly affected. It is easy to understand, therefore, how foreign bodies may be clracminto the lung’s in cases of drowning, and the importance of this fact in the consideration of the pathology and CANCER OF THE LIP IN A MAN AGED EIGHTY.
heart’s
aged
mercury
treatment
THE patient was in the Middlesex Hospital upwards of a year ago, with cancer of the lower lip of about three months’ duration ; the submaxillary glands were enlarged. The disease was a regular oval, smooth and shallow sore, almost a model of a Hunterian chancre at first ; it then gradllaJJ,V became irregular, and the epithelial form of cancer developed itself. The patient, eighty years of age, was a great smoker and found the sore no inconvenience. It was removed by a V incision by Mr. Mitchell Henry, and the wound beitle(I up by adhesion.
yet
to
NÆVUS AT THE END OF THE NOSE. months ago an infant was brought to University Col. with a nævus situated at the end of the nose. a little to the left side. ’Ihere was a question as to its treatment ; but as the nævus was irregular. Mr. Henry Thompson preferred ligaturing it, although it would leave a little cicatrix, and this was accordingly put into practice. He remarked, that even with the application of nitric acid, or of perchloride of iron, there was the cotainty of a cicatrix in the event of the occurrence of sloughing. We subsequently learnt that the Jigature was successful ; and as the child was so young, no mark 01 any importance would be ultimately observed. A
FEW
lege Hospital
ofapr.cet.
The Committee next passed on to the subject of drowning. The first question investigated was-For what period can an animal he submerged, and recover without the aid of artificial meat’s ? It was found as the result of numerous experiments on dogs. that, in striking contrast to the previous ones, 1½ minutes’ immersion in water suffices to clesr rov life. Other experiments satisfactorily showed that the difference of time between simple apnœa and that by drowning is not due
submersion,
or to
depression of temperature,
ur
to struggling,
hut that it is connected with the fact, rltat in the one case a free passage of air out of the lungs, and of water into them, is permitted ; in The other, the exit of air and the entrance of water are
prevented.
There c III be no doubt, from other considerations put forward, that although both these circumstances are concerned in producing the difference observed, yet that it is mainly due to the entrance of wafer and the effects thereby pro need. The treatment of apnœa was next considered. For conclusions respecting artificial respiration, the Committee refer o the second portion of the Report. Many other methods of resuscitation which have been recom-
mended
were
employed, including actual cautery, venesection,.
38 cold
splash, alternate application of hot and cold water, generally nearly equal to that previously inspired, occasionally less. galvanism, puncture of the diaphragm. Although some of the above means were occasionally of In the treatment of apnœa generally, the Committee offer the manifest advantage, no one was of such unequivocal efficacy in following suggestions:a sufficient number of cases as to warrant the Committee in That all obstruction to the passage of air to and from the specially recommending its adoption. lungs be at once, so far as is practicable, removed;-that the The experiments upon the dead subject were made with a mouth and nostrils, for example, be cleansed from all foreign
view to determine the value of the various methods which have matters or adhering mucus. That in the absence of natural respiration, artificial respirabeen employed for alternately compressing and expanding the Dr. Silvester’s plan be forthwith employed in the folcavity of the chest in such a manner as to imitate the natural tion by manner :-The body being laid on its back (either on a movements of the thoracic walls in breathing. The following lowing flat surface, or, better, on a plane inclined a little from the feet methods have been investigated:1. Pressure exerted by the hands on the anterior wall of the upwards), a firm cushion or some similar support should be under the shoulders, the head being kept on a line with thorax, the body being in the prone posture. Such pressure placed has for its object, to expel a portion of the air contained in the the trunk. The tongue should be drawn forward so as to prochest: on relaxing the pressure, the chest expands and air jecta little from the side of the mouth. Then the arms should be until they nearly meet above the head (the enters. 2. The postural or so-called " ready" method, described by operator graspingthem just above the elbows), and then at Dr. Marshall Hall, which consists essentially in "turning the once lowered and replaced at the side. This should be immefollowed by moderate pressure with both hands upon body gently on the side and a little beyond, and then briskly diately the of the sternum. This process is to be repeated on the face alternately;" and in making pressure along the twelve or fourteen times in the minute. back of the chest each time the body is brought into the prone That if no natural respiratory efforts supervene, a dash of position. water (120° Fahr.) or cold water be employed, for the purhot which the action of the The method of Dr. in 3. Silvester, of exciting respiratory efforts, pectoral and other muscles passing from the shoulders to the pose That the temperature ot the body be maintained by friction, of the in is imitated. An inchest deep inspiration parietes warm blankets, the warm bath, &c. spiratory effort is produced by extending the arms upwards by In the case of drowning, in addition to the foregoing suggesthe sides of the head ; on restoring them to their original position by the side of the body, the expanded walls are allowed tions, the following plan may be in the first instance practised: body with the face downwards, and hanging a little to resume their previous state, and expiration takes place, the over the of a table, shutter, or board, raised to an angle quantity of air expelled being in proportion to that which had of about edge thirty degrees, so that the head may be lower than been previously inspired. Open the mouth and draw the tongue forward. It being necessary to measure the flow of air in and out ofthe feet. the respiratory cavity under conditions of pressure closely re- Keep the body in this posture for a few seconds, or a little if fluid escapes. The escape of fluid may be assisted by sembling those which exist in natural respiration, no means ofC longer once or twice ul3on the back. pressing could be in its would measurement offet used, which, working, C. J. B. WILLIAMS, Chairman. any appreciable resistance to the passage of air. With this W. S. KIRKES. consideration in view, an instrument designed by Dr. Sandersor GEORGE HARLEY. was employed. (The instrument was exhibited to the Society.’ J. B. SANDERSON. C. E BROWN-SÉQUARD. Genera! results. H. HYDE SALTER. 1. As regards the volume of air which can be expelled from E. H. SIEVEKING, ex officio. the thorax by compression of its walls, and inspired by the WM. S. SAVORY, Hon. Secretary. elastic expansion consequent on relaxation of the pressure, it On the motion of Dr. Edward Smith, the resolution of the was found(a) That pressure by both hands on the lower third of the Council appointing the Committee was read. Dr. C. J. B. WILLIAMS said, that if the subject of suspended sternum in the adult male subject usually displaced from 8 to animation and its treatment appeared to be one of great im10 inches of air. The pressure actually exerted amounted to about 301bs. It portance when the Committee were appointed for its investiwas, therefore, not greater than might be safely applied to the gation, the result of their labours did not make it less so ; for living subject. The volume of air expelled varied from 8 cubic during their researches several new points of both physiological and practical interest had arrested their attention. The Report inches to 15 cubic inches. (b) That pressure made in the same manner on the upper just read contained a larg= mass of facts bearing on the sub. part of the sternum usually displaced 2 or 3 cubic inches less ject, and these facts would be fully appreciated when they should be maturely considered ; but the members of the Comthan pressure on the lower part. (c) That pressure exerted by one hand on the upper part, by mittee thought it might be acceptable to the Society if one of the other on the lower part of the sternum, produced about the their body were to give a short summary of some of the most same results as were observed in (1. striking results. He (Dr. Williams) had been requested to do In this case the whole amount of pressure did not exceed that this since he entered the room. and not having been previously aware of the office which would devolve on him, he was not exerted in a. (d) That the pressure of a weight laid on the lower third of prepared to go fully into details ; but be believed that he was with the general results of the expethe sternum produced similar results according to its amount. sufliciently (e) That lateral pressure exerted on the ribs or costal carti- riments to be enabled to give a summary of their most imporlages of both sides simultaneously was in no instance more tant features. He would premise that he could take no merit to with regard to the experiments which had been so effectual. ( f ) That compression by a broad bandage encircling the ingeniously devised and laboriously carried on by the other memchest, the ends of which were crossed over the sternum, and bers of the Committee. He had been present at very few of the drawn in opposite directions by two persons, produced no experiments themselves ; but, as chairman of the Committee, greater effect than pressure with the hands on the sternum or had merely as,,,isted in receiving and completing the reports sides. from the sub-committees. The Committee, having to consider 2. Asregards the whole amount of exchange of air produced the subject of " Suspended Animation," directed their inquiries " that kind of interference with life which results from stopby the method of Dr. Marshall Hall, to imitate respiration," it varied much, according as the subject was favourable or the page of the breath in suffocation, strangulation, and drowning. contrary ; sometimes not exceeding a few cubic inches, but The first series of experiments was to investigate the result of never exceeding 15 cubic inches. apncea, or stoppage of the breath ; and for this purpose 3. As regards Dr. Silvester’s methorl, it was found, that on the trachea of animals was opened, and a tube inserted so as to extending the arms upwards, a volume of air was inspired into command the supply of air; and this tube being furnished with the chest, which varied, in different subjects, from 9 to 44 cubic a stop-cock could be closed, and the results noted, especially inches, and it was observed that the results obtained in sue. these :-After the closure of the tube, 1. how long respiratory cessful experiments on the same body were remarkably uniform, efforts continue; 2, how long the heart’s action continues; 3, in which respect, as well as in their amount, they contrastecL how long the heart beats after the breathing efforts cease. The with those obtained bv the method of Dr. M. Hall. Or experiments show a considerable variety of result ; but, as a average, it may be stated that in dogs efforts at breathrestoring the arms to the side, the quantity of air expelled wa:
drawn upwards lower part
.
- Place the
_
"
acquainted
himself
to
simple
.
.
general
39 continued a few seconds more than four minutes after the and their extravasation into the bronchial tubes. This was a closure of the tube ; and the heart’s action three minutes and a subject for further experimental investigation, and he thought quarter longer. The duration and force of these respiratory it one of great importance, as bearing on the action of water as efforts, in an animal deprived of air, were not more remarkable a noxious or a therapeutic agent. He would not detail the than important as inlicatino, the period within which an ani- various means of resuscitation which were tried by the Commal deprived of air could recover; and this was found to be mittee, but the results of the trials were not such as to induce almost, but not quite, as long as the duration of these efforts- the Committee to recommend them strongly for general adopthat is to say, a dog deprived of air four minutes only, tion. Various instructive experiments were made on different would recover ; but if the exclusion of air lasted ten se- modes of performing artificial respiration, and the most concluconds longer, he did not recover. The extraordinary force sive of these had reference to he so-called "ready methods" of of these struggles for breath was shown by plunging the end Dr. Marshall Hall and Dr. Silvester. One of their Committee of the tube into mercury; when it was found that the in- (Dr. Sanderson) contrived the apparatus on the table for measpiratory effort sometimes raised a column of four inches of suring the air which could be forced out of it into the lungs of mercury, and, if the tube was shorter, would draw the quick- a dead body by these methods of artificial respiration ; and silver in considerable quantities into the bronchial tubes and the general result was, that by Dr. Hall’s method the quantity air-cells of the lungs. The next subject of investigation was of air moved in and out of the lungs rarely reached nine cubic suspended animation from drowning; and here the experi- inches, and never exceeded fifteen; whereas by Dr. Silvester’s menters soon found a remarkable difference in the greater ra- plan an interchange of forty cubic inches was effected ; and pidity of the death, and the shorter time during which life is when this method was further improved by alternating the recoverable. An animal simply deprived of air for four minutes drawing up of the arms, with depressing them, and with presmay recover; but one immersed in water for one minute and a sure on the lower part of the sternum, the expelled air was as half is irrecoverably dead. Recovery took place in several much as fifty cubic inches. So far, then, as these experiments cases where the immersion lasted one minute and fifteen go, they show a great superiority of Dr. Silvester’s over Dr. seconds; but fifteen seconds more made all the difference. The Marshall Hall’s " ready method." Dr. EDWARD SMITH remarked upon the great importance of experimenters proceeded to search into the cause of this peculiarly destructive operation of drowning, as compared with the present discussion from the interest of the subject, and the simple privation of air ; and very soon they were enabled to trace fact that this being the first occasion on which the Society had it to the action of the water itself, forcibly drawn into the lungs appointed a Committee to make scientific investigations, it by the respiratory struggles of the animal. Two dogs were might be a precedent for future action. He thought it most plunged into water, one having its trachea closed by a stop- desirable that the Society should endeavour to accurately esticock at the moment of immersion. The dog with the trachea mate the true value of the results which such Committees free was taken out in two minutes, irrecoverably dead. The could produce. On the present occasion they had a Committee other, with the trachea closed, was taken out at the end of amongst whom were men of world-wide reputation, and a subfour minutes; the trachea was opened, and in the course of a ject of inquiry of the highest interest, and not of greater comfew seconds the animal began to gasp, and soon recovered. plexity than would be found in all practical questions in Another mode of diminishing the inspiratory struggles of the medicine. The Report must be regarded in two aspects : one, animal was by stupefying it with chloroform before immersion that of the scientific facts which had been elicited ; the other, in water, and it was actually found that recovery took place in their exact application to the purposes for which the Comafter two minutes and fifteen seconds’ immersion. On this mittee was appointed-to determine the best methods of point he (Dr. Williams) adverted to a popular opinion, that it restoring the drowned. As to the facts, no one could doubt is more difficult to drown a drunken man than one who is their extent and interest, the care with which they had been sober, as having some foundation on this fact, that insensibility ascertained, and the pains taken to estimate the influence of The methods adopted appeared also to of any kind retards the fatal influence of drowning by dimi- disturbing causes. nishing those violent struggles for breath which, by forcing have been very correct. He wished to know if the construcBut tion of the spirometer with a long arm and the scale. at the end water into the lungs, soon put the case beyond recovery. nothing so fully pointed out the extent and nature of the fatal of it gave a more minute registration than would be found with influence of water in the lungs as the appearance of these other air-holders of small diameter with the scale at the side, organs in drowned animals as compared with those killed by for this was simply an air-holder after the plan of Davy, simple apncea. In the latter the air-passages remained free Pereira, and Hutchinson. He adverted to the importance of from all secretion or effusion, and the lungs themselves were the quantity of bloody water found in the lungs of the dogs light and buoyant, and contained remarkably little blood. Now drowned, and explained that the water would be introduced this is contrary to what is generally described as the state of from the bronchi into the bloodvessels by endosmosis, and the lungs in asphyxia; and probably in ordinary cases, where these would cause the swelling and bursting of the blood-cordeath is not sudden, but prolonged, more or less engorgement puscles after the circulation had been greatly retarded or may take place. But here there was no engorgement or ob- arrested, and would also cause rupture of the capillaries, or the struction, and it was not wonderful that animals would recover attenuated blood would pass through the walls by exosmosis, more readily. But with drowned animals not only were all and thus appear in the bronchi. He did not think that the the air-passages choked with frothy fluid, and that fixid gene- experiments upon the action of chloroform in deferring the rally more or less bloody, but the whole lungs were always fatal issue were conclusive, since they were too few, and the highly engorged with blood, so that they were heavy, dark- increased duration of. life very small, and it had not been coloured, pitted on pressure, and on beingcut, exuded an abun- shown that a narcotized animal might not have greater toledance of blood-tinged fluid with many air-bubbles in it. On ranee of apncea independent of the idea which the Committee this subject he would make two remarks on his own respon- had - the diminution of muscular effort. The matter of sibility, apart from his office in the Committee. One was, greatest interest in the Report was the comparison of the MarHow opposed these observations and conclusions are to those shall Hall and Silvester methods, and he (Dr. Smith) thought many years ago propounded by Goodwyn in his treatise on that both might be equally advantageous in the cases in quesSuspended Animation, whose opinions have generally been tion. The experiments had shown that, with the lungs full, adopted to the present time. G 10d wyn concluded from his there was greater change of air with the Silvester method. observations, that water never to a hurtful extent enters the The Marshall Hall method started from the point of expiration, lungs of the drowned, and he deprecated the popular practice but living persons could by their effort expire forty cubic inches of hanging up a drowned person by the heels to let the water below that point, and if, by external pressure on the inanimate, run out. He (Dr. Williams) was by no means sure that, as Dr. one half of that quantity could be displaced, it would probably Goodwyn was certainly wrong in his pathology, some modifica- suffice for the purpose in hand. The Silvester method, by tion of the popular practice may not be beneficial. The other enlarging the cavity of the chest above the line of expiration, remark related to the mode in which the water which got into the must cause greater displacement of air ; but it had been lungs of the drowned proved so rapidly and extensively injurious. shown by the Report, that in a case of phthisis, where the lung No doubt much was due to its mechanical pressure on the tubes capacity was greatly reduced, the effect of the two methods and cells, forming an impervious barrier to the readmission of air; was precisely the same. Such would also probably be the case but this would not account for the extraordinary increase of with drowned persons, in whom the lungs were full of water, blood in the lung, and its transudation into the air-tubes. He which offered a great obstacle to the introduction of air; and believed the injurious influence of water to be due to its chemi- in this condition the Committee had not made any experiments. eal power of acting by endosmosis on the blood within the It was in reference to the practical object in the appointment capillaries of the lungs, swelling up and bursting the blood- of the Commi tee that the Report failed. The Committee had corpuscles, and causing their rapid accumulation in the organ, not proved that any one of their inquiries was applicable to
ing
B2
40 The time during which a man suspended animation in the human individual, and concluded the drowned human subject. could be immersed in water and recover could not be proved by that the instrument used by the Committee in by experiments on dogs, and the Committee themselves had their inquiries was one he had invented and described in 1854; shown that all their plans for the restoration of drowned dogs it nearly so practical as that exhibited lately to the had failed. The Committee had, in one part of the Report, Society. disclaimed any intention to sav how far the Silvester method Mr. CHARLES HUNTER said, that as he was one of those genwas fitted for the restoration of the drowned ; and yet in their tlemen who six years ago conducted the experiments upon the recommendations they advise the use of this method almost dead body for Dr. Marshall Hall, and upon those experiments - exclusively, without having in any experiment tried it, under the " Ready Niethod" was established, he felt called upon for The recommendation to place the body a few words in its defence. He regretted that the Committee these conditions. prone, and allow fluid to run out of the mouth, was an old thought fit to condemn it, and observed, that if the Marshall recommendation ; but they had inferred, and not proved. its Hall method after all was a failure, the long series of experivalue, and that only from experiments on drowned dogs which ments carefully made by him (Mr. Hunter) with others must go they could not resuscitate. The experiments ou dogs had for nothing; and yet the original experiments were much more shown that neither cold nor hot water alone had any value as numerous than those made by this Committee, and perfectly restorative agents, but that the alternative of the two was conclusive in their general results to those who made and saw somewhat useful ; but this alternative had not been recom- them. They were, moreover, backed by astonishing evidence mended for man. Hence he (Dr. Smith) regarded this Report in its favour from medical men in all parts of the kingdomas but the commencement of the inquiry, a labour which had testifying to its success in actual cases of drowning. In reply elicited important facts fitted to be employed in further re- to Dr. Harley, he said the Silvester plan was tried a few times, searches ; but as to the great object had in view in the appoint- but without success equal to that obtained by the " Ready ment of the Committee-the scientific determination of the Method."He would correct the idea that only ten cubic inches best method for restoring drowned men-he thought that it were obtained in the experiments-it was much more, and, in altogether failed. He urged the importance of the same gentle- favourable cases, varied between twenty-five and thirty-five men continuing the inquiry, and of making experiments under inches, and sometimes forty inches. Mr. Hunter was the conditions in which the knowledge must be applied, viz., glad to find his own experiments on the lungs of drowned aniupon men after immersion. He thought that the results of themals, as described by him in THE LANCET, were corroborated present inquiry proved that for the observation of defined facts by the Committee; he was also glad to hear that they did recommend the pronation of the body as the first measure in cases with known methods of inquiry, or with slight modifications of drowning-it was the essential part of the Marshall Hall known methods, the of Committees would -the work being done at a given time, and with authority, pro- treatment. The special advantages of the pronation are that vided the names of the observers were appended to each fluids escape from the mouth, throat, and lungs, and the tongue - observation ; but for the solution of complex questions (as dropping forward leaves the glottis free during inspiration. He questions of practice are), Committees would fail, since the was sorry, then, to find that the Committee recommend the Silvester plan. He could imagine no plan so rational as the ,essence of such an inquiry is the invention of a new method, method for a case of drowning. The experiand new methods can never be devised to order, but only Marshall through long continued thought without the investigator being ments of theCommittee prove that water is drawn forcibly into lungs in drowning, and that that water hastens death; ’commonly able to trace the steps which led him to the result, Hence the last series of questions must always be solved as how necessary, therefore, a method of recovery that will get of the water ! The Committee objected to the Marshall heretofore by individuals, and that not in any particular country, age, or time, but when the happy idea has occurred Hall method that the expiratory act precedes the inspiratory. considered it a physiological advantage, as by first to an inquirer. Such he believed to be the experience of those Mr. -who had been extensively engaged in scientific research. He inducing expiration much of the fluid is got rid of that has entered the lungs, as well as the bad air, which it is as imporattached great value to the facts contained in the Report. of as to introduce good air. He observed that to Dr. WEBSTER said that he thought the Silvester method was the best, and that the recommendation was very important, frequently in his experiments artificial respiration could not be He was sorry to hear that the lives of so many dogs had been effected in the supine position, but could by prono-lateral movesacrificed in the experiments, He hoped that in future, if ments. He considered that in drowning cases pronation of the body should be continued some length of time, as fluid can be possible, experiments on living animals would be avoided, Dr. MARCET agreed with Dr. Edward Smith, inasmuch as, expelled from the lungs of a drowned individual for half an from the method of investigation adopted by the Committee, hour by the Marshall Hall method. He inquired if the Comhe felt assured of the correctness of their results. He was, mittee meant to recommend the continuous warm bath or not, however, sorry that so little consideration had been given to as they had recorded no experiments in the Report. His own the instrumental means of performing artificial respiration, observations he considered proved it to be a most prejudicial which he believed to be of the greatest importance in a prac- measure, impeding respiratory action, and excluding the prone tical point of view; because, in his opinion, a much larger and postural movements. Mr. ACTON was sorry to hear that the opposition to the Re,quantity of air was required to inflate the lungs in suspended animation than the Silvester or the Marshall Hall method port was more to its details than to the Report itself. He -could possibly effect. It was to be borne in mind that in cases thought that the members of the Society should consider that of asphyxia or of poisoning by chloroform, a poisonous gas ac the Committee had come forward for the first time, and that, cumulated in the blood; and the object of artificial respira- as in the Academy of Medicine at Paris, they ought to be rewith laudation. Members of the Society should not tion was, to remove this poison and excite the action of the heart. He (Dr. Marcet) contended that in order to obtain come forward, each with his own particular views, to attack the Report ; and, instead of dwelling on its shortcomings, they a sufficient amount of diffusion to allow of poisonous gases to escape from the blood at the lungs, it was necessary that these ought to receive the labour of the Committee thankfully. Dr. EiDD considered that artificial respiration would be organs should be inflated with as much or nearly as much air in restoring persons from the effects of an overdose of as they could contain, and this no ready method was capable of doing, as the volume of air required would be from 150 to chloroform. He had seen cases in which pressure on the chest 200 cubic inches. He believed that instruments for performing seemed to restore life. Dr. C. J. B. WILLIAMS said that the experiments detailed in artificial respiration should not be set aside on the ground that they cannot be had and applied quick enough when wanted, the Report had been made with great care, and the methods of and proposed that surgeons and hospitals should provide them- Dr. Marshall Hall and Dr. Silvester had been fully comselves with some apparatus of acknowledged efficiency for in- pared. He thought that the Committee had done wisely flating the lungs. In hospitals there would be no difficulty in in not recommending instruments, but what they consicarrying out this plan, so as to have in readiness a means of dered to be the readiest plan under all circumstances. He restoring animation in cases of accidents with chloroform. Dr. would remark, in reply to some objections made by Dr. Marcet then alluded to the instrument he had exhibited to the Webster as to the destruction of animal life involved in these that no one experiment had been undertaken Society on the 11th February last. He said he had obtained most satisfactory results when using it to restore animation in without a definite and a useful object; that animal sufferings cases of dogs poisoned with chloroform, and that in these expe- ; and life had been spared as much as was possible in pursuing riments he had been able to avoid peforming tracheotomy for ’ inquiry; and he did not think that, when it was considered the purpose of inserting a canula into the trachea, which greatly how animal life was hourly and unsparingly sacrificed for the added to the interest of the results. He had no doubt that this gratification of appetite, there could be any objection to the very simole instrument would prove most available in cases of ded;catic)n of a few lives to the elucidation of a subject of real
observing
wasnot
-
cubic
appointment
of ensure
all
Hall
the rid
Hunter
tant get rid
ceived
valuable
I
experiments,
the
41 importance to the interests of humanity. In answer to Mr. Hunter’s question, he would observe that the Committee did not recommend the warm bath, but, if necessary, the alternat-e application of hot and cold water.
Reviews A Manual TOPHER
of
and
-zlfino2-
Notices of Books.
Assistant-Surgeon
to
and
Bandaging. By CHRISHospital, Westminster Hospital, &c. Second
Surgery
HEATH, Surgeon
to the West of London
London: Churchill. THE difference between a good surgeon and a bad one is said very often to lie in the observance of small things. The general principles and more serious operations of surgery are common to most men in about the same degree and kind; but there is a large number of unwritten details of management which will often make the difference between success and failure. In hospitals these are usually left to the house-surgeon and assistants, who are trained by, and act under, the directions of the chief surgeons. Mr. Heath, therefore, in reducing this floating surgi-cal lore to a written code has conveniently addressed his book to house-surgeons ; but, in truth, it concerns all who operate, and who are responsible for the treatment of all those minor accidents which make up the bulk of ordinary surgical practice. Embodying the general practice of our hospitals, and more especially that of Mr. Fergusson, under whom Mr. Heath was trained, this book could not fail to be very useful, and perfectly explanatory of the best average methods of procedure. The early call for a second edition shows that it has found numerous readers, and it is likely to have a permanent sale. This edition is enlarged and improved. We do not always agree with the rules laid down. It was necessary to be somewhat dogmatic in such a book, and this tone appears to be so far congenial to the mind of the author that he never ceases to maintain it. He is unhesitating in his judgments and directions; but, in teaching, it is no doubt better to make up your own mind and prescribe a definite course to the student. In puncturing the tonsil, Mr. Heath directs the bistoury to be thrust through the palate. This is quite unne. " No sutures must be placed in a cut throat ;; this is cessary. important," says the author in italics. This, again, is a precept which admits of modification. Where the incision is a wide gash, as it commonly is, involving a considerable extent of soft parts, it is frequently very advisable to put in sutures on either side, leaving only the median part of the wound open. It would be easy to multiply instances of a similar kind, but this is not requisite. There is very little room for fault-finding in Mr. Heath’s book, and a great deal to praise. It is the production of a thoroughly practical, well-informed man, and will be useful to all house-surgeons, and to others who have a mind to do their own work, and to do it well Edition.
Ligature of the
Gloteal Artery for Traumatic Aneurism. By GEORGE W. (JAMPBELL, A. M., M.D., &c., Professor oj Surgery, M’Gill University, Montreal. Pamphlet.
ANEURISMS of the gluteal artery are commonly traumatic, and when otherwise, they are treated by ligature of the internal or common iliac artery. In the traumatic form, however, ligature of the gluteal is recommended as preferable, but it is an extremely difficult operation in consequence of the deel dissection necessary to reach the vessel, and the complication of surrounding circumstances, especially the great and alarming haemorrhage oftentimes attending it. The celebrated case oi John Bell, and the more recent and not less remarkable one o] Mr. Syme, (THE LANCET, vol. i., 1861, p. 610,) in which tht gluteal artery was tied for large aneurisms of that vessel, musi be familiar to the profession. Of all operations usually wit. nessed, probably none appears more alarming than ligature A small gluteal aneurism would in of the glutea.1artery.
The assume great proportions if not attended to early. of Professor Campbell, of 1Iontreal, occurred in a lad aged fourteen, under the c:tre of Dr. Fenwick. He had sustained a severe wound in the buttock by a sharp-pointed piece of iron, heated to whiteness in a blacksmith’s shop. Much bleeding followed, and the result was the formation- of an aneurism of the gluteal artery, which gave rise to repeated and dangerous attacks of haemorrhage. The tumour was of the size of a hen’s egg, and the trunk ofthe vessel was tied where it emerges from the sciatic notch, without opening the sac of the aneurism. Not half an ounce of blood was lost, and the ultimate result t;me case
was
satisfactory.
Professor
Campbell states that the plan of procedure he adopted was more fortunate in its results, and certainly much less difficult in its execution, than if the ordinary rule in traumatic aneurism had been adopted, of opening the sac, aatl securing the orifice of the artery there. The patient had already been so much enfeebled by previous haemorrhages that it wasessential to his very existence that the operation should be performed with as little further loss of blood as possible. Dr. Campbell’s pamphlet is well worthy of attentive perusal. in Ano, and Hœmorrhoidal Affections; Pathology and Treatment. By T..J. ASHTON, iormerly Surgeon to the Blenheim Free Dispensary, &c. pp. 182. Fcap. Svo. London : Churchill. IN Mr. Ashton’s well-known and larger work, " On the Diseases of the Rectum," which has passed through three editions, and been reprinted in America, all the affections of the lower bowel are most fully considered. He has, however, wisely we think, adopted the suggestion of publishing, in a separate
Prollopsits, Fistula their
a treatise on those common diseases of the rectum which by their frequent occurrence more constantly claim attention. The present little work is, therefore, devoted to the subjects of Prolapsus, Fistula, and Haemorrhoids, mostly rewritten with the intention of more clearly pointing out the two conditions under which prolapsus of the rectum occurs, the structural differences of the several kinds of hæmorrhoidal tumour with special reference to their treatment, and the manner in which the internal opening in fistula in ano isformed. The clearness of description of these maladies, and the unambiguity of the author’s style, especially commend themselves to the notice of the practitioner, who will find this brochure at the same time a valuable guide to the treatment oF--a class of very troublesome affections.
form,
The Products and Resources of Tasmania. By GEO. WHITING. Hobart Town, 1862. THIS is a pamphlet issued by the Commissioners for Tasmania (or Van Diemen’s Land), descriptive of the products of that colony sent to the International Exhibition. The island forwards many valuable woods and other vegetable productions;. but few of them are drugs : amongst the latter, gum kino, wattle gum (a substitute for gum arabic), and gelatinous seaweed, appear to be the principal. At the end of the brochure is a treatise on the Climate and Health of Tasmania,, by Dr. E. S. Hall. He says the mean atmospheric pressure near Hobart Town, the capital, is 29 ’80S inches; the mean annual temperature, 54°92. Hot winds have been known to endure for three days in succession. Snow rarely falls in Hobart Town, and was never known to remain Diseases of the brain and on the ground for twenty-four hours. nervous system, in proportion to the total from all causes, give more deaths in Tasmania than in either Victoria or New South Wales. The atmosphere is more clear than in either of those colonies. Mean rain-fall in twenty years, 21’52 inches. The climate is invigorating, and breezy, especially at night. Zymotic diseases and phthisis are not prevalent, and invalids from India, China, and Australia resort to Tasmania for the recovery of their health.
Medical Societies.
remove
ROYAL MEDICAL &
CHIRURGICAL SOCIETY.
TUESDAY,
JULY 1ST.
DR. BABINGTON, PRESIDENT,
IN THE
CHAIR.
REPORT OF THE COMMITTEE APP01XTED TO INVESTIGATE THE SUBJECT OF SUSPENDED ANIMATION.
THE
inquiry was conductedBy means of experiments upon living animals; By means of experiments upon the dead human body. SIAPHYLORAPHY COMPLICATED WITH ENLARGED In investigating anew the subject of apnœa by means f TONSILS. periments on the lower animals, it seemed expedient to observe, THE operation of staphyloraphy is one so frequently practised in the first place, the principal phenomena of apnœa, in itsleasi form-namely, when produced by simply depriv. by Mr. Fergusson at Kind’s College Hospital, and we may say complicated the animal of air. invariably with success, that we have not usually drawn atten ingThe principal facts to which attention was directed during tion to it unless there was something special or unusual tc notice in the individual cases. On the 16th of June, a girl was the progress of the apnœa thus induced wereThe duration of the respiratory movements; submitted to the operation, with fissure through the soft palate, The duration of the heatt’s action. and a partial one through the hard. The parts were not abunThe duration of the heart’s action was observeddant, but yet 8ufficien ly fleshy to be favourable for the opera(n) In relation to the duration of the respiratory movements. which was the There was tion, satisfactorily accomplished. (b) In relation to the time after the stoppage of the breath. disadvantage, however, as Mr. Fergusson remarked, of enlargement of the tonsils, and patients will seldom submit to their ing. From the experiments performed it appeared that in the dog removal before the other operation. He thought the cases do not heal so kindly when the tonsils are enlarged. The patient the average duration of the respiratory movements after the in the present instance was at first refractory; but she calmed animal has been deprived of air is 4 min. 5 sec., the extremes 3min. 30 sec. and 4 min. 40 sec. The average duration down, and the operation was done with facility. It occupied being the heart’s action is 7 min, 11 sec., the extremes being from first to last but. twelve minutes-a very short time indeed, 6ofmin. 40 sec. and 7 rnin. 45 sec. Mr. Fergusson observed, particularly since four stitches were I these experiments it appears that on an average the From introduced.
action continues for 3 min. 15 sec. after the animal has ceased to make respiratory efforts, the extremes being 2 min. REMOVAL OF A USELESS LEG. and 4 min. respectively. ON the 21st ntt. Mr. Paget amputated the leg of a man in Rabbits on an average ceased to malte respiratory efforts in about thirty, who was the 3 min. 25 sec. Their heart’s action stopped in 7 min. 10 sec.; St. Bartholomew’s Hospital, subject of an ulcer at its lower and middle part of many years’ consequently the interval between the last respiratory effort standing, which rendered the limb perfectly useless for pro- and the cessation of the heart’s action was 3 min. 45 sec. The next question investigated was-the period after the gression, and his life most miserable. Last year he was a patient in the hospital and subsequently again for some months, with- simple deprivation of air at which recovery is possible, under out benefit. He had been in other hospitals as well. On his natural circumstances, without the aid of any artificial means present admission, he entreated Mr. Paget to remove his leg, of resuscitation. but that gentleman at first hesitated to do so, as the health The experiments performed led to the conclusion that a dog of the patient was indifferent. The latter, however, preferred may be deprived of air during 3 min. 50see., and afterwards risking his life to retaiuing his limb. Hitherto the result has recover without the application of artificial means ; that a dog been satisfactory. is not likely to recover, if left to itself, after having been deprived of air during 4 min. 10 sec. The force of the inspiratory efforts during apncea was obCURVED-HORN TOE NAIL. SOME months back, Mr. Erichsen removed from a woman, in served in the experiments to be so great that it was determined ro measure then). They were found to be capable, in the dog, University College Hospital, the great toe nail of the right of raising a column of four inches. It appeared, morefoot, which had been enlarged and growing in a curved horn- over, that their force increases up to a certain period. of manner for the It was shaped period twenty years. upwards In other experiments, plaster of Paris, and even mercury,. of two inches long. The neighbouring toes were becoming were thus drawn upward- into the minute bronchial tubes. somewhat similarly affected. It is easy to understand, therefore, how foreign bodies may be clracminto the lung’s in cases of drowning, and the importance of this fact in the consideration of the pathology and CANCER OF THE LIP IN A MAN AGED EIGHTY.
heart’s
aged
mercury
treatment
THE patient was in the Middlesex Hospital upwards of a year ago, with cancer of the lower lip of about three months’ duration ; the submaxillary glands were enlarged. The disease was a regular oval, smooth and shallow sore, almost a model of a Hunterian chancre at first ; it then gradllaJJ,V became irregular, and the epithelial form of cancer developed itself. The patient, eighty years of age, was a great smoker and found the sore no inconvenience. It was removed by a V incision by Mr. Mitchell Henry, and the wound beitle(I up by adhesion.
yet
to
NÆVUS AT THE END OF THE NOSE. months ago an infant was brought to University Col. with a nævus situated at the end of the nose. a little to the left side. ’Ihere was a question as to its treatment ; but as the nævus was irregular. Mr. Henry Thompson preferred ligaturing it, although it would leave a little cicatrix, and this was accordingly put into practice. He remarked, that even with the application of nitric acid, or of perchloride of iron, there was the cotainty of a cicatrix in the event of the occurrence of sloughing. We subsequently learnt that the Jigature was successful ; and as the child was so young, no mark 01 any importance would be ultimately observed. A
FEW
lege Hospital
ofapr.cet.
The Committee next passed on to the subject of drowning. The first question investigated was-For what period can an animal he submerged, and recover without the aid of artificial meat’s ? It was found as the result of numerous experiments on dogs. that, in striking contrast to the previous ones, 1½ minutes’ immersion in water suffices to clesr rov life. Other experiments satisfactorily showed that the difference of time between simple apnœa and that by drowning is not due
submersion,
or to
depression of temperature,
ur
to struggling,
hut that it is connected with the fact, rltat in the one case a free passage of air out of the lungs, and of water into them, is permitted ; in The other, the exit of air and the entrance of water are
prevented.
There c III be no doubt, from other considerations put forward, that although both these circumstances are concerned in producing the difference observed, yet that it is mainly due to the entrance of wafer and the effects thereby pro need. The treatment of apnœa was next considered. For conclusions respecting artificial respiration, the Committee refer o the second portion of the Report. Many other methods of resuscitation which have been recom-
mended
were
employed, including actual cautery, venesection,.
38 cold
splash, alternate application of hot and cold water, generally nearly equal to that previously inspired, occasionally less. galvanism, puncture of the diaphragm. Although some of the above means were occasionally of In the treatment of apnœa generally, the Committee offer the manifest advantage, no one was of such unequivocal efficacy in following suggestions:a sufficient number of cases as to warrant the Committee in That all obstruction to the passage of air to and from the specially recommending its adoption. lungs be at once, so far as is practicable, removed;-that the The experiments upon the dead subject were made with a mouth and nostrils, for example, be cleansed from all foreign
view to determine the value of the various methods which have matters or adhering mucus. That in the absence of natural respiration, artificial respirabeen employed for alternately compressing and expanding the Dr. Silvester’s plan be forthwith employed in the folcavity of the chest in such a manner as to imitate the natural tion by manner :-The body being laid on its back (either on a movements of the thoracic walls in breathing. The following lowing flat surface, or, better, on a plane inclined a little from the feet methods have been investigated:1. Pressure exerted by the hands on the anterior wall of the upwards), a firm cushion or some similar support should be under the shoulders, the head being kept on a line with thorax, the body being in the prone posture. Such pressure placed has for its object, to expel a portion of the air contained in the the trunk. The tongue should be drawn forward so as to prochest: on relaxing the pressure, the chest expands and air jecta little from the side of the mouth. Then the arms should be until they nearly meet above the head (the enters. 2. The postural or so-called " ready" method, described by operator graspingthem just above the elbows), and then at Dr. Marshall Hall, which consists essentially in "turning the once lowered and replaced at the side. This should be immefollowed by moderate pressure with both hands upon body gently on the side and a little beyond, and then briskly diately the of the sternum. This process is to be repeated on the face alternately;" and in making pressure along the twelve or fourteen times in the minute. back of the chest each time the body is brought into the prone That if no natural respiratory efforts supervene, a dash of position. water (120° Fahr.) or cold water be employed, for the purhot which the action of the The method of Dr. in 3. Silvester, of exciting respiratory efforts, pectoral and other muscles passing from the shoulders to the pose That the temperature ot the body be maintained by friction, of the in is imitated. An inchest deep inspiration parietes warm blankets, the warm bath, &c. spiratory effort is produced by extending the arms upwards by In the case of drowning, in addition to the foregoing suggesthe sides of the head ; on restoring them to their original position by the side of the body, the expanded walls are allowed tions, the following plan may be in the first instance practised: body with the face downwards, and hanging a little to resume their previous state, and expiration takes place, the over the of a table, shutter, or board, raised to an angle quantity of air expelled being in proportion to that which had of about edge thirty degrees, so that the head may be lower than been previously inspired. Open the mouth and draw the tongue forward. It being necessary to measure the flow of air in and out ofthe feet. the respiratory cavity under conditions of pressure closely re- Keep the body in this posture for a few seconds, or a little if fluid escapes. The escape of fluid may be assisted by sembling those which exist in natural respiration, no means ofC longer once or twice ul3on the back. pressing could be in its would measurement offet used, which, working, C. J. B. WILLIAMS, Chairman. any appreciable resistance to the passage of air. With this W. S. KIRKES. consideration in view, an instrument designed by Dr. Sandersor GEORGE HARLEY. was employed. (The instrument was exhibited to the Society.’ J. B. SANDERSON. C. E BROWN-SÉQUARD. Genera! results. H. HYDE SALTER. 1. As regards the volume of air which can be expelled from E. H. SIEVEKING, ex officio. the thorax by compression of its walls, and inspired by the WM. S. SAVORY, Hon. Secretary. elastic expansion consequent on relaxation of the pressure, it On the motion of Dr. Edward Smith, the resolution of the was found(a) That pressure by both hands on the lower third of the Council appointing the Committee was read. Dr. C. J. B. WILLIAMS said, that if the subject of suspended sternum in the adult male subject usually displaced from 8 to animation and its treatment appeared to be one of great im10 inches of air. The pressure actually exerted amounted to about 301bs. It portance when the Committee were appointed for its investiwas, therefore, not greater than might be safely applied to the gation, the result of their labours did not make it less so ; for living subject. The volume of air expelled varied from 8 cubic during their researches several new points of both physiological and practical interest had arrested their attention. The Report inches to 15 cubic inches. (b) That pressure made in the same manner on the upper just read contained a larg= mass of facts bearing on the sub. part of the sternum usually displaced 2 or 3 cubic inches less ject, and these facts would be fully appreciated when they should be maturely considered ; but the members of the Comthan pressure on the lower part. (c) That pressure exerted by one hand on the upper part, by mittee thought it might be acceptable to the Society if one of the other on the lower part of the sternum, produced about the their body were to give a short summary of some of the most same results as were observed in (1. striking results. He (Dr. Williams) had been requested to do In this case the whole amount of pressure did not exceed that this since he entered the room. and not having been previously aware of the office which would devolve on him, he was not exerted in a. (d) That the pressure of a weight laid on the lower third of prepared to go fully into details ; but be believed that he was with the general results of the expethe sternum produced similar results according to its amount. sufliciently (e) That lateral pressure exerted on the ribs or costal carti- riments to be enabled to give a summary of their most imporlages of both sides simultaneously was in no instance more tant features. He would premise that he could take no merit to with regard to the experiments which had been so effectual. ( f ) That compression by a broad bandage encircling the ingeniously devised and laboriously carried on by the other memchest, the ends of which were crossed over the sternum, and bers of the Committee. He had been present at very few of the drawn in opposite directions by two persons, produced no experiments themselves ; but, as chairman of the Committee, greater effect than pressure with the hands on the sternum or had merely as,,,isted in receiving and completing the reports sides. from the sub-committees. The Committee, having to consider 2. Asregards the whole amount of exchange of air produced the subject of " Suspended Animation," directed their inquiries " that kind of interference with life which results from stopby the method of Dr. Marshall Hall, to imitate respiration," it varied much, according as the subject was favourable or the page of the breath in suffocation, strangulation, and drowning. contrary ; sometimes not exceeding a few cubic inches, but The first series of experiments was to investigate the result of never exceeding 15 cubic inches. apncea, or stoppage of the breath ; and for this purpose 3. As regards Dr. Silvester’s methorl, it was found, that on the trachea of animals was opened, and a tube inserted so as to extending the arms upwards, a volume of air was inspired into command the supply of air; and this tube being furnished with the chest, which varied, in different subjects, from 9 to 44 cubic a stop-cock could be closed, and the results noted, especially inches, and it was observed that the results obtained in sue. these :-After the closure of the tube, 1. how long respiratory cessful experiments on the same body were remarkably uniform, efforts continue; 2, how long the heart’s action continues; 3, in which respect, as well as in their amount, they contrastecL how long the heart beats after the breathing efforts cease. The with those obtained bv the method of Dr. M. Hall. Or experiments show a considerable variety of result ; but, as a average, it may be stated that in dogs efforts at breathrestoring the arms to the side, the quantity of air expelled wa:
drawn upwards lower part
.
- Place the
_
"
acquainted
himself
to
simple
.
.
general
39 continued a few seconds more than four minutes after the and their extravasation into the bronchial tubes. This was a closure of the tube ; and the heart’s action three minutes and a subject for further experimental investigation, and he thought quarter longer. The duration and force of these respiratory it one of great importance, as bearing on the action of water as efforts, in an animal deprived of air, were not more remarkable a noxious or a therapeutic agent. He would not detail the than important as inlicatino, the period within which an ani- various means of resuscitation which were tried by the Commal deprived of air could recover; and this was found to be mittee, but the results of the trials were not such as to induce almost, but not quite, as long as the duration of these efforts- the Committee to recommend them strongly for general adopthat is to say, a dog deprived of air four minutes only, tion. Various instructive experiments were made on different would recover ; but if the exclusion of air lasted ten se- modes of performing artificial respiration, and the most concluconds longer, he did not recover. The extraordinary force sive of these had reference to he so-called "ready methods" of of these struggles for breath was shown by plunging the end Dr. Marshall Hall and Dr. Silvester. One of their Committee of the tube into mercury; when it was found that the in- (Dr. Sanderson) contrived the apparatus on the table for measpiratory effort sometimes raised a column of four inches of suring the air which could be forced out of it into the lungs of mercury, and, if the tube was shorter, would draw the quick- a dead body by these methods of artificial respiration ; and silver in considerable quantities into the bronchial tubes and the general result was, that by Dr. Hall’s method the quantity air-cells of the lungs. The next subject of investigation was of air moved in and out of the lungs rarely reached nine cubic suspended animation from drowning; and here the experi- inches, and never exceeded fifteen; whereas by Dr. Silvester’s menters soon found a remarkable difference in the greater ra- plan an interchange of forty cubic inches was effected ; and pidity of the death, and the shorter time during which life is when this method was further improved by alternating the recoverable. An animal simply deprived of air for four minutes drawing up of the arms, with depressing them, and with presmay recover; but one immersed in water for one minute and a sure on the lower part of the sternum, the expelled air was as half is irrecoverably dead. Recovery took place in several much as fifty cubic inches. So far, then, as these experiments cases where the immersion lasted one minute and fifteen go, they show a great superiority of Dr. Silvester’s over Dr. seconds; but fifteen seconds more made all the difference. The Marshall Hall’s " ready method." Dr. EDWARD SMITH remarked upon the great importance of experimenters proceeded to search into the cause of this peculiarly destructive operation of drowning, as compared with the present discussion from the interest of the subject, and the simple privation of air ; and very soon they were enabled to trace fact that this being the first occasion on which the Society had it to the action of the water itself, forcibly drawn into the lungs appointed a Committee to make scientific investigations, it by the respiratory struggles of the animal. Two dogs were might be a precedent for future action. He thought it most plunged into water, one having its trachea closed by a stop- desirable that the Society should endeavour to accurately esticock at the moment of immersion. The dog with the trachea mate the true value of the results which such Committees free was taken out in two minutes, irrecoverably dead. The could produce. On the present occasion they had a Committee other, with the trachea closed, was taken out at the end of amongst whom were men of world-wide reputation, and a subfour minutes; the trachea was opened, and in the course of a ject of inquiry of the highest interest, and not of greater comfew seconds the animal began to gasp, and soon recovered. plexity than would be found in all practical questions in Another mode of diminishing the inspiratory struggles of the medicine. The Report must be regarded in two aspects : one, animal was by stupefying it with chloroform before immersion that of the scientific facts which had been elicited ; the other, in water, and it was actually found that recovery took place in their exact application to the purposes for which the Comafter two minutes and fifteen seconds’ immersion. On this mittee was appointed-to determine the best methods of point he (Dr. Williams) adverted to a popular opinion, that it restoring the drowned. As to the facts, no one could doubt is more difficult to drown a drunken man than one who is their extent and interest, the care with which they had been sober, as having some foundation on this fact, that insensibility ascertained, and the pains taken to estimate the influence of The methods adopted appeared also to of any kind retards the fatal influence of drowning by dimi- disturbing causes. nishing those violent struggles for breath which, by forcing have been very correct. He wished to know if the construcBut tion of the spirometer with a long arm and the scale. at the end water into the lungs, soon put the case beyond recovery. nothing so fully pointed out the extent and nature of the fatal of it gave a more minute registration than would be found with influence of water in the lungs as the appearance of these other air-holders of small diameter with the scale at the side, organs in drowned animals as compared with those killed by for this was simply an air-holder after the plan of Davy, simple apncea. In the latter the air-passages remained free Pereira, and Hutchinson. He adverted to the importance of from all secretion or effusion, and the lungs themselves were the quantity of bloody water found in the lungs of the dogs light and buoyant, and contained remarkably little blood. Now drowned, and explained that the water would be introduced this is contrary to what is generally described as the state of from the bronchi into the bloodvessels by endosmosis, and the lungs in asphyxia; and probably in ordinary cases, where these would cause the swelling and bursting of the blood-cordeath is not sudden, but prolonged, more or less engorgement puscles after the circulation had been greatly retarded or may take place. But here there was no engorgement or ob- arrested, and would also cause rupture of the capillaries, or the struction, and it was not wonderful that animals would recover attenuated blood would pass through the walls by exosmosis, more readily. But with drowned animals not only were all and thus appear in the bronchi. He did not think that the the air-passages choked with frothy fluid, and that fixid gene- experiments upon the action of chloroform in deferring the rally more or less bloody, but the whole lungs were always fatal issue were conclusive, since they were too few, and the highly engorged with blood, so that they were heavy, dark- increased duration of. life very small, and it had not been coloured, pitted on pressure, and on beingcut, exuded an abun- shown that a narcotized animal might not have greater toledance of blood-tinged fluid with many air-bubbles in it. On ranee of apncea independent of the idea which the Committee this subject he would make two remarks on his own respon- had - the diminution of muscular effort. The matter of sibility, apart from his office in the Committee. One was, greatest interest in the Report was the comparison of the MarHow opposed these observations and conclusions are to those shall Hall and Silvester methods, and he (Dr. Smith) thought many years ago propounded by Goodwyn in his treatise on that both might be equally advantageous in the cases in quesSuspended Animation, whose opinions have generally been tion. The experiments had shown that, with the lungs full, adopted to the present time. G 10d wyn concluded from his there was greater change of air with the Silvester method. observations, that water never to a hurtful extent enters the The Marshall Hall method started from the point of expiration, lungs of the drowned, and he deprecated the popular practice but living persons could by their effort expire forty cubic inches of hanging up a drowned person by the heels to let the water below that point, and if, by external pressure on the inanimate, run out. He (Dr. Williams) was by no means sure that, as Dr. one half of that quantity could be displaced, it would probably Goodwyn was certainly wrong in his pathology, some modifica- suffice for the purpose in hand. The Silvester method, by tion of the popular practice may not be beneficial. The other enlarging the cavity of the chest above the line of expiration, remark related to the mode in which the water which got into the must cause greater displacement of air ; but it had been lungs of the drowned proved so rapidly and extensively injurious. shown by the Report, that in a case of phthisis, where the lung No doubt much was due to its mechanical pressure on the tubes capacity was greatly reduced, the effect of the two methods and cells, forming an impervious barrier to the readmission of air; was precisely the same. Such would also probably be the case but this would not account for the extraordinary increase of with drowned persons, in whom the lungs were full of water, blood in the lung, and its transudation into the air-tubes. He which offered a great obstacle to the introduction of air; and believed the injurious influence of water to be due to its chemi- in this condition the Committee had not made any experiments. eal power of acting by endosmosis on the blood within the It was in reference to the practical object in the appointment capillaries of the lungs, swelling up and bursting the blood- of the Commi tee that the Report failed. The Committee had corpuscles, and causing their rapid accumulation in the organ, not proved that any one of their inquiries was applicable to
ing
B2
40 The time during which a man suspended animation in the human individual, and concluded the drowned human subject. could be immersed in water and recover could not be proved by that the instrument used by the Committee in by experiments on dogs, and the Committee themselves had their inquiries was one he had invented and described in 1854; shown that all their plans for the restoration of drowned dogs it nearly so practical as that exhibited lately to the had failed. The Committee had, in one part of the Report, Society. disclaimed any intention to sav how far the Silvester method Mr. CHARLES HUNTER said, that as he was one of those genwas fitted for the restoration of the drowned ; and yet in their tlemen who six years ago conducted the experiments upon the recommendations they advise the use of this method almost dead body for Dr. Marshall Hall, and upon those experiments - exclusively, without having in any experiment tried it, under the " Ready Niethod" was established, he felt called upon for The recommendation to place the body a few words in its defence. He regretted that the Committee these conditions. prone, and allow fluid to run out of the mouth, was an old thought fit to condemn it, and observed, that if the Marshall recommendation ; but they had inferred, and not proved. its Hall method after all was a failure, the long series of experivalue, and that only from experiments on drowned dogs which ments carefully made by him (Mr. Hunter) with others must go they could not resuscitate. The experiments ou dogs had for nothing; and yet the original experiments were much more shown that neither cold nor hot water alone had any value as numerous than those made by this Committee, and perfectly restorative agents, but that the alternative of the two was conclusive in their general results to those who made and saw somewhat useful ; but this alternative had not been recom- them. They were, moreover, backed by astonishing evidence mended for man. Hence he (Dr. Smith) regarded this Report in its favour from medical men in all parts of the kingdomas but the commencement of the inquiry, a labour which had testifying to its success in actual cases of drowning. In reply elicited important facts fitted to be employed in further re- to Dr. Harley, he said the Silvester plan was tried a few times, searches ; but as to the great object had in view in the appoint- but without success equal to that obtained by the " Ready ment of the Committee-the scientific determination of the Method."He would correct the idea that only ten cubic inches best method for restoring drowned men-he thought that it were obtained in the experiments-it was much more, and, in altogether failed. He urged the importance of the same gentle- favourable cases, varied between twenty-five and thirty-five men continuing the inquiry, and of making experiments under inches, and sometimes forty inches. Mr. Hunter was the conditions in which the knowledge must be applied, viz., glad to find his own experiments on the lungs of drowned aniupon men after immersion. He thought that the results of themals, as described by him in THE LANCET, were corroborated present inquiry proved that for the observation of defined facts by the Committee; he was also glad to hear that they did recommend the pronation of the body as the first measure in cases with known methods of inquiry, or with slight modifications of drowning-it was the essential part of the Marshall Hall known methods, the of Committees would -the work being done at a given time, and with authority, pro- treatment. The special advantages of the pronation are that vided the names of the observers were appended to each fluids escape from the mouth, throat, and lungs, and the tongue - observation ; but for the solution of complex questions (as dropping forward leaves the glottis free during inspiration. He questions of practice are), Committees would fail, since the was sorry, then, to find that the Committee recommend the Silvester plan. He could imagine no plan so rational as the ,essence of such an inquiry is the invention of a new method, method for a case of drowning. The experiand new methods can never be devised to order, but only Marshall through long continued thought without the investigator being ments of theCommittee prove that water is drawn forcibly into lungs in drowning, and that that water hastens death; ’commonly able to trace the steps which led him to the result, Hence the last series of questions must always be solved as how necessary, therefore, a method of recovery that will get of the water ! The Committee objected to the Marshall heretofore by individuals, and that not in any particular country, age, or time, but when the happy idea has occurred Hall method that the expiratory act precedes the inspiratory. considered it a physiological advantage, as by first to an inquirer. Such he believed to be the experience of those Mr. -who had been extensively engaged in scientific research. He inducing expiration much of the fluid is got rid of that has entered the lungs, as well as the bad air, which it is as imporattached great value to the facts contained in the Report. of as to introduce good air. He observed that to Dr. WEBSTER said that he thought the Silvester method was the best, and that the recommendation was very important, frequently in his experiments artificial respiration could not be He was sorry to hear that the lives of so many dogs had been effected in the supine position, but could by prono-lateral movesacrificed in the experiments, He hoped that in future, if ments. He considered that in drowning cases pronation of the body should be continued some length of time, as fluid can be possible, experiments on living animals would be avoided, Dr. MARCET agreed with Dr. Edward Smith, inasmuch as, expelled from the lungs of a drowned individual for half an from the method of investigation adopted by the Committee, hour by the Marshall Hall method. He inquired if the Comhe felt assured of the correctness of their results. He was, mittee meant to recommend the continuous warm bath or not, however, sorry that so little consideration had been given to as they had recorded no experiments in the Report. His own the instrumental means of performing artificial respiration, observations he considered proved it to be a most prejudicial which he believed to be of the greatest importance in a prac- measure, impeding respiratory action, and excluding the prone tical point of view; because, in his opinion, a much larger and postural movements. Mr. ACTON was sorry to hear that the opposition to the Re,quantity of air was required to inflate the lungs in suspended animation than the Silvester or the Marshall Hall method port was more to its details than to the Report itself. He -could possibly effect. It was to be borne in mind that in cases thought that the members of the Society should consider that of asphyxia or of poisoning by chloroform, a poisonous gas ac the Committee had come forward for the first time, and that, cumulated in the blood; and the object of artificial respira- as in the Academy of Medicine at Paris, they ought to be rewith laudation. Members of the Society should not tion was, to remove this poison and excite the action of the heart. He (Dr. Marcet) contended that in order to obtain come forward, each with his own particular views, to attack the Report ; and, instead of dwelling on its shortcomings, they a sufficient amount of diffusion to allow of poisonous gases to escape from the blood at the lungs, it was necessary that these ought to receive the labour of the Committee thankfully. Dr. EiDD considered that artificial respiration would be organs should be inflated with as much or nearly as much air in restoring persons from the effects of an overdose of as they could contain, and this no ready method was capable of doing, as the volume of air required would be from 150 to chloroform. He had seen cases in which pressure on the chest 200 cubic inches. He believed that instruments for performing seemed to restore life. Dr. C. J. B. WILLIAMS said that the experiments detailed in artificial respiration should not be set aside on the ground that they cannot be had and applied quick enough when wanted, the Report had been made with great care, and the methods of and proposed that surgeons and hospitals should provide them- Dr. Marshall Hall and Dr. Silvester had been fully comselves with some apparatus of acknowledged efficiency for in- pared. He thought that the Committee had done wisely flating the lungs. In hospitals there would be no difficulty in in not recommending instruments, but what they consicarrying out this plan, so as to have in readiness a means of dered to be the readiest plan under all circumstances. He restoring animation in cases of accidents with chloroform. Dr. would remark, in reply to some objections made by Dr. Marcet then alluded to the instrument he had exhibited to the Webster as to the destruction of animal life involved in these that no one experiment had been undertaken Society on the 11th February last. He said he had obtained most satisfactory results when using it to restore animation in without a definite and a useful object; that animal sufferings cases of dogs poisoned with chloroform, and that in these expe- ; and life had been spared as much as was possible in pursuing riments he had been able to avoid peforming tracheotomy for ’ inquiry; and he did not think that, when it was considered the purpose of inserting a canula into the trachea, which greatly how animal life was hourly and unsparingly sacrificed for the added to the interest of the results. He had no doubt that this gratification of appetite, there could be any objection to the very simole instrument would prove most available in cases of ded;catic)n of a few lives to the elucidation of a subject of real
observing
wasnot
-
cubic
appointment
of ensure
all
Hall
the rid
Hunter
tant get rid
ceived
valuable
I
experiments,
the
41 importance to the interests of humanity. In answer to Mr. Hunter’s question, he would observe that the Committee did not recommend the warm bath, but, if necessary, the alternat-e application of hot and cold water.
Reviews A Manual TOPHER
of
and
-zlfino2-
Notices of Books.
Assistant-Surgeon
to
and
Bandaging. By CHRISHospital, Westminster Hospital, &c. Second
Surgery
HEATH, Surgeon
to the West of London
London: Churchill. THE difference between a good surgeon and a bad one is said very often to lie in the observance of small things. The general principles and more serious operations of surgery are common to most men in about the same degree and kind; but there is a large number of unwritten details of management which will often make the difference between success and failure. In hospitals these are usually left to the house-surgeon and assistants, who are trained by, and act under, the directions of the chief surgeons. Mr. Heath, therefore, in reducing this floating surgi-cal lore to a written code has conveniently addressed his book to house-surgeons ; but, in truth, it concerns all who operate, and who are responsible for the treatment of all those minor accidents which make up the bulk of ordinary surgical practice. Embodying the general practice of our hospitals, and more especially that of Mr. Fergusson, under whom Mr. Heath was trained, this book could not fail to be very useful, and perfectly explanatory of the best average methods of procedure. The early call for a second edition shows that it has found numerous readers, and it is likely to have a permanent sale. This edition is enlarged and improved. We do not always agree with the rules laid down. It was necessary to be somewhat dogmatic in such a book, and this tone appears to be so far congenial to the mind of the author that he never ceases to maintain it. He is unhesitating in his judgments and directions; but, in teaching, it is no doubt better to make up your own mind and prescribe a definite course to the student. In puncturing the tonsil, Mr. Heath directs the bistoury to be thrust through the palate. This is quite unne. " No sutures must be placed in a cut throat ;; this is cessary. important," says the author in italics. This, again, is a precept which admits of modification. Where the incision is a wide gash, as it commonly is, involving a considerable extent of soft parts, it is frequently very advisable to put in sutures on either side, leaving only the median part of the wound open. It would be easy to multiply instances of a similar kind, but this is not requisite. There is very little room for fault-finding in Mr. Heath’s book, and a great deal to praise. It is the production of a thoroughly practical, well-informed man, and will be useful to all house-surgeons, and to others who have a mind to do their own work, and to do it well Edition.
Ligature of the
Gloteal Artery for Traumatic Aneurism. By GEORGE W. (JAMPBELL, A. M., M.D., &c., Professor oj Surgery, M’Gill University, Montreal. Pamphlet.
ANEURISMS of the gluteal artery are commonly traumatic, and when otherwise, they are treated by ligature of the internal or common iliac artery. In the traumatic form, however, ligature of the gluteal is recommended as preferable, but it is an extremely difficult operation in consequence of the deel dissection necessary to reach the vessel, and the complication of surrounding circumstances, especially the great and alarming haemorrhage oftentimes attending it. The celebrated case oi John Bell, and the more recent and not less remarkable one o] Mr. Syme, (THE LANCET, vol. i., 1861, p. 610,) in which tht gluteal artery was tied for large aneurisms of that vessel, musi be familiar to the profession. Of all operations usually wit. nessed, probably none appears more alarming than ligature A small gluteal aneurism would in of the glutea.1artery.
The assume great proportions if not attended to early. of Professor Campbell, of 1Iontreal, occurred in a lad aged fourteen, under the c:tre of Dr. Fenwick. He had sustained a severe wound in the buttock by a sharp-pointed piece of iron, heated to whiteness in a blacksmith’s shop. Much bleeding followed, and the result was the formation- of an aneurism of the gluteal artery, which gave rise to repeated and dangerous attacks of haemorrhage. The tumour was of the size of a hen’s egg, and the trunk ofthe vessel was tied where it emerges from the sciatic notch, without opening the sac of the aneurism. Not half an ounce of blood was lost, and the ultimate result t;me case
was
satisfactory.
Professor
Campbell states that the plan of procedure he adopted was more fortunate in its results, and certainly much less difficult in its execution, than if the ordinary rule in traumatic aneurism had been adopted, of opening the sac, aatl securing the orifice of the artery there. The patient had already been so much enfeebled by previous haemorrhages that it wasessential to his very existence that the operation should be performed with as little further loss of blood as possible. Dr. Campbell’s pamphlet is well worthy of attentive perusal. in Ano, and Hœmorrhoidal Affections; Pathology and Treatment. By T..J. ASHTON, iormerly Surgeon to the Blenheim Free Dispensary, &c. pp. 182. Fcap. Svo. London : Churchill. IN Mr. Ashton’s well-known and larger work, " On the Diseases of the Rectum," which has passed through three editions, and been reprinted in America, all the affections of the lower bowel are most fully considered. He has, however, wisely we think, adopted the suggestion of publishing, in a separate
Prollopsits, Fistula their
a treatise on those common diseases of the rectum which by their frequent occurrence more constantly claim attention. The present little work is, therefore, devoted to the subjects of Prolapsus, Fistula, and Haemorrhoids, mostly rewritten with the intention of more clearly pointing out the two conditions under which prolapsus of the rectum occurs, the structural differences of the several kinds of hæmorrhoidal tumour with special reference to their treatment, and the manner in which the internal opening in fistula in ano isformed. The clearness of description of these maladies, and the unambiguity of the author’s style, especially commend themselves to the notice of the practitioner, who will find this brochure at the same time a valuable guide to the treatment oF--a class of very troublesome affections.
form,
The Products and Resources of Tasmania. By GEO. WHITING. Hobart Town, 1862. THIS is a pamphlet issued by the Commissioners for Tasmania (or Van Diemen’s Land), descriptive of the products of that colony sent to the International Exhibition. The island forwards many valuable woods and other vegetable productions;. but few of them are drugs : amongst the latter, gum kino, wattle gum (a substitute for gum arabic), and gelatinous seaweed, appear to be the principal. At the end of the brochure is a treatise on the Climate and Health of Tasmania,, by Dr. E. S. Hall. He says the mean atmospheric pressure near Hobart Town, the capital, is 29 ’80S inches; the mean annual temperature, 54°92. Hot winds have been known to endure for three days in succession. Snow rarely falls in Hobart Town, and was never known to remain Diseases of the brain and on the ground for twenty-four hours. nervous system, in proportion to the total from all causes, give more deaths in Tasmania than in either Victoria or New South Wales. The atmosphere is more clear than in either of those colonies. Mean rain-fall in twenty years, 21’52 inches. The climate is invigorating, and breezy, especially at night. Zymotic diseases and phthisis are not prevalent, and invalids from India, China, and Australia resort to Tasmania for the recovery of their health.