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MEDICAL INTELLIGENCER.

47

of the unskilfulness of the operator. ly result from inflammation and swell

So widely did this impression obtain, that the surgeon ceased to be employed, and was obliged to leave the place where his prospects, previously to the occurrence of this fatal accident, had been unusually promising.

Puncture of a nerve may happen in the hands of the most skilful, as well as in those of the uninformed, for the branches of the cutaneous nerves sometimes pass over the vein, when their usual course is to pass under the vessel, and unlike the artery, which may be felt by its pulsation, and thus any deviation from the regular course be observed, these cutaneous branches of nerves cannot be distinguished. The branches of the internal cutaneous nerve generally pass under the median basilic vein, whilst those of the external cutaneous more frequently pass over the cephalic and median cepha-, lic veins. A gentleman, who was house surgeon in one of the metropolitan hospitals, suffered for several weeks painful and uneasy sensations in his arm from the puncture of a nerve in bleeding. I have heard of tetanus being an occasional consequence of this accident, but no instance of so severe a result has come under my observation, although the possibility of such an occurrence cannot be doubted, knowing what slight injuries sometimes give rise to that formidable disease.

Puncture of the fascia, and its supposed consequence, inflammation of the fascia, have been described by authors as sometimes taking place. The puncture I do not question; but that the symptoms usually ascribed to this accident are really produced by inflammation of the fascia, I believe there is sufficient reason to doubt; for whilst it is known that the fascia is much less vascular and sensible than the textures immediately in contact with it, the symptoms usually described would certain

ing of the parts underneath the fascia. The tension, and distress arising from the swelling beneath the fascia has, sometimes, required the division of the tendinous expansion of the biceps near its insertion into the fascia, and extensive suppuration, burrowing under the fascia, has called for a more free division of both fascia and integuments.

Wound of a lymphatic vessel I have known to happen, although of rare occurrence. In one case a capillary aperture remained for some weeks from which there was a constant oozing of limpid fluid, capable of being restrained by pressure below the orifice, but not affected by pressure higher up the arm. No other inconvenience was experienced, and the aperture healed spontaneously. (To be continued.)

ORRIS ROOT; CAUTION AS TO ITS USE.

-Orris root is frequently used by females

and others, in large quantities, as a scent and it has lately happened, that very serious consequences were produced by this practice. Dr. Armont lately read to a case in which two young girls became the Royal Academy of Medicine of France paralytic and insensible, from having put à considerable quantity of orris root into their hair on going to bed. When they awoke in the morning, they were seized with violent head-ache and giddiness, with pain and heat in the throat, similar to what is produced by cantharides, and the younger of the two was completely paralytic on the right side for more than five

hours.

SUBLINGUAL PUSTULES IN RABIES.

M. Dupuytren communicated to the Academy letters from M. Marochetti, of St. Petersburgh, and M. Lefon, resident in Turkey, in which those physicians maintain that the excision and cauterization of the pustules that come under the tongue and they request the Academy to supply in rabies, prevent the hydrophobic disease, them with the means of continuing their researches. M. Dupuytren observed, that as the method of cure proposed was preventive, he should always prefer the excision and cauterization of the wounds

to that of the pustules, which were by no means certain in their appearance. M.

Honoré mentioned two cases of rabies in which he could not find these pustules either in the individuals, or in the animals which had bitten them. Messrs Girard and Barthelemy said, they had not been more successful; the latter, in numerous experiments that he has made, during the last three years, on dogs, and the former in numerous cases of rabies which occurred during the late summer in the establishment at Altfort. M. Orfila, on the other hand, cited a case communicated by M. Marcq, in which pustules under the tongue had been seen, and a cure effected by their cauterization. The Academy appointed a permanent Committee to inquire into this subject.

GALVANISM has lately been used, and with great success, in the treatment of paralysis. A case is described in the Revue Medicale, for May, 1825, in which the lower extremities were completely paralyzed. Nux vomica, digitalis arrina, and other remedies were employed in vain. Galvanism was then employed, and after seven applications, the disease was completely removed.

ERRATUM.-Page 35, second column, 32d line, for vaccinia read vaccina.

WEEKLY REPORT OF DEATHS IN BOSTON.

Accidental, 1-Apoplexy, 1-Consumption, 6-Dropsy in the head, 1-Fits, 2— Infantile, 1-Lung Fever, 1—Unknown, 3-Stillborn, 2. Males, 7—Females, 9.

Materia Medica.

HE following are the general outlines

States, which has been written by WILLIAM ZOLLICKOFFER, M. D. &c. &c. and which will, without any farther delay, be published in the month of September. The cause of its not having emanated from the press last fall, may be attributed to the intention that the author had in view, of enlarging it, in order, if posssible, to render it more useful and acceptable. The work alluded to will contain 240 pages, octavo, instead of 180, as was formerly contemplated. It will, therefore, be perceived, that the matter contained therein has been increased in consequence of the delay.

CHAPTER 1. Treats of the improvements of the Materia Medica.-2. Modus Operandi of Medicines.—3. Classification of Medicines.

A letter from Huntington, S. C. dated May 21, 1826, says, "It is quite unhealthy in this section of country-Epidemic Influenza has been very prevalent since Christmas, of which a number have died DIVISION 1-Chapter 4. Treats of Nar-the disease is still prevailing- the wea- cotics.-5. Antispasmodics.-6. Tonics. ther extremely dry and warm, and the at- 7. Astringents. The four last chapters mosphere appears to be loaded with im- are included in the first division of genepurities." ral stimulants.

STRENGTH OF MEN.-The strength of savages has frequently been represented as far superior to that of men in a state of civilization: towards the end of the last century an ingenious instrument, to which he gave the name of dynamometer, was invented by M. Regnier of Semur, for determing with precision both human power and that of machinery. This was employed by Peron in his voyage to New Holland, and this able navigator has shown that the strength of savages is uniformly less than that of civilized men.

NEW EMETIC. It is said that soap suds, drunk in large quantities, is a speedy and effectual emetic, well suited to cases of poison, and whenever else an immediate rejection of the contents of the stomach is desirable.

DIVISION 2-Chapter 8. Treats of Emetics.---9. Cathartics.-10. Emmenagogues.-11. Diuretics.-12. Diaphoretics.--13. Expectorants.--14. Sialagogues.-15. Errhines.-16. Epispastics. 17. Escharotics. The chapters included in the second division are such as treat of local stimulants.

DIVISION 3-Chapter 18. Treats of Refrigerents. The articles that are introduced in this division belong to the chemical remedies,

DIVISION 4-Chapter1 9. Treats of Demulcents--20. Anthelmintics. These two last belong to the mechanical remedies. The classes of Antacids, Lithontriptics, Diluents, and Emollients, have been omitted, from the circumstance of their not being materials that properly belong to these classes.

The price of the work will be two dollars.

Published weekly, by John Cotton, Proprietor, at 184, Washington-St. corner of FranklinSt. to whom all communications must be addressed (post-paid). Price two dollars per annum, if paid in advance, but, if not paid within three months, two dollars and a half will be required, and this will, in no case, be deviated from.

MEDICAL INTELLIGENCER.

VOL. IV.

"NON EST VIVERE, SED VALERE VITA."

TUESDAY, JUNE 27, 1826.

No. 6.

ON THE OCCASIONAL ILL CONSEQUENCES the too early use of the arm; a foul

OF VENESECTION.

(Concluded from page 47.) Inflammation of the integuments and subjacent cellular membrane, commonly called festering, is the most frequent of the accidents resulting from bleeding. It may extend from a mere spot surrounding the orifice, sometimes to a considerable distance, and in degree may be slight or severe. There is stiffness of the arm, attended with pain and swelling. Sometimes the lymphatic vessels and glands partake in the inflammation, and hence swellings in the axilla, &c. occasionally supervene. I have not known an instance of this affection of the lymphatics, from bleeding, where the orifice had healed without festering. If the sides of the orifice be accurately placed in contact and be thus retained, without being disturbed, for a sufficient time, the want of union will be extremely rare; but when it is considered how apparently slight the causes are which may prevent union, the frequency of that occurrence cannot excite surprise. If the sides of the orifice be not in contact, they cannot Boite by adhesion, or, as it is technically termed, by the first intention; hence the wound scabs or suppurates, and inflammation may ascompany to a greater or less extent. Sometimes a small particle of fat protrudes at the orifice, and if this be not removed or replaced, union is prevented; any extraneous matter, such as particles from a dirty sponge, blood coagulated in the orifice, or the compress so placed as to separate the edges, may prevent union; this may also be effected by

or rough lancet may be an occasional cause; it has happened that a lancet armed with vaccine virus has been used through mistake; constitutional causes may, perhaps, prevent union, but when the requisite precautions have been used, I am well convinced the want of union will be of rare occurrence. I have entered thus fully into the causes of festering, as, though mere festering is the least of the occasional ill consequences of bleeding, it is, as it were, the parent of greater evils.

The treatment consists in rest and such means as will subdue the inflammation of the part; if the inflam-, mation be not subdued, it not unfrequently terminates in abscess.

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Abscess in some instances has proceeded to a dangerous and alarming extent; I have seen the deeper parts at the bend of the arm laid bare to an extent of several inches, by the loss of substance occasioned by abscess of the cellular membrane, and sloughing of the integuments. In one instance, the patient, who had been bled as an hoital out-patient, was one of those unfortunate beings, an Irish labourer, forming one of the inmates of a crowded apartment, where every thing was unfavourable to health, and so great was the constitutional irritation, that for many days his life was in danger. He recovered; but for several weeks was unable to use the arm.

Erysipelas may arise from bleeding when the orifice does not heal kindly. It bears the same characters as when taking place on other parts of the body, and is generally connected with constitutional de

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rangement, on which must in a great degree depend the mode of treatment; but I have not known it to occur when festering of the orifice has not preceded. You are aware that erysipelas sometimes terminates in mortification and death.

Inflammation of the brain is another of those dangerous consequences of venesection, which has in many instances terminated fatally. This, like the former accidents, has its origin in the irritation and suppuration of the orifice, which proceeds upwards in the course of the vein. Unless the inflammation be subdued by early and judicious treatment, it extends along the course of the vein towards the heart, and dissection has shown the vessel filled with pus as far as its termination in the subclavian vein. Whether the pus thus found be formed within the vein, or has passed into it by the open orifice from whence the inflammation had proceeded, does not appear to have been ascertained; but of the dangerous and fatal results of pus carried into the circulation we cannot doubt; and the experiments of M. Gaspard, related in an early volume of Magendie's Journal of Physiology, afford demonstrative evidence on that interesting subject.

The application of a compress above the punctured part has been recommended, and a total division of the vein has been suggested by Mr. Abernethy, as a mode of treatment which may be proper; but I should rather trust to those means which might subdue the inflammation.

Strangulation of the limb by undue or excessive tightness of the bandage after bleeding, has not, so far as I know, been noticed by authors; a fatal instance occurred in an out-patient of one of the metropolitan hospitals, in the summer of 1822. The patient was so slightly indisposed as to have continued his employment up to the time he was bled; he was bled by one of the pupils, and there

was, perhaps, some difficulty in stopping the blood. The arm was tied up, and directions given not to untie it. In the afternoon he complained of stiffness in the arm, and in the evening that it was painful. The pain increased so as to prevent him from sleeping, and his wife stated "his groans were dreadful." Early in the morning he awoke his wife, stating to her that the pain had been so great that he had not been able to close his eyes. She removed the bandage from his arm, and he became somewhat easier. She observed the arm was swelled. He passed another restless night. His wife was obliged to leave him during the day, and when she returned he said "he had suffered a martyrdom." She observed that the arm was a darkish kind of purple for a hand's breadth above the arm, and red below it and very much swelled. His night was again restless, and next morning (the fourth from the bleeding) the arm was black about a hand's breadth on each side of the wound, and the upper part of the limb was swollen very much. In the course of his illness his head became much affected. The further details were such as mark the progress of mortification. This poor unfortunate patient was bled on Saturday, and expired on the following Thursday, leaving a widow and three children without any means of support.

The treatment, I fear, will not bear scrutiny. From Saturday till Tuesday the time was unfortunately lost, nothing having been done; and the widow, in deploring her loss, expressed her grief that her husband, although unable to leave his bed and notwithstanding her repeated solicitation, had not been visited by any of the principal surgeons of the Hospital where he had been bled, till within an hour of his death.

In viewing this melancholy case it may serve to impress upon our

minds the necessity of attention even to the smallest details, upon which the welfare of a fellow-creature may depend.

It is probable that the difficulty in stopping the blood might arise from the orifice being made larger than necessary; this circumstance, and a laudable anxiety to prevent after bleeding from the wound, might lead to the undue tightness of the bandage; this, and the caution given not to untie the bandage, allowed the mischief to go on increasing, whilst the patient bore the pain for many hours with great fortitude, till he no longer could support the suffering. Even here all might have been retrieved,had he been fortunate enough to receive judicious surgical aid, but much valuable time was lost, and when competent assistance was obtained, it was too late.

The gradual increase of pain and swelling whilst the bandage was continued, marks the progress towards strangulation, and whether the bandage be used after bleeding, or as part of the dressing of an accidental wound, or of a fractured limb, and whether it be too tight at first, or become so by the gradual swelling of the limb, still the injury may be to that extent to endanger the limb, or even the life of the unfortunate sufferer.

From what has been shown, it is obvious that simple as the operation of bleeding may be considered when perfectly performed, yet dangerous and even fatal consequences have resulted from errors apparently very trivial in the outset. I have endeavoured to trace the causes of these errors that you may avoid them. The principle I have habitually acted upon has been, where the responsibility rested upon my self, to let instruction, careful and asiduous instruction, precede practice, by which I have avoided many anxieties which must otherwise have fallen to my lot. Many years enga

ged in public as well as private practice, my pupils have not had the opportunity, nor, I believe, the inclination to be idle. One of them, who, during the period of more than nine years, has been my pupil and my assistant, and whose habitual attention to his professional duties has won my esteem, has, during that period, had occasion to perform venesection in thousands of instances, and without one single untoward accident; his junior, one of your fellow students, now present, has kept an account of more than eight hundred instances in which he has performed blood-letting, and he assures me that only four of these have festered, to which may be added one in which inflammation of the parts under the fascia required rest of the arm for two or three weeks. No serious accident has occurred. The case of wounded lymphatic occurred in my practice, but whether in my own hands, or those of my pupils, I do not recollect, for I profess to have no superiority in what they have been instructed in, for I have no secrets to withhold.

In expressing my belief that the ill consequences occasionally succeeding venesection may, by proper care, be almost wholly avoided, I speak from no limited experience; but far from thinking there is any merit in having possessed ample opportunities, I am the more convinced it is the imperious duty of every one who enjoys such advantages, to render them subservient to the welfare of others. Since all are liable to err, there is no need, in alluding to errors of practice, to hurt the feelings of individuals, the object being to prevent the recurrence of similar evils; but the surgeon who conceals the errors he may have fallen into, or which he may have observed, is as blameable as the pi lot who should conceal his knowledge of rocks and shoals which hat caused shipwreck and destruction.

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