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“NON EST VIVERE, SED VALERE VITA."
TUESDAY, JULY 4, 1826.
BLEEDING FROM THE EXTERNAL JUGULAR may be done by the fingers and
thumb of the operator's left hand as The occasions for this operation readily as by a bandage. The point are, when it is necessary to abstract of the lancet is entered obliquely to a large quantity of blood more spae- the direction of the vein, and carried dily than it can be drawn from a vein through the integuments and platisin the arm; or, wben it is desirable, ma myoides till it opens the vein, but in addition to the effect of a general not deep enough to transtix it, when bloodletting, to diminish more imme. the point of the láncet is raised so as diately the fulness of the vessels of to make the aperture through the inthe head; sometimes, also, it is call- teguments come directly over that of ed for in the diseases of children, the vein. Care is taken so to arrange when general bloodletting is requir: the position, that it should not be ed, and yet the veins of the arm may changed during the performance of be so small or so deeply imbedded the operation, for a slight motion of in fat, as to render bleeding from the neck is apt to change the relathe arm difficult or impracticable.
tion of the parts, so as to render the The surgical agatomy of the neck, opening valvolar, and thus prevent particularly of the superficial and lat- a sufficient quantity of blood being eral parts, should be carefully stu- obtained. die betore this operation is perform
I should particularly suggest an ed by the student on the living body; : attentive watching of the countefor though the operation is extreme- nance and pulse of the patient durly simple in skilful hands, yet fatal ing the abstraction of blood from this accidents have been known to result large vein, as the effect produced is from the performance of it. The comparatively more sudden than io point usually suggested for opening ordinary bleeding, and in children the jugular vein, is where that ves- this becomes imperatively necessary. sel crosses over the sterno mastoid I should further recommend the ab. muscle, and is covered only by the straction to be suspended, if not beinteguments, and the platisma my- fore, at least as soon as the counte. oides. This thin muscle, which nance and pulse indicate the apmust be perforated before the vein proach of syncope, by which I be. can be reached, affords a somewhat lieve every remedial indication may greater resistance than is felt in be fulfilled without danger; whilsi, bleeding at the beod of the arm. in carrying the depletion so far as to The same precautions of placing the produce perfect deliquium, a state of thumb so as to keep the vein steady, danger is induced, from which no and using the fingers not employed one can with certainty say the pa. in holding the lancet as a rest to af. tient is sure to recover. A sufficient ford stendiness to the band, are as quantity having been abstracted, and essential as in bleeding from the arm. the pressure below removed, the orThe operation is performed by com- ifice must be cleaned, and neatly and pressing the external jugular vein of accurately closed, and its sides be recach side at its lower parl, and this tained in contact, either by a strip
or strips of plaster, or by compress sede more rational means of mouldand bandage. In this, as in other ing the character, was habitually parts of surgery, there are lesser fretful and obstinate. The mother precautions, which are not unworthy had unguardedly left the child withof our attention. In performing this out any attendant, and wben she reoperation upon children, it may be turned found the child, as it were, well to ascertain that the steadiness deluged in blood, and expiring or of the nurse or assistant can be de- dead. The geotleman who had perpended upon. That intensity of pa- formed the operation was known to rental feeling, which every one must be liberally educated, and humane honour, is sometimes too powerful to and attentive in the exercise of his be under the control of sound judg. profession, yet, strange as it may ment, and therefore renders mothers seem, I found an altercation bad kadoubtful assistants on such occasions. ken place, scarcely to be expected, I have been informed of a case in recently after so lamentable an ocwhich, during the performance of currence; the unfortunate mother this operation, the child, supported accused the practitioner of having on its mother's knee, fainted. The killed the child, and he retorting pallid death-like countenance of her that she had caused its death by leap infant might well alarm a mother, ing it for the purpose of going out to who had never a person
faint get drunk; perhaps some cause of before; in her alarm she raised the blame might attach to each. The child upright, grasping and pressing orifice had certainly been made larit to her bosom, and apparently in- ger than I should, under ordinary sensible to the entreaties made to circumstances, have deemed necesplace the child in a horizontal posi• sary, and the poor mother was no tion instantly; the effect of the up- free from indications of intoxication. right position was equivalent to a Notwithstanding the large orifice, as larger loss of blood, convulsions su- the bleeding had been restrained in pervened, and the unfortunate suf- the first instance, it might have been ferer expired.
commanded subsequently, and even Secondary hæmorrhage, in propor. supposing the child by its restlesslion to the largeness of the vessel, ness to have misplaced the bandage is more to be feared than from the and compress, yet had the probabil
Several years ago, an unfor. ity of such an occurrence been pointtunate instance of secondary hæmor- ed out, and constant watching insistrbage from the external jugular, ed upon and adopted in consequence, after bleeding, came under my cog. even had the bleeding recurred, a nizance, which forcibly illustrated finger placed upon the orifice would the necessity which I have previ- have restrained the further loss of ously dwelt upon, of giving directions blood, till the parts might have been respecting any probable occurrence more effectually secured by the prowhich should be avoided, and of fessional attendant, and thus the faadapting the mode of communication tal event have been prevented. to the intellect of the patient or at. Should there be great difficulty in tendants. The operation had been restraining the hæmorrhage after performed, and considerable relief bleeding from the neck, a circumexperienced; the orifice was closed stance which I have never experiby compress and a bandage, and was enced, although I have bad frequentsupposed to be secure. The patient ly occasion to bleed from the exterwas a child, and, as too often hap- nal jugular in cases of hooping cough, pens in humble life, when the alter- croup, &c., where the impulse given nate exercise of indiscreet indgl. to the blood during a fit of coughing rence and basty chastisement super- was extremely liable to disturb the
parts, yet care being taken that the short distance, danger may be preorifice has been no larger than re. vented; whilst in the country, and quired, I have found the flow of at a great distance from the patient, blood to cease immediately on re- should the attendants be wanting in moving the pressure below the ope- presence of mind, death might ensue ning; so that I have generally found fore the practitioner could arrive. a strip of plaster, after the orific I would again exhort you to rehad been carefully closed, a sufficient flect on the rational indications of security; but if there bas been the the treatment of disease drawn from slightest probability of return of the consideration of the previous bisbleeding, I have adopted the precau- tory and symptoms, and to see your tion of using graduated compresses way clearly, that you may not use and bandage, in addition to careful dangerous and severe remedies when superintendence. Although from the the patient's safety may be effected extensive motion of the neck there by mild and safe measures. Thus may be some difficulty in retaining in apoplexy, and some other diseases, the bandage in its proper situation, when a vital organ, such as the yet, when we come to consider the brain, may be undergoing a dangeruse and application of bandages, I ous injury by the bursting of one of shall bave occasion to demonstrate its blood-vessels, it is our imperathat the simple roller, or bandage, tive duty, if called in time, tó adopt may be so applied as to make effi. instantaneously those energetic recient pressure upon any part of the sources of the healing art which are body.
capable of immediately arrestiog the The mode which nature adopts to furiher progress of injury, and you restrain hæmorrhage is, first by faint- will find, in such cases, the abstracing, by wbich the blood, ceasing to tion of blood from the jugular vein, flow, coagulates at the point from or from the temporal artery, in such which it issued; and secondly, by quantity as to act as a general bloodextravasation into the surrounding letting, amongst the most efficacious cellular membrane, there coagulat- means with which we are acquainted. ing and mechanically disinishing or Having shown you that the taking closing the aperture from which the of blood from the external jugular blood had flowed. This is often ob- vein may be performed with safety served after the application of leech- and advantage, under judicious treates, the livid colour thus produced by ment, when the circumstances of any extravasation of blood having some case require it, yet you must be times been mistaken as an indication aware that the attempt to perform of mortification.
it often fails in the hands of those Should any case occur in which who have not been at the pains to there appeared sufficient reason to learn, with sufficient precision, the apprehend the occurrence of secon- various circumstances of situation, dary hæmorrhage, although I consi- depth, and relative position of the
der it the duty of every surgeon to parts concerned in the operation. • avoid the unnecessary infliction of The instances I have adduced will be
pain upon those confided to his care, sufficient to put you on your guard yet I should employ the twisted su- that the operation is not always free ture, as affording perfect security from danger; hence I need not eoagainst secondary hæmorrhage, in large on the upprincipled folly of preference to the risk of loss of life, performing a dangerous operation wbich I have shown you may result; when the recovery of the patient but means of trealment must vary may be equally promoted by sase with circumstances; with attentive aod simple means. If patients someaurses, and the practitioner within a times aitach undue importarce in
operations which may have been ing is so conducted as not to give a start needlessly performed, such consider- to the blood or produce general perspiraation ought not, for one instant, to tion. In just this proportion of cases bias your judgment in the choice of therefore it is useless, nay worse than means, which ought to be guidey useless; it induces fatigue, and not viga solely by the welfare of the patient
igur, confiding in or committed to your inat exercise does them any good.” Why,
persons tell us they don't see care and integrity.
they don't take any exercise. They draw Taking this view of the duties of
one leg after another it is true, and this your profession, you cannot be made they do perhaps for half an hour, or until too sensible, that the ordinary duties
they can scarce darw it any longer. But of surgery, are much more frequent. ly demanded than those exertions of this is not what physicians mean by walktalent rarely required, which some. ing. It is a technical term when employs times stamp the character of a dar. ed in a prescription, and must be under
By ing operator; and as you advance in stood before it can be followed. life you will become convinced, that walking, we mean a quick active exer
continued precision in the use of ordinary cise of the locomotive organs, means is of higher value, as subser. for some time, performed in open air, and vient to the relief of your suffering so conducted as to induce a general glow fellow-creatures, than any degree of and moisture upon the surface. If persons skill in extraordinary operations. would remember this, they would see how Mr. Alcock's Lecture.
powerful an instrument is walking in the preservation as well as the restoration of
health. There are few general directions given We often see men, looking pale and by physicians which are so commonly sickly, carefully guarded from the air, misunderstood, and imperfectly followed, creeping along our streets with a weak as the injunction to take free exercise-to and tardy step, and we always pity such walk out daily, and to allow no state of men. They are undoubtedly following, as the weather to interrupt the regularity of they think, the prescription of their physithis exercise. It is not the mere circum- cian, who has recommended walking. But stance of walking which can give any they have misunderstood his meaning, vigour to the frame or strength to the di- and although they get by their walk the gestive functions. Walking is the means benefit of the air, they return languid and of effecting a certain object, and this last fatigued. Let such step as quickly as it is that promises the general benefits of they can, let them make an exertion to exercise. It is by this means we wish to walk as fast as their strength will allow, quicken and invigorate the circulation, and if very weak let them walk six rods and give action to the functions of the instead of creeping half a mile, and they skin--to give a start to the blood and pro- will feel refreshed. Perspiration is more duce a general perspiration. These two readily induced in proportion to debility, purposes effected, the digestion is improve and therefore all its benefits may be gained, the bowels kept in order, the equili- ed with comparative ease by the enfeebrium of the circulation preserved, the bled. mind invigorated, and all the powers of As a general custom, loitering or walk. the system strengthened ;-general health ing slow is injurious, inasmuch as it detherefore is the consequence, and without prives individuals of the privilege of that those effects of walking the general health preventive of disease which ought to be will decline.
neglected by no one. It is a general cusNow in ninety-nine cases in an hund- tom in Europe for gentlemen to run red-we speak far within bounds-walk- through the streets. This is an' admira.
ble custom, and most sincerely do we soft, and are good for nothing. Cologne wish it could be adopted this side the At- water, diluted, may be used occasionally, lantic. It has a thousand advantages. and will be found both agreeable and useIt quickens and invigorates the circula. ful. I will give a fine, clear complexion tion. It enlivens the mind, promotes to the teeth, and preserve the breath healthful perspiration, and gratifies the pure and fragrant. impatience which arises from the mental activity it produces. Not that we would AN ORATION ON PROFESSIONAL REPUTAhave men always running through the TION, BY JOHN D. GODMAN.
This performance contains a great deal streets, but let every man, several times in the day, particularly when in haste, of good advice which is calculated to be run instead of walk, and he will be bet- particularly useful to the younger memter able, in body and mind, to attend to bers of the profession. The author evihis business, live longer, and enjoy life dently has elevated views of the dignity better.
of medicine, and has made some very sensible observations on the subject, and laid
down many excellent rules for attaining In this complaint, no remedies are now
a solid professional reputation. His style so generally in use as opium and the warm
is not sufficiently simple to please our bath. A German physician has recently taste, but on this we do not much insist, written on the subject, and condemns the having much greater confidence in the use of these means. He has met with healing powers of time and experience, great success by first bleeding the patient for the cure of this malady, than in any
sour criticisms of our own. freely, and next applying bladders of ice
We respect to the head and along the spine. After the author's independence in vindicating four hours the jaw falls ; an emetic of an
the utility of classical learning against the timony is then given, followed by an ene
perverse and superficial objections which ma of flax-seed tea, and half an ounce of wrong-headed and shallow thinkers are spirit of turpentine, and a tea-spoon or busy id urging against one of the most imtwo of laudanum. By these means, he portant branches of human learning. says, the proper connexion between the muscular and nervous system is restored,
MECHANICAL TREATMENT OF POISONS. and the patient is in no danger of a re
The mechanical treatment of poilapse. The use of the ice should be per
sons is a subject of considerable insevered in till spasm be subdued.
portance ; but there is a period to which its usefulness is limited, name
ly, whilst the poison remains in the We have often said that teeth require relief from the extraction of the
stomach ; for it is in vain to expect great care. First let them be well set in
remainder, after a sufficient quantity order, by removing the tartar, &c. with a
to detroy life may have passed the proper instrument, and using frequently a large and as stiff a brush as can be pro- the circulation.
pylorus, or have been carried into cured. It should be used dry two or
There is another circumstance of three times a week, for this will harden which we should be aware, that the gums, and prevent the collection of whilst the stomach retains its irritaextraneous matter, and give a fine polish
bility, the poison may be as effectto the teeth. A simple brush, however ually and as speedily evacuated by hard, can never injure the enamel, and a vomiting, as by the use of a pump; soft brush is worse than useless. The and if such emetics as the sulphate best brushes seldom admit of use more otzinc, which in sufficient dose acts than a month or two, when they become almost instantaneously, be timely ad