from two to four grains of the sulphate of zinc, the best. A generous, but not a stimulating diet, must be advised.-Med. Times and Gazette, April 30, 1853, p 439.

ORGANS OF CIRCULATION

74.-ON WOUNDS OF BLOOD-VESSELS OF THE LOWER

EXTREMITIES.

By WILLIAM LAWRENCE, Esq., F.R.S.

When arteries under the calf of the leg are wounded it is difficult to follow the well-founded and generally-received rule of exposing and securing the injured vessels, even under the most favourable circumstances; that is, if we see the case at an early period, when no considerable swelling has occurred, and the natural relations of the surrounding parts are not obscured by ecchymosis. Frequently we do not know what vessel is wounded, nor the precise locality of the mischief. Sooner or later, and often very quickly, the whole limb becomes swollen by extravasation of blood, while all the soft structures may be lacerated, contused, and infiltrated with blood. Exploratory incisions for discovering the injured vessel, would be undertaken with very little chance of success; in such a state of limb, they might be attended with dangerous loss of blood, and would certainly involve the necessity of extensive and deep incisions in the injured parts. Thus we come to the conclusion, that amputation is necessary in some of these cases, in order to prevent worse consequences. An example of this kind is afforded in the case of a patient who, although recovered from amputation of the thigh, has not yet left the hospital.

Case.-Violent Contusion of the Leg-Rupture of the Anterior Tibial ArteryAmputation of the Thigh-Recovery.-John Connor, aged forty-three, a labourer, of tolerably stout frame and intemperate habits, was admitted into the hospital on April 5, 1853, about 11 P.M., being at the time very drunk. He was brought in directly from a neighbouring street, where he had been knocked down by a fire-engine, of which one or both wheels had passed obliquely over the back of the leg from below the calf to the knee. The engine weighed 26 cwt., and there were fourteen men on it at the time.

On the next day, the limb, especially in the situation of the calf, was greatly swollen and tense, with slight livid discolorations, giving it a mottled appearance. There was no external injury,-not even a graze. The anterior and posterior tibial arteries pulsated, but so feebly, that some doubt was entertained on the point. Messrs. Archer, on whose accuracy I rely implicitly, verified the fact by feeling, at the same time, one of them an artery in the foot, the other the radial: the numbers corresponded exactly. Thirty leeches were applied in the evening, from increase of pain, which had been considerable during the day.

7th. Relieved by the local bleeding, which had been copious; but he did not sleep. An opiate at bed-time.

12th. The limb has been in more or less pain; and he has rested badly. Last night, great aggravation of suffering occurred in the calf of the leg, extending to the ankle and the heel, and still continuing. It entirely prevented rest. The limb was now enormously swollen from the ankle to the ham, and as hard as a board. This extreme tension, with severe and unremitting pain, urgently required relief. Accordingly, having found some little yielding to pressure on the external aspect of the limb, I made an incision, six inches in length, from a little below the head of the fibula downwards, and then opened the fascia, which was extremely tense, to the same extent. The divided integuments gaped widely, and the muscles protruded at the slit in the fascia. A small quantity of dark liquid blood flowed from the wound. Thirty minims of tinct. opii at bed-time.

13th. He was easier after the incision, and slept tolerably well during the earlier part of the night; but pain returned with great severity towards morning, and it still continues in the calf, ankles, and heel. The entire circumference of the limb is swollen, with the same incompressible hardness. Pulse 92, small and soft; countenance worn and anxious.

15th. Great and continued suffering, with little rest in the two past nights,

although two half-drachm doses of tinct. opii were taken each night. An incision of some inches through the integuments and fascia was made, on the inner side of the limb, where the tension seemed rather less than elsewhere, but with no useful result.

16th. As the formidable mischief in the limb, depending obviously on serious injury of some deep-seated vessel or vessels, continued unrelieved, without any prospect of change, except to a more dangerous condition, amputation was the only means of saving life. With the concurrence of my colleagues, I proposed it to the patient, and performed it with his unwilling assent. The alternative of searching for the wounded vessel, by an incision in the calf, and, if it could not be found, proceeding to amputation, was mentioned. Such a course seemed to me altogether objectionable, as imminently dangerous to life.

The patient was brought under the influence of chloroform, and the limb was then removed by the circular operation. Ecchymosis had extended along the posterior aspect of the thigh, above the situation of the external incision, thickening and hardening the integument and subjacent structures-not, however, so as to interfere with the operation. Being relieved from pain in the part, the patient slept well, and was altogether better on the following day. The support of generous diet and wine required by his state of great weakness agreed well; and the healing process was completed quickly, without any unfavourable occurrence.

Examination of the Limb.-The muscles of the calf were lacerated and bruised to an extraordinary degree, the fleshy masses of the gastrocnemius being very nearly severed about the middle of the muscle. The soft parts covering the upper third of the fibula were in a similar condition. This bone had been fractured tranversely, close to its articulation with the tibia; and the sharp edge of the fracture, driven violently against the tibia, had cut across the anterior tibial artery just at its passage through the interosseous ligament.

The posterior tibial vein was partially wounded about the middle of the leg; and there was a coagulum in the orifice. Under the calf and among the injured muscles there was a large accumulation of coagula.

The pulsation of both tibial arteries was felt in this case during the first two days that the patient was in the hospital, but not afterwards. This difference probably arose from the gradual extension of swelling to the foot, the pulse in these vessels having been very feeble previously. The free anastomosis between the anterior and posterior tibial arteries accounts sufficiently for the pulse of the former having been felt on the back of the foot, although the trunk had been completely divided in the leg. We know that pulsation has sometimes returned, through the medium of the collateral circulation, in the sac of a popliteal aneurism, after the femoral artery had been tied. We naturally examine the state of pulsation in the arteries of an extremity when the trunk from which they proceed is supposed to have been wounded. That the continuance of pulsation does not prove that the trunk has not been wounded, is clear from this case, and was shown still more decidedly in one instance observed by Mr. Paget in this hospital. A youth was brought in with an open wound near the middle of the thigh, inflicted a few days before, and attended with profuse bleeding. The femoral trunk beyond the wound, the anterior and posterior tibial arteries pulsated naturally. The return of arterial bleeding on the twenty-first day made it necessary to expose the femoral artery, in which a longitudinal wound was found, not less than one-third of an inch in length.

As the posterior tibial vein was wounded in the case of Connor, the effused blood under the calf probably proceeded from that vessel; for the wound of the anterior tibial artery was towards the front of the limb, while the posterior tibial vessels and nerve were undisturbed in their position behind, so that it was necessary to raise them laterally, in order to trace out the seat of injury. In a patient brought into the hospital under the care of Mr. Stanley, the leg had been seriously damaged by the wheel of a carriage passing over it. There was great swelling, and the case was regarded as severe bruising, with ecchymosis. After some time, inflammation came on and extended, and the patient died. Rupture of the posterior tibial vein was found, with great extravasation under the calf-Med. Times and Gazette, June 11, 1853, p. 591.

75.-CASE OF ANEURISM OF EXTERNAL ILIAC CURED BY GALVANOPUNCTURE.

By EDMUND U. EYRE, Esq., H.E.I.C.S.

[The patient, a Sergeant in the Madras Fusiliers, had for some days felt an uneasy sensation in the left groin, extending down the thigh, which soon became much swollen, and in a few days a tumour was discovered, the size of a fowl's egg, in this situation. From the 2nd August, 1852, to the 4th September, the case remained much the same. Signorini's tourniquet had been applied to the tumour, and month after month passed without any change. Under these circumstances, there was considerable discussion as to what should be done. He could not remain longer a burden to the state, and no attempt at radical cure was justifiable. Mr. Eyre proceeds :]

I had met with a few cases recorded, where galvano-puncturation was successfully resorted to. It was either in aneurism of small vessels, such as the temporal, or where compression of the vessels above could be maintained; indeed, the arrest of the circulation to some degree above the aneurismal sac was regarded as essential. In this case, owing to the situation, it was impossible to effect it; nevertheless I thought, under the circumstances of the case, it was warrantable to give galvanopuncturation a trial; and on the 4th September two long fine reedles were introduced an inch within the sac, each being connected with the wires of a galvano-magnetic machine. The object was to avoid shocks, and merely pass a current through the sac. Pressure, as firm as could be borne, was made above, but it was insufficient to stop pulsation in the tumour. The sensible effect produced was, pain in the groin and violent agitation of the whole body. At the expiration of twenty minutes the needles were withdrawn. The tumour was pulsating as before. Strict quietude was enjoined. For three days after neither did the aneurismal tumour nor his general health give indications that any effect had been produced. On the 8th it is noted, "Tumour painful; is in a nervous and depressed state; cannot sleep." This condition passed off, and nothing presented worthy of notice till the 12th, when pain in the tumour recurred, and he was again in a nervous restless state. Leeches were applied to the groin, and sedatives administered.

[On Sept. 16th there was much constitutional disturbance, with violent inflammation around the hip. Combated by purgatives and refrigerants. On the 19th the inflammation was subdued. The tumour was larger, but pulsation not so strong. Digitalis and morphia prescribed.]

27th. Tumour sensibly harder, and pulsation fainter.

October 6th. Pulsation to-day is very faint.

8th. Pulsation hardly to be felt.

11th. No pulsation for the last three days; the tumour is hard and diminishing; no pulsation can be heard by the stethoscope for two inches above or below the sac. 20th. No return of pulsation, and the tumour is gradually lessening; limb but little longer than the opposite one; has lost the numbness so long felt in it, and only complains of want of power to walk.

It is unnecessary to continue further extracts from the journal. From the date last recorded to the present, January 4th, 1853, Sergeant H- has been making good progress in walking.

The remains of the aneurismal sac feels like an enlarged inguinal gland, about the size of a nut. There is cedema of the leg still.

In the cases whose treatment by galvano-puncturation led me to try it in Sergeant H, the cure was effected by a continuous current of electricity, producing coagulation of the blood in the sac. One may infer this, by the rapid effect, from a case of subclavian aneurism: "The tumour was felt to be becoming gradually solidified; and before the withdrawal of the needles, it had become perfectly solid, and pulsation was no longer felt in it." In another case of popliteal aneurism, a like rapid effect was not obtained (attributed to the agitation of the patient); still, in twenty-four hours pulsation ceased, and in seven days he left the hospital, walking quite well. This was not the modus operandi in the sergeant's case, but inflammation and deposit of lymph, which filled up the sac. This mode is a hazardous one, and was not intentionally induced. The galvanic effect was probably too violent to produce the

former, though the machine-an electro-magnetic coil one-was used at its lowest power. I thought at first too little had been done; but when I found the external sign of the inflammation going on within the sac, accompanied by much constitutional disturbance, I began to fear that too much had been done. I watched with solicitude for the dark spot on the tumour, the forerunner of sloughing. Happily, the threatened danger passed away. The patient was of sound constitution; he lay in a spacious, well ventilated ward, and the season was favourable; under opposite circumstances the event might not have been so propitious. Notwithstanding the medical cure effected in this case, I should reluctantly resort to it again for aneurism of the external iliac, unless I had the electric power under command; but still, a successful case by such means may not be without its value in the records of surgery.-Lancet, July 30, 1853, p. 94.

76. ON THE INJECTION OF A CONCENTRATED SOLUTION OF PERCHLORIDE IRON INTO ANEURISMAL TUMOURS, TO OBTAIN COAGULATION OF THE BLOOD BOTH IN THE ARTERY AND THE SAC.

M. PRAVAZ, of Lyons, the original inventor of the treatment of aneurisms by elec tro-puncture, has just made public, through his friend M. Lallemand, a new method of obliterating arteries and aneurismal sacs by the injection of a concentrated solution of perchloride of iron. This plan of treatment has been brought before the Academy of Sciences of Paris and the Surgical Society, and has met with a very warm approval, as several successful cases have now been published. One of these refers to a varicose aneurism at the bend of the elbow, another to a popliteal aneurism, and a third to an aneurism of the superior orbital artery. It would seem that a very few drops of the concentrated solution are sufficient to bring on coagulation, as has been ascertained by numerous experiments. The practice is well worth trying in this country, as M. Lallemand fondly hopes that the perchloride will eventually supersede the ligature. It is strange that, in the speeches and discussions on this subject, the method of compression so successfully carried out in Ireland is hardly mentioned.

The preparation of the solution has been made public by M. Burin de Buisson, pharmacien, of Lyons, and is described as follows:-Take of sulphate of iron of commerce (emerald colour), two pounds; water, six pounds; pure iron filings, the fifth part of a pound; sulphuric acid, half an ounce: put the whole into an enamelled cast-iron vessel and leave the latter upon the sand-bath until gas is no longer given off; filter, add to the fluid half a pound of liquid hydro-sulphuric acid, and allow to rest for twelve hours. Put, after that time, the solution upon the fire, boil for half an hour, and filter. To the filtered liquid add six ounces and a half of pure concentrated sulphuric acid; and place the mixture into an enamelled cast-iron vessel, which should be but half filled. Boil, and add, in small quantities, pure nitric acid, until it causes no longer the escape of red fumes. Remove the vessel from the fire, add to the fluid twenty-five or thirty times its weight of cold water, and the whole of the iron will be precipitated in the state of peroxide by the addition of a slight excess of ammonia. Wash the precipitate by decantation with pure water a great many times, and dry it in the air by spreading it in thin layers upon linen.

This dry and pulverized oxide is then calcined to redness in a large and shallow iron vessel, so that the temperature may not rise too high. This is the martial saffron of the shops, which is, in fact, pure peroxide of iron when prepared as above.

The perchloride of iron is then obtained in the following manner :-Take of the peroxide of iron, resulting from the process just described, six ounces and a half; pure and white hydro-chloric acid, two pounds; mix and allow the action to go on without fire for five or six hours; then put the vessel on a water-bath, and boil until the almost complete solution of the oxide is obtained; this should be done in a porcelain capsule, weighed beforehand. The liquid is decanted to separate the undissolved oxide, and the former is carefully evaporated upon the water-bath, constantly stirring, to the consistency of thick syrup, which is then weighed. Half this weight of distilled water is then added, the heat is kept up for a few moments, and the

whole is thrown on the filter. The capsule and the filter should now be washed with a quantity of water, equal to that used in the last place, and to the first fluid obtained, as much of the second is added to get a mixture of the density of from 43.5 to 44 degrees.

By proceeding in this manner a very limpid fluid is obtained, with a slight acid reaction, but perfectly pure, having reached the maximum of saturation, and always identical. It may be kept without any of the salt being thrown down, provided the bottle be well stopped; the colour is dark-brown when the liquid is looked at in full, and of a greenish-gold colour when held to the light, or seen in a thin stratum. Five or six drops of this fluid, mixed with the white of an egg diluted with six drachms of water, are sufficient to coagulate the whole into a mass in the space of fifteen seconds. This mass firmly adheres to the bottom of the glass when the latter is turned up, and takes a pretty long time before it slowly drops, when the watery parts begin to run off, as the serum separates from coagulated blood.

At the meeting of the Surgical Society of Paris, held May 4, 1853, M. Debout presented the two carotids of a horse, into which perchloride of iron had been injected. In one of these vessels, for the distance of two inches, the artery being held by the fingers above and below, only six drops of the perchloride had been thrown. The clot formed had, however, been re-dissolved by the current of blood, and carried into the torrent of the circulation. The lining membrane of this vessel was healthy, except a small spot where an abscess was about to form. In the other carotid fifteen drops of the perchloride had been injected for two inches and a half of its length, the upper and lower part of this length of artery being also compressed by the fingers. This vessel remained plugged all the time the animal lived. On a post-mortem examination, the whole length of the clot was found adherent to the parietes of the artery, the lining membrane being the seat of suppurative inflammation. The vessel was quite obliterated both above and below in consequence of adhesive inflammation.

In a subsequent meeting, M. Debout gave a minute description both of the experiment and of the post-mortem appearance, and concluded that M. Pravaz, the discoverer of this property of the perchloride, was right in advising injections of very small doses. M. Debout very properly added, that compression of the artery above the sac (as proposed and carried out by Dr. Bellingham, of Dublin) should be resorted to as an adjuvant of the injection, as there is a tendency in the blood remaining free in the artery to break down the clot formed by the perchloride. The author of the paper mentioned a case of aneurism at the bend of the elbow, following venesection, in the sac of which coagulation was obtained by a continuous galvanic current; compression of the vessel was neglected, and a week after the formation of the clot the latter was destroyed and washed away by the force of the arterial circulation. -Lancet, June 18, 1853, p. 561.

77.-False Aneurism of the Pos'erior Tibial Artery, from a Wound, &c. By WM. ADAMS, Esq.-The injection of perchloride of iron caused coagulation of the blood in the spurious aneurismal sac, produced by division of the posterior tibial artery in a child aged four weeks. The firm clot squeezed out the serum, which was seen oozing from the surface of the wound. The instrument used for injection was a glass syringe, with a long and slender tube, which was made to penetrate the clot, and convey the perchloride to the fluid blood below.-Med. Times and Gazette, July 30, 1853, p. 124.

78.-New Instrument for Injecting the Perchloride of Iron in cases of Nævus, &c.— [In several cases in which this remedy had been employed in cases of nævus, two circumstances proved unfavourable to its success. In the first place, by its being in some too freely used, inflammation and sloughing had been produced; and, in the second, the flow of blood had prevented the defective instrument acting efficiently. To remedy this latter defect, Mr. Fergusson has invented the following.]

It consists of a very small glass syringe, the point of which terminates in a fine