Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.

Date:
MDCCCXLIX [1849]
Catalogue details

Licence: Public Domain Mark

Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.

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    found to be hard, greatly reduced in size, and free from pulsation. He returned to a laborious occupation, and fifteen months after the operation his attention was di¬ rected to a re-appearance of the tumour. On presenting himself, the tumour was found to be about the size of a small orange, soft and fluctuating, with the in¬ teguments covering it discoloured. In a few days ulceration took place, and he died after repeated hemorrhages. On dissection, it was found that the ligature had been placed on the artery just above its bifurcation, where it was perfectly sound, and that the blood had been fur¬ nished to the tumour by the collateral vessels. On the patient’s re-admission, ligature of the aorta had been thought of by Dr Peace, with the view of prolonging the patient’s life, but it was found that pres¬ sure on this great trunk at its lower part did not arrest the flow of blood ; and, on dissection afterwards, the reason of this appeared, from the collateral arteries be¬ ing given off above “ the point at which it is prominent upon the vertebras.” In the same report a case is noticed as having been described by Dr West, in February last, as showing how the circu¬ lation has gone on after obliteration of the aorta. In tracing the aorta beyond the origin of the great vessels of the arch, its cavity was found to be entirely obli¬ terated immediately beyond the attach¬ ment of the ductus arteriosus. The stric¬ ture was a narrow one, and beyond it the vessel resumed very nearly its natural di¬ mension, and so continued throughout its course, “ giving off” the usual branches. The internal mammary and the epigastric arteries were as large as the internal iliacs, and the former were tortuous.—Medical Examiner, 1849. [A considerable number of cases, in which complete obliteration of the aorta did not arrest the circulation, have been recorded, and in several of these the obli¬ teration occurred just beyond the point where the obliterated ductus arteriosus is connected to the arch of the aorta, that is, shortly after the origin of the left subclavian. In these the blood is found to reach the aorta beyond the obliteration, by its enlarged intercostal arteries, which obtain it from the inter¬ nal mammary and superior intercostal of the subclavian, and the thoracic branches of the axillary artery ; and in the abdo¬ men, by the enlarged diaphragmatic and lumbar arteries, which are fed by the in¬ ternal mammary, and through it by the epigastric; but the supply to the lower NO. XI.—VOL. II. extremities is largely re-iuforced by the strong current from the subclavian, through the enlarged mammary and epi¬ gastric branches, to the external iliac. It is to be regretted that the American report does not give a more detailed ac¬ count of the collateral vessels by which the circulation was continued, more espe¬ cially in the case of ligature of the com¬ mon iliac. In this case the circumstances under which it was proposed to tie the aorta are singular. The common iliac artery being already impervious, no effect could be expected to be produced on the diseased side, unless the ligature were placed on the aorta above the origin of some of the lumbar arteries (through which the colla¬ teral circulation is chiefly carried on to certain branches of the external and in¬ ternal iliacs) ; which could scarcely be safe, either as regards the success of the endeavour, or the effect upon the circu¬ lation.] 309.—Lithotomy in America. Export of Committee on Surgery.—Dr Dudley, Pro¬ fessor of Surgery in the Transylvania University, is said to have, up to 1846, operated in 185 cases of stone, of which number 180 are reported as successful. This remarkable result is not owing to a selection of cases having been made, as three only had been refused, but is attri¬ buted to the “ thorough preparation of the general system” made by Dr Dudley preparatory to the operation. In the Pennsylvania Hospital, from 1752 to 1848, eighty-three patients had been cut, invariably by the lateral method, and, except in a few instances of very young children, the gorget had been used, and of these ten died. Of the eighty- three, five were females, none of whom died ; and out of thirty-six of the eighty- three, in which the ages are given, twenty- two were under ten years of age, and ten under twenty. These thirty-six are those which occurred since the year 1832, and of them only two died, and these were children at three and four years of age. Dr Mettawer of Virginia, has operated in seventy-three cases, two of which proved fatal, one from prostatic hemor¬ rhage, the other from spasm of the ilium. Dr John C. Warren has operated on thirty patients, of whom two died; one on account of an error in diet, the other had a purulent effusion, owing to the great size of the stone, and the force required to extract it. Dr Marsh of Albany, and Dr Eve of Georgia, have operated each seven times, 2 F