Periscope.-Death from Aconite.-Case of Poisoning from Hgdrocyonic Acid. DEATH FROM ACONITE.-INQUEST. In consequence of various rumours respecting the death of Dr. Male, an inquest was held at Birmingham, of which the following account presents some inte est: The first witness, John Barker, deposed that he had lived in the service of the deceased nearly eight years. On Wednesday, 23rd, he was out, and on Thursday about seven o'clock, witness took him up a cup of coffee, which he drank. He (witness) than went to the stable, and soon deceased came down, complaining of a pain between the bowels and chest; deceased had complained for some time past of pains in the back; he had some warm water taken up to him, and was sick two or three times; deceased ask ed him if he looked unwell, and witness replied he looked very unwell; in a short time, Miss Male, his daughter, came to him, about nine o'clock; on Friday the deceased sent for him; he appeared alarmingly ill, more so than he had ever seen him before; he said he wished to bid him (witness) farewell, and to evince his kindness and respect towards him; he seemed to consider himself in a dying state. 263 that for thirty-five years we had lived together in an uninterrupted friendship; twenty hours after death I made a post mortem examination, in the presence of Mr. Clayton, Dr. James Johnstone, and Dr. Bell Fletcher, and my son; his body, with the slightest possible exception, was in a healthy state; the blood was unusually fluid. Witness attributed death to the accumulated doses of the aconite depressing the nervous system. In answer to some questions put by jurors, Mr. Russell said, that such doses would not be likely to leave traces in a post-mortem examination beyond a fluidity in the blood. Had deceased been a younger man, in all probability he would have recovered from the shock of the medicine. Aconite is little used, and he was not prepared to say that ten diops would produce fatal effects. The coroner then briefly alluded to the circumstances which had induced the family to request an inquiry into the melancholy event-an event which he, in common with the medical profe-sion generally, most sincerely deplored. The deceased was respected and honoured in life, and his loss so calamitously brought about, would be extensively and deeply felt by more than one class of society. The jury then gave in a verdict of "accidental death from an over dose of aconite taken medically by the deceased."-Provincial Journal. RECOVERY. the characteristic effects of the poison, and it is a very striking example of a large class of cases of suicide in which the impulse to the commission of the act precedes the act itself by a very short interval, and springs up during a temporary excitement of the mind. The particulars of the case were noted down on the day following the attempt at suicide. Mr. Russell, surgeon, of Newhall street, was next sworn, and said, I have known the deceased for a number of years, he has complained to me occasionally, for six weeks or two months past, of pains in the back and lions; on CASE OF POISONING BY HYDROCYANIC ACIDThursday morning, about half-past nine, his son, the Rev. Dr. Male, came for me, and on going to his father's house, I found the deceased in bed; his extremities were cold, the By WILLIAM A. GUY, M.B., Cantab., Professor of Forensic Medi cinc, King's College, and Physician to King's College Hospital. general surface of the skin cold and clammy, the pulse quick and feeble (at 130), with cramps and pains in his legs, The following case of poisoning by hydrocyanic acid was and spasmodic pains in his stomach; he said his head was for obvious reasons, not published at the time of its occurrence. confused; he told me that, not experiencing relief, (allud- It is now brought forward as, in many respects, an imporing to the pains) from medicines in ordinary use, he had tant addition to the cases which have recently been put on been taking tincture of aconite; he then asked me if I had record. It is especially interesting as showing the interval ever given the medicine, and I said no; I then asked him of perfect consciousness and complete command of the vowhat doses he had taken, and he replied on the preceding luntary muscles which may intervene between the swallowSunday five drops, two or three times a day; I cannot being of a large dose of prussic acid and the development of positive whether he said twice or thrice, but I believe he said two or three times a day, and had increased it to six, and ten drops; one dose of ten drops only had been taken on the previous night; he had been also suffering from diarrhea for a few days, and had taken a dose of ten drops of solution of opium early that morning for it; I inquired where he had got his notion relative to the aconite; he said In the month of November, 1844, I was called up at night he had been reading a book now circulating through our to see a young gentleman who had swallowed prussic acid. societies treating upon the advantages of aconite in similar The particulars of the case, as detailed by himself and his pains; he expressed his conviction that he should die, relatives, are as follow:-He is the son of a medical man, is that the medicine was too powerful for him; but he also about nineteen years of age, and studying the law. His disexpressed his most earnest desire that he might recover, as position is naturally cheerful; he has met with no disappointhis life was of the utmost importance to his children at this ment, and never, until the present attempt, had contemplated time; this he repeated during his illness, to myself and suicide. His habits are temperate and industrious. On the Dr. J. Johnstone: I cheered him as much as I could, re- afternoon of the day on which he swallowed the poison he minding him of his former depression when ill, and that I dined in the Hall of one of the Inns of Court, and drank, acthought he had nervous power sufficient to wear out the cording to his own account, half a bottle of wine-a quantity effect of the medicine he had taken; I gave him mild aper- much exceeding that which he was in the habit of taking. ients to overcome the poison, with camphor and ammonia; On reaching home he was observed to be somewhat affected his son-in-law, Mr. Amphlett, saw him along with me in by liquor, and before going to bed went, under some pretence, the evening, and we left him somewhat, in our opinion, re-into the surgery, from which he took a stoppered bottle conlieved; on Friday we again met, and towards evening with Dr. James Johnstone, as we found him more sunk, Dr. Johnstone agreed with us in our treatment, &c.; late that evening I found him in a dying state, gradually sinking; he was in a torpid state, from which, however, he could easily be roused, and then his intellects were clear; he had no paralysis; his death took place about ten o'clock on Saturday morning; he was perfectly composed, and took an affectionate leave of myself and others, reminding me taining, according to the estimate of his father and the ap prentice, from one to two drachms of prussic acid of the pharmacopoeial strength, but, according to his own statement, about a mouthful. Soon after he had gone to bed the family was startled by a noise in his room as of a heavy body falling, and a relative, who was passing at the time, was alarmed by a loud gurgling noise. His father was almost immediately on the spot, and seeing the bottle on the drawers, dashed several buckets of water over the face and chest of 264 Periscope.-On the Treatment of Fractures. his son. This roused him. He was then taken into an ad- but to an insufficient extent. The extreme coldness of the joining room and put to bed, the treatment consisting in holding ammonia to the nostrils, and applying heat to the spine and feet. An injection was also given, containing tincture of assafœtida. When I reached the house I found him in the following state, in which he had continued without alteration for three hours: He lay on his back, drawing in his breath with great effort, each inspiration being accompanied by a loud gasping sound, and a distinct mucous rale. The pulse was upwards of 140 in the minute, and the respiration 36. The surface of the body was very cold; the countenance was of a dull leaden hue; the lips blue; the pupil extremely dilated, and the jaws rigid, in which state they had remained for the whole period, so that it had been impossible to administer any antidote. The treatment from this time forward consisted in holding ammonia under the nostrils, assiduous frictions with the flesh-brush, and the application of heat to the surface by means of flannels, warmed at the fire, and constantly renewed. At the expiration of about five hours there was some effort to vomit, encouraged by tickling the throat, and some bloody mucus was wiped from the mouth. Soon afterwards he could be made to swallow, when some warm brandy and water and some strong coffee were given him. At this time, too, he could be made to answer in monosyllables, and could raise himself on his elbows. He was also perfectly sensible, but looked bewildered. At the end of about six hours he was sufficiently recovered to answer questions, move himself about, and call for lemonade, which he drank freely. The mucous rale had disappeared, the respiration and pulse were still frequent, the pupil was restored to nearly its usual size, and the skin was warm. Being disposed to be quiet, and seeming out of danger, he was left to himself. After a time he complained of fulness at the pit of the stomach, and asked for an emetic, which was given him, with the effect of bringing off his stomach a large quantity of undigested food. : I saw him about fourteen hours after taking the poison, and found him quite well, though weak. He gave the following distinct account of the attempt of the night before :He was suddenly tempted, as he said, by the devil to take prussic acid, under a confused idea that it would not hurt him. He swallowed, according to his own account, a mouthful of the acid from the bottle in bed. He then got out of bed, walked round the foot of it to a chest of drawers standing within a few yards of his bed-side, placed the stopper so firmly in the bottle that it could not be removed, and then walked back to bed, intending to get in again. He reached the side of his bed, sat down upon it, and then lost all consciousness. During all this time he said that he had no giddiness, and no unpleasant sensation of any kind, no more than if he had taken so much water. He also assured me, and his manner made me quite confident that he spoke the truth, that the idea of suicide had never before entered his head. The father of the lad has since informed me that the fæces, and, as he believes, the urine too, were expelled as the first effect of the poison. surface rendered such treatment imperative, and the blueness SURGERY. ON THE TREATMENT OF FRACTURES WHICH USUALLY UNITE IN A DEFECTIVE MANNER. By. M. GUERIN DE VAUNES, Anatomical Assistant of the We The author's principal aim in publishing these papers is to prove that, if certain fractures only unite by means of brous tissue, or by the formation of a more or less deformed callus, it is owing to a radical defect in their treatment. In fractures of the clavicle, which first engage his attention, most authors, from Hippocrates down, allow that the union is generally accompanied by some deformity, but he affirms that all writers to the present time have overlooked one of the most important indications of treatment. need not follow M. Guerin through the lists of the different methods employed by surgeons at various periods, as these are sufficiently known to our readers; but many of his critical observations on this subject are worthy of being quoted, and naturally lead to the enunciation of his own views. "Hippocrates," he says, "in order to put the fragments of the clavicle in contact, had already advised a cushion to be applied between the shoulders, with a view of carrying outwards the external end of the clavicle. Paulus Ægineta, to attain this object, put under the armpit of the patient a pad of wool, which, according to Bichat, had carried art to its perfection; if employed to reduce the fragments, this process had been continued to maintain them; but Desault alone understood the mechanism of the displacement, and to fulfil the indications of this fracture, he made use of the humerus as a lever to push the shoulder backwards, upwards and outwards, in acting according to the natural direction of the bone. "I partake the admiration of Bichat for the apparatus of Desault, which bears, says he, the stamp of true genius. I wish it to be preserved entire, but with an addition to it, believe, nevertheless, that his bandage is insufficient; I the nature of which will be presently better understood. "If I admit that Desault has fulfilled the indications which consist in carrying the shoulder upwards, backwards, and outwards, to be consistent with what I have said, I must prove that there are others which have escaped him. That will not be difficult. Desault, in fact, like all the surgeons who have preceded and followed him, has only On examining the bottle which had contained the prussic ment in contact with the internal, and to maintain this ap occupied himself with one thing, to put the external fragacid, it was found quite empty, so that it was not possible to position in acting on the arm or shoulder of the affected ascertain the strength of the preparation which the lad had side. But nobody has thought of preventing the mobility of taken. From the statement of the father and apprentice, the internal fragment. Yet this is a fundamental principle that the bottle contained one or two drachms, and that of the in the treatment of these fractures, which has been overlad himself, who affirmed that he had swallowed a mouthful, looked. When the masters of art shew the point where it is highly probable that the dose taken was such as to prove the light ought to appear, all eyes remain fixed in that difatal had it not been for the prompt application of the cold rection, till some one turns round and perceives a light on affusion, the continued use of ammonia, and the assiduous ap- the opposite side. It is what has happened in the treatplication of warmth, to the surface. At the time that I first ment of the fracture under consideration, for I read in the saw the patient, the remedies most strongly indicated, in ad-posthumous work of Desault: The power which carries dition to those already employed, were warmth and friction downwards the top of the shoulder had appeared illusory to to the surface, of which the first had been already applied, the ancient Greek physicians, who attributed the apparent Periscope.-Ligature of both Carotids. 265 depression of this part to the elevation of the sternal frag- believe, there is not a better bandage for this object than ment, and in this belief sought, by compressing it, to re-es- that invented by that surgeon, provided it be rendered imtablish its lost level with the other. More judicious than moveable by dextrine or starch. those who went before him, Hippocrates demonstrated that "2d. The thoracic extremity of the opposite side ought their doctrine, false in its principles, was more dangerous to be fixed to the chest, so as to prevent its movements. I in its consequences, and that the immoveable sternal frag- know that the patient will thus find himself often embarrasment only lost its relative position with the humerus, be-sed, not being able to eat without the aid of a nurse or cause this was depressed by the weight of the arm, a doc- friend, unable as he will be of raising himself, &c., he must trine evidently proved by the comparison of the sound always have near him a kind person charged to assist him shoulder with that of the affected side, which all practition-in all his movements. ers have since admitted. The predecessors of Hippocrates: "A final indication yet remains to be accomplished; we attributed too much to the elevation of the sternal fragment, must, in fact, oppose the contraction of the sternocleidoand the father of medicine deserves great creait for having mastoid muscle. This end is attained in keeping the face shown the inefficacy, and even the danger, of compression of the patient turned on the side of the fracture, by means applied on this fragment. But he led into error those who of starched bandages embracing the head and the affected followed him, in sustaining that the inner fragment is im- shoulder, and thus putting the muscle in a state of relaxamoveable. You will soon be convinced, if you repeat, on tion. I do not conceal from myself the inconvenience of a the dead subject, the following experiment, which I have mode of treatment like this, which, during a month, paraperformed several times. lyses all the motions of the upper part of the body; but many a woman of the world would submit to it willingly, in order to have a fracture united in a regular manner, and not deformed. Moreover, this bone, spongy, and penetrated by a grand number of vessels, has in itself a great disposition to produce callus, and it will be possible, at the end of some days, in which the fragments are kept in exact apposition, to permit the motions of the head without injury to the union.-Archives Generales de Medicine, March and June, 1845.-In Dublin Journal of Medical Science. "Break a collar bone by letting a dead body fall on the shoulder, then raise the arm of the opposite side; you will then see that the sternal fragment is not immoveable, and that it glides up and down on the ouetr fragment; if you carry back the arm of the sound side, the sternal fragment will glide on the other from behind forwards, whilst it will follow an opposite direction if you carry the arm forwards. "This is not all; if you say to a man, having a fracture of the clavicle, and whose two arms hang down by the side of the body, to turn the head round to the healthy side, you will then see the internal fragment carried from below upwards, which is a consequence of the traction exercised on it by the sterno-cleido-mastoid muscle. LIGATURE OF BOTH CAROTIDS. Dr. Ellis, of the Grand Rapids, Michigan, relates, in the New. "These experiments prove, in an undeniable manner, York Journal of Medicine, the case of a young man, on whom he that there is a connected action between the sound clavi-ligatured both carotids with an interval of four days and a half cle and the sternal fragment of the injured side; in the se- between each operation. The patient, twenty-one years of age, cond place, that the riding of the fragments is not only on was shot by a comrade, who mistook him for a bear; the ball account of the external being drawn by the weight of the struck him near the centre, and immediately above the spine of arm, but also to the raising of the sternal fragment which the scapula of the left side, passing out, after making a flesh is drawn up by the sterno-cleido mastoid. wound of about two inches and a half, towards the neck, and af. ter about the same space, it entered the neck over the centre and posterior edge of the sternocleidomastoid muscle, passed up through the centre of the tongue, and out of it to the right of the mesian line, struck the lateral incisor, cuspid, and bicuspid of the right side, knocked them out, and the alveolar process, external to them; passed then through the upper lip, leaving a ragged opening through it. At the time there was little or no hemorr. "I now speak of ordinary cases, in which the clavicle is broken transversely, and not of those rare cases in which the external fragment, fractured obliquely, at the expense of its inferior surface, is found placed above the inner fragment "In repeating these experiments several times, I am convinced that the mobility of the sternal fragment is in an inverse ratio to its length, that is to say, so much the less as the fracture has taken place further from the insertion of the cleido-mastoid muscle. "This agreement existing between the healthy arm and the sternal fragment of the clavicle, I am bound to inquire if the different bandages and apparatus employed in the treatment of this fracture tend to maintain the inner fragment." hage. During the night of the seventh day, secondary hemorr hage from the wound in the tongue occurred, but was readily subdued by compressing the left carotid and the orifices of the wound. The bleeding recurring the next night, Dr. Ellis ap. be doing well, until the eleventh day after the accident, when plied a ligature to the left carotid. The patient then appeared to there was a return of the hemorrhage, which was arrested by compression of the right carotid. The loss of blood again occur ring, it was decided, in consultation, that the lingual artery should be tied, or else the right carotid. The latter vessel was selected, "After having done so, M. Guerin asserts that he has as it was uncertain whether the hemorrhage was from the right not seen any apparatus which prevents this fragment being lingual, or from the unligatured end of the left carotid, and also carried upwards, forwards, or backwards, according to the because there was considerable tumefaction under the angle of motions of the sound arm. It now remains for us to give, The ligature of the right carotid did not cause any disagreeable the jaw, so as to prevent the corner of the os hyoides being felt. in the author's own words, a description of the means of feelings; there was not any fainting, no unpleasant sensations securing a fractured clavicle in proper apposition, and to about the head; all the perceptible change was a slight paleness, obviate the causes of displacement which he has pointed and a cessation of pulsation in both temporal arteries, and of the out. Like most persons who have hit on a novelty, per- hemorrhage. The pulse soon increased in frequency; but did not haps he is disposed to invest it with more importance than maintain itself at the high number (140) it first reached. Some it deserves, yet there can be no doubt but that his observa- difficulty of breathing afterwards came on, with a hacking cough, tions deserve attention for their truth and rationality, and which was treated with aconite and belladonna. The ligature his apparatus, cumbersome and disagreeable to the patient from the left carotid came away on the seventeenth day, and that as it must be, may be found serviceable in cases of fractured from the right on the fourteenth from its application. The wound clavicle, attended with considerable displacement of the on the left side continued to discharge for several weeks, when broken ends of the bone. the portion of the artery between the ligature and wound slough. ed, and came away in three pieces at different times. "1st. The affected shoulder ought to be carried upwards, tient, at the date of the report, was in comfortable health, and at. outwards, or backwards, as Desault has indicated, and, I tending to business. Dr. Ellis, in remarking on the case, saya The pa 266 Periscope.-On the Operation for Hure Lip. In all the little patients the hemorrhage, inseperable from the divisions of the tissues, was very slight; I will except one, how. ever, in whom it produced a little paleness. In two of these infants the blood, despite my precautions, passed into the mouth, and was swallowed; a faint sign of deglutition informed me of its occurrence. One of these vomited the blood half an hour after the operation; in the case of the other it passed into the alimen there are several reasons which make the above case very interesting. It shows the comparative safety with which both caro. tids can be ligatured, so far as the brain is concerned, and the danger of pulmonary congestion. It shows with what rapidity the anastomosing branches of the opposite vessel supply blood enough to give rise to pulsation in the temporal artery, and of course the danger of hemorrhage from the unligatured end of the artery, where it is not possible to ligature both ends of the wound.tary canal, and was rejected by stool the following day. Swallow. ed vessel. ON THE OPERATION FOR HARE.LIP. By M. PAUL DUBOIS. At what period should we operate ?-In the Academy of Medicine, on the 27th May, the distinguished Professor of Mid. wifery at the Hospital of the Cliniques, entered into an extempore detail of his views as to operating on very young children, and described the method which he prefers. M. Dubois first detailed the particulars of a considerable number of cases of infants oper. ated on by himself or his friends, at intervals varying from a few minutes to several days or weeks after birth, and all of which had proved completely successful; he then proceeded to say: The mode of operation which I adopt is that preferred by all surgeons of the present day. I pare the edges of the lips, and then unite the bleeding parts by a twisted suture. I make use of very fine pins called insect pins, and the ordinary waxed thread; I shall make but one remark with reference to the pins, viz., that those which I employ are exceedingly thin: the pins got at in. strument makers are too long in proportion to their thickness; though the tissues to be pierced offer but slight resistance, that resistance is sufficient to make long and slender pins bend, which increases both the suffering and the length of the operation. It appears to me, then, much better to diminish considerably the ordinary length of the pins. ing the blood was followed by none of the colics, or other acci. dents, which have been represented by some surgeons as likely to compromise the success of the operation. In all the cases the after treatment was very easy. M. A. Berard" Will M. Dubois have the goodness to men. tion the treatment to which he alludes?" M. P. Dubois. That is just what I am going to do. In all the infants I removed the first ligatures twenty, and more fre quently twenty-four hours after the operation, and substituted in their place others less binding, This treatment was repeated every day, until the withdrawal of the pins, diminishing gradually the constriction. In these dressings I was assisted by a person who secured the head of the child, and gently compressed the cheeks when it began to cry. The dressing caused some to cry; but to get them to stop it was only necessary to wait a few minutes be. fore continuing to unroll the threads. It was often completed without awaking the child, especially where the patent, in expec tation of my arrival, had obeyed my injunction, previously, to moisten the threads with warm milk. This liquid was preferred; since, if it penetrated into the mouth, which was almost inevitable, it might be swallowed with impunity. The upper pins were generally withdrawn after the sixty-second hour, and the lower after from eighty to ninety-six hours. The differences, in this respect, depended on the greater or less apparent firmness of union. The Academy will doubtless remark, that the removal of the pins did not take place earlier than in subjects of a more advanced age; but it will also see, that the gradual slack. ening of the ligatures lessons the inconvenience of leaving the pins in a long time; and, besides, their presence is a useful safe. guard, in the absence of other means of keeping the parts in apposition. I have not had recourse to the proceeding advised by M. Clemot of Rochfort, and which my colleague, M. Roux, has sometimes employed, but for its acquaintance with which the medical public is solely indebted to M. Malgaigne. This proceeding, which has for its object to restore the median lobe of the upper lip, did not appear to me necessary in the cases which I have detailed to the Only in one case, after the removal of the pins, did I apply a Academy; and I was apprehensive also of complicating an oper. narrow stripe of court plaster, and even that was removed in a ation, the success of which appears to me to depend on avoiding few hours. I think its use was not called for. I employed it be. all important loss of blood, and in the simplicity and rapidity of its cause, deviating from my usual practice, I had removed all the performance. In none of the cases which I have described, did pins sixty-two houre after the operation. This was in the young. I employ a uniting bandage in addition to the sutures. In this est of the patients that I presented to the Academy; it was operat particular I have followed the axample of my father, who nevered on five days ago, and the pins were withdrawn within the last used one, either with infants or with adults. Neither have I forty-eight hours. substituted for the bandage the means employed by M. Bonfils de Nancy, which consists in having a person to compress with his hands the cheeks of the little patient in a manner analogous to the uniting bandage. I think that M. Bonfils' precaution is unnecessary, and may even prove a source of annoyance and agita. tion to the child; whilst the uniting bandage is attended with the same inconveniences, with this additional one, that it is almost certain to be displaced by the movements provoked by its presence, and then it is more injurious than beneficial. In all the children union took place rapidly and firmly ; in none were the tissues cut, either by the pins or ligatures; and I dwell on this circumstance, because it seems to me to remove an ob. jection long ago started by a great number of surgeons, and brought forward again in our own day by Dupuytren, viz., that in very young infants the tissues have a softness which renders them too easily cut by the needles or the ligatures. This objection, advanced by men of such eminence, merits the more attention, as the premises are true, although the conclusion is false. It is inThe pain produced by the operation was strongly expressed, deed truc, that the tissues of new born inlants are soft in a re. that is to say, by energetic cries; it is but right to add, that the markable degroe; but this softness, as Busch has. with great just. cries indicative of real suffering were notwithstanding not more ness, remarked, is due to their extreme vascularity; and the violent than they often were when the child was suffering much circumstance, far from having an unfavourable influence on the less, or even influenced only by desire. You understand, Gentle-operation, is one of the conditions the most advantageous for men, that I have no intention of disputing the reality or even the promp union. As to secability, it is quite imaginary, if supposed, acuteness of the pain resulting from the operation in the case of as I believe it was, to be so great that the tissues would not bear very young children, such as I have brought before you; but I without tearing the traction nccessary to bring the cut surfaces may be permited to say; that in their case the physical suffering is into apposition; but it is real in so far as ulceration, rapidly pro. not combined with what would be added by the intelligence of a duced by foreign bodies introduced into the tissues, is concerned; riper age; it is therefore very probable that they have but the and this ulceration may be very much accelerated by the com. mere faint consciousness of suffering; and certain it is, that in my pression exercised by tight ligatures. Still the effects of this tend. cases they did not retain the recollection or anticipation of it. ency may be easily diminished, or even totally obviated, by the This circumstance is not one of the least important of the advant. rapidity with which adhesion is effected, allowing the ligatures to ages of operating early; and I shall by and-by allude to its value be changed after the lapse of twenty-four hours. in reference to the after-treatment. On the other hand, I believe, I may say that the feeling of pain is very rapidly dissipated in very young children; in all, in fact, sleep quickly followed the operation; two fell asleep immediately after the insertion of the last pin, and before more than a single turn of thread was put round it; the rest of the dressing was completed whilst they were asleep, and they were carried from the operation table to their Cradle without awaking them. In none of my cases was the giving of nourishment suspended; all were supported by means requiring considerable efforts of suc. tion; two by the bottle, and the rest by the breast as usual; one eased to take the breast only during the operation and the sleep that followed it; the others were fed by the bottle and artifici I ipple for the first day only. I am happy to have the opportuni y of mentioning that, in the two cases in which my father practised this operation on children younger than any I have presented to Periscope.-Death from Sub-Peritoneal Rupture of the Stomach. the Academy, the use of the breast was not at all interfered with. The Academy will permit me to delay for a moment on the resalt of these operations, which have excited more attention and alarm in the minds of sur 267 became partially suspended; the surface assumed a purple hue; the swelling increased with each effort of inspiration, and the patient, apparently involuntarily, was unceasingly Of the difficulties which have been supposed inseparable from engaged in efforts of deglutition. Soon all semblance of the operation practised on very young children, there are none human shape almost completely disappeared, but occasiongeons than those which depends on the efforts of suction, instineally a plaintive voice gave indication that the patient contively provoked by the introduction into the mouth either of the tinued to suffer. Still intelligence was unaffected, and the natural or artificial nipple. I must also add, that even the parti. patient calmly and collectedly took part in the consultation sans of the operation have admitted the reality of all these dan. gers. They first get rid of the difficulty by proscribing the opera. tion; the second by extravagant caution, in permitting only a few drops of milk to be introduced into the child's mouth, or even compelling the little patient to fast for several days. of three of his brethren as to the means to be opposed to such sudden and alarming indications, and, although hopeless of relief, strongly expressed his disapprobation of the proposal to practise paracentisis abdominis. From the very first a constant burning sensation of thirst caused the patient to cry out continually for cold water, which was swa!lowed with constantly increasing difficulty, although the involuntary efforts of deglutition were going on with ceaseless rapidity. Death took place immediately after an attempt to drink, but for a long time the chest continued to heave at gradually lengthening intervals, and every such effort swelled the body still more. The facts which I have just detailed will prove, I hope, that the apprehensions entertained both by the adversaries and the partisans of the operation for hare-lip in very young children, are greatly exaggerated, and neither justify the objections of the one nor the excessive caution of the other. Permit me also to add, that these very precautions are much more injurious than the dangers they were intended to obviate. I do not at all believe that a fast of two or three days can produce, as has been pre. tended, rapid marasmus, followed by yielding of the sutures, but I "Sectio Cadaveris.- The lungs were pressed back am confident that it is very hard to be borne by infants, and ex. against the spinal column, and the heart was gorged with cites in thein agitation and prolonged crying, as dangerous, in re-black blood. In the pericardium and right pleura there was ference to the operation, as any effort of suction. Such was the some yellow serum, but no other lesion was observed in the case with those infants who were separated from their nurse for chest. The anterior abdominal wall, enormously distended nearly an entire day, and when allowed again to take the nurse's with gas did not collapse when the peritoneal cavity (which breast, their tranquillity was restored. One of these was the el-contained no air) was cut into. dest of the children brought before you. One only, of the patients I exhibited to the Academy, cried "A cruciform incision shewed the stomach so distended violently and continuously for some days after the operation; I as to occupy almost the whole abdomen, and its muscular shall return to it in an instant; the others cried but little, and at coat appeared hypertrophied. On drawing it forward the long intervals. Sleep is the state which is almost habitual to in. gastro-hepatic omentum gave way and gas made its escape fants during the first days of their existence. It is broken only to from the stomach through a large opening extending the satisfy their wants, by suffering, or by desire. It has been evi- whole length of the smaller curvature, from the cardia to dent that the operation, in those who underwent it, but little al- the pylorus. At the place of rupture the muscular and mutered that happy state of things, which must tend to produce a cous coats were in a state of pultaceous softening; the mufavourable result. I have said that one only of these patients was an exception, it was the second in age of those I brought before cous coat, in proportion as it approached the opening, bethe Academy; its cries, doubtless excited by artificial alimenta. came injected with blueish blood, and sensibly thinned; tion, which it endured with difficulty, were violent, and often there was no trace whatever, either of engorgement, ulcecontinued during several hours; this circumstance alarmed me ration, or adhesion; no other lesion could be discovered." very much for the success of the operation, and made me some. It is very much to be regretted that in his account of this times regret that I had attempted it in this case; the result was, important case, the Belgian Professor has not displayed notwithstanding, most favourable, and you have doubtless re-more of that minute accuracy and precision which is the marked, that of the three infants which were presented to the just boast of the French pathological school. We should Academy, the one of which I am speaking presents the least ob- like to know how long the patient lived after the alarming servable cicatrix, the mark left by the operation being, in fact, so slight, that considerable attention is necessary to discover it, symptoms commenced, and the order of occurrence and exact nature of those symptoms; what were the means taken Therefore it follows from these facts that the cries of infants ope. rated on for hare-lip are less frequent than have been supposed. to test the integrity of the air passages, what were the and that, even when most violent and prolonged, they do not hin- contents of the stomach, and in what state, with many der the success of the operation when the lips of the wound have other questions necessary to satisfy our minds as to the exbeen kept properly in contact. act nature of the lesion in question. The Editor of the Gazette Medicale de Paris, after quoting this case (which he considers unique), expresses doubts whether the air was actually effused from an orifice in the stomach, and seems inclined to believe that some lesion in the air passages had been overlooked, that the rupture occurred, not in the small, but in the large curvature of the stomach, and that the rupture of the muscular and mucous coats was caused by the same violence that tore through the peritoneum, or was wholly or partially occasioned by post-mortem erosion by "A surgeon of active and temperate habits, but oc- the gastric juice, as in the cases described by Hunter. casionally guilty of errors in regard to diet, had been com-The following case, however, is so analogous, both in the plaining, during six months, of what he believed to be gas-excito-motary phenomena during life, and in the lesions tralgia, when he was summoned to serve on a jury at Gaud. found after death, that we are inclined to take the ProfesSuddenly, after partaking of a hearty dinner, he felt him-sor's facts as he gives them, the more especially as we self alarmingly unwell. His skin was cold, corrugated, and have read in Hallei's Opuscula Pathologica, an also in the covered with perspiration; the pulse contracted, and scarce-Archives Generales de Medecine (Vol. X. or XI., by M. ly perceptible; the voice almost gone; respiration anx- Marjohn), of emphysema arising from a breach of continu ious; abdomen tense, and enormously dilated; an emol-ity in the intesti al canal, although we have not the vo lient lavement was administered, when suddenly, during lumes at hand to refer to. Many observers have testified the efforts at defæcation, emphysema made its appearance, that emphysema from this cause is not rare in the inferior and, extending to the neck, rapidly gave rise to the most animals. (Obs. sar les Animaux domestiques par MM. alarming symptoms of suffocation. The action of the lungs Caabert and Huzard.) DEATH FROM SUB-PERITONEAL RUPTURE OF In the Annales et Bulletin de la Societe de Mdecine de Gaud, Professor Burgqraeve gives a case of very great interest, both to the pathologist and to the medical jurist, of which the following are the particulars, as far as they can be learned from the Professor's description. |