Page images
PDF
EPUB

outer coat, and a more tender inner one, adhering ftrongly to the furrounding parts, while the young ones, that are very flightly attached to its fides, are not of a larger diameter than a part of an inch. Whether thefe are merely accidental differences in the growth, or depend upon fome more effential diftinction, must remain to be determined by future obfervations.'

Dr. H. then proceeds to make fome general obfervations on thofe hydatids which, as in the prefent cafe, produce their like, and multiply with no other connection with the body than as it affords them a nidus. They have been found in various parts of the body, and different opinions have been formed concerning their nature. Tyfon and Hartmann were the first who difcovered them to be animals poffeffed of a peculiar ftructure and power of motion; and Pallas has examined them accurately, and given them the name of Tania hydatigena. It is in thofe of quadrupeds, however, that the animal nature of them has been proved. They have a mouth and neck, and an evident peristaltic motion in their coats. The human hydatids can as yet only from analogy be referred to the fame clafs. Their growth and decay will explain the increafe and diminution of tumours in the abdomen containing them. In the prefent cafe, Dr. H. thinks that their origin was probably in the spleen, and that one of the bags there having burft, they fell by their own gravity into the pelvis, and there adhered and multiplied. As to the treatment of hydatids, the only method must be to procure them an outlet, unless mercury fhould deftroy them, as it does other animals.

In a fupplement, the Doctor gives an account of his examination of fome hydatids taken from the abdomen of a sheep. They were exactly the fame with those described by Tyson. He also examined fome which were found in the brain of a fheep, producing the difeafe called the ftaggers. These, like the human hydatids, had no mouth.

5. Cafe of a Gentleman labouring under the epidemic Remittent Fever of Bufforah, in the Year 1780, drawn up by himself; with an Account of various Circumstances relating to that Difeafe. This curious and interefting relation is given by one who is not of the profeffion, but is not unacquainted with medicine. It is a moft ftriking picture of the endemic fever of a hot country, and affords a very inftructive example both of ineffectual and of effectual treatment. His fever began on June 5th, and was foon attended with the moft diftreffing and alarming fymptoms. In the beginning, by the ufe of evacuant medicines, a fair intermiffion was obtained, but due advantage was not taken of the opportunity. We fhall tranfcribe the events of the twelfth day, which proved critical:

16th. At eleven o'clock the violence of the fever came on; I grew delirious, fwooned, and the fymptoms of approaching death, I was afterwards told, grew evident to thofe around me. My eyes were fixed, my tongue hung from my mouth, and my face grew quite black. I recovered from this fit about twelve o'clock, and felt excruciating pain, and a burning fuffocating heat. My ftomach and bowels feemed all on fire, my lungs played with the utmoft difficulty, and I felt a pain and fenfation about my heart which I cannot defcribe. I was unable to move; my fervant lifted me; I fell into a fwoon for a few minutes, and, when I came to myself, a great quantity of black putrid bile flowed from me. Relief was inftantaneous, and I flept or fwooned till about five o'clock, when I found myself free from fever, and able to speak, my recollection clear, and my mind perfectly compofed, but my body fo weak that I had no power of moving, except one of my hands. They gave me fome fuftenance; I had a little fleep; but about midnight I fell into a fituation, which I had all the reafon to think indicated the immediate approach of death. My tongue cleft to my mouth, my extremities were as cold as ice, and the coldness alfo appeared to extend up my thigh; my arm was deftitute of pulfe, nor was the fmalleft pulfation of the heart perceptible; I never had my recollection clearer, or perhaps fo clear, in my life. My fervant was lying by my bedfide; I was convulfed for fome minutes; and, on recovering, I got out the word Boy.-Fortunately for me he was not afleep, and heard me; I then got out the word Wine; on which he brought me a glafs of claret, which, with much difficulty, I got down. I felt myfelt much revived; I reflected on my fituation; and, although I had not the most remote idea of furviving that night, I recollected that I had fome fine powdered bark in my trunk, and it occurred to me, that if any thing could be done to preferve my Fife, it would be that medicine taken in red wine; but my fpeech immediately failing me, I could not direct the fervant to give it to me. Death feemed approaching; coldness had feized all my limbs; my fight became confufed, as I perceived from looking at the stars, which danced before me; and the rattle or noife in my throat was very perceptible to the fervant, as he afterwards told me. I fainted, and continued in a state of infenfibility, I believe, for about an hour. The loud lamentations of the fervant, bewailing his own misfortune in lofing his master in a country fo remote from his own, seemed to recal me to life. I felt as if refreshed with a little fleep, and got out the words bark and wine; it was inftantly brought, and the man gave me two large tea spoonfuls, and a large glafs of claret. The effect was inftantaneous, and operated like a charm; the coldness left me, I could fpeak intelligibly, and could move my hands. I told the fervant to give me a tea-fpoonful of the bark every hour, in a glass of claret. By eight in the morning I had taken fix doses, and more than half a bottle of claret. I was confiderably ftrengthened, and could converse with Mr. Beaumont, who encouraged me to perfevere in the bark, and treated me with uncommon attention. I had been fadly neglected at Bufforah, but this was amply made up to me by the humane and tender attentions of Mr. Beaumont, who was a great predeftinarian, and who never shunned danger when he felt it a duty to affift a fellowcreature. He waited upon me like a nurse, confoled me under pain

[blocks in formation]

and fickness, and, when my fever was at its greatest height, he has often held me in his arms, when I wanted to be removed or my bed shifted. About this time my legs and thighs became covered with blotches of a dufky brown hue, fome of them as broad as the palm of the hand, quite dry, and they itched intolerably. At the fame time several little boils broke out in different parts of my body, but there was only one, over my eye, which came to fuppuration; the others, and the eruption on my legs and thighs, all disappeared.'

This was not, however, the end of the difeafe: Various troublesome symptoms remained; and, a fortnight afterward, about the change of the moon, a return of the fever happened, which affumed a tertian type, and was not removed without a copious exhibition of the bark. Of the eight other perfons who formed the party, fix died; and it was computed that 25,000 were carried off by the fever in Bufforah and its neighbourhood. The fymptoms of this disease are thus defcribed:

The firft fymptoms of this fever, or plague, are generally swelling of the tongue, a violent head-ach, bleeding at the nose, pains all over the body, a conftant inclination to make water, which comes in drops, and attended with great pain, and is as high-coloured as blood; (if the urine, on standing, becomes purple, it is faid to be a certain fign of death;) extreme heat, great apprehenfion, all objects appearing of a yellow colour, uncommon terror, and at the fame time a great defire for death; there are alfo boils or eruptions on the skin, which most commonly appear either juft before the disease proves fatal, or the patient begins to recover.'

6. On the Want of a Pericardium in the Human Body; by Matt. Baillie, M. D. Among the rarer inftances of defect in the human body, is that of the want of a pericardium. Haller denied that this defect ever occurred: but there are on record a few inftances, given from good authority. The subject of the prefent paper was a man about 40 years old, brought to Dr. B.'s diffecting-room, of whom no account could be obtained. The defective appearance was immediately obvious on opening the thorax, and is here defcribed with an accuracy that can leave no doubt of the fact.

7. On Introfufception; by Mr. John Hunter.-For this curious paper we must refer to the volume at large.

8. Of uncommon Appearances of Difeafe in Blood Vesels; by Matt. Baillie, M. D. The firit of thefe morbid affections mentioned, is the coagulation of the blood in the veffels of the living animal. This happens, when a veffel has been closed by a ligature, and when it is dilated into a bag. The latter is the cafe of aneurifmal arteries: but the coagulum rarely forms till the artery is confiderably diftended. Still more rarely does it fill up the whole cavity of the veffel, so as to ftop all circulation through it. Sometimes, however, fuch a coagulum forms

without

without any previous ftoppage of the veffel, or any confiderable dilatation. Dr. B. gives an account of fuch an occurrence in the right carotid artery of a man brought for diffection, whose whole arterial fyftem fhewed a tendency to aneurism. It formed an oval uniform fwelling, about 1 inch in length, firm, and feeling like an abforbent gland. A figure of it is annexed.

The fecond topic is the obliteration of veffeis. In various inftances, we know that veffels, which are become ufelefs, fhrivel up, and are converted into a ligamentous fubftance. This is a natural process: but Dr. B. gives a cafe (illuftrated by a plate,) of the inferior vena cava being thus changed, and rendered quite impervious, from the entrance of the emulgent veins to the right auricle of the breaft. The lumbar veins were enlarged; and, by means of their communication with the vena azygos (double in this inftance,) the blood was conveyed to the heart.

The offification of veffels is the next fubject. This is very common in the arterial fyftem, but, in the venal, is almost unknown. One inftance, however, is found in the collection in Windmillftreet, in which a confiderable offification was formed in the coats of the inferior vena cava, near to its bifurcation into the iliacs.

9. Account of Mr. Hunter's Method of performing the Operation for the Cure of the Popliteal Aneurism; by Mr. Everard Home. No artery in the body, unless it be the aorta, is found to be fo fufceptible of aneurifm as the popliteal; and it is remarkable that its fubjects have been very frequently coachmen and poftilions. The method of cure, by tying the artery near the feat of the difeafe, has generally proved ineffectual; and the amputation of the limb is an event, if poffible, to be avoided. The common notion of an aneurism has been that of a fimple dilatation of the artery from a local weakness in its coats, independently of other difeafe: but Mr. Hunter has found an alteration of ftructure in them previously to dilatation; and, from the bad fuccefs of tying the artery immediately above the sac, it seems probable that a difeafed ftate extends fome way along it. His idea of an improved mode of practice was, to lay bare and tie the artery in the anterior part of the thigh, at fome diftance from the diseased part, and trust to taking off the force of the circulation for ftopping the progrefs of the aneurism, and perhaps for its cure by the efforts of nature. In pursuance of this plan, he performed his operation in December 1785. We think it unneceffary to follow Mr. Home in his minute defcription of it, fince its general mode must be pretty obvious; and feveral variations took place in those which were afterward performed. The artery was tied fomewhat below the middle of the thigh with four flack ligatures. The event was that, after a tedious and troublefome cure of the wound, owing

[blocks in formation]

to the repeated expulfion of pieces of ligature, the patient perfectly recovered, and no appearance of tumour in the ham remained. In March 1787, he died of a fever; and an opportu nity was gained of examining the ftate of the parts. The femoral artery was found impervious from its giving off the profunda to the part included in the ligature; at this part there was an offification for about an inch and a half, below which the artery was again pervious down to the aneurismal fac, and contained blood, but did not communicate with the fac itself, having become impervious juft at its entrance. The remains of the fac were of the size of a hen's egg, but more oblong, and flattened. The lower orifice of the artery was quite obliterated; and the fac itself was filled with folid coagulum. The operation therefore appeared to have had all its expected effect in allowing the contents of the fac to coagulate, and the artery to become impervious. The collateral arterial branches were in a natural ftate, not unusually dilated; and yet the circulation into the lower limb had been fully carried on.

Mr. Hunter's fecond operation was unfuccefsful. The artery was fecured by one ligature only, and the wound was ereffed to the bottom. Repeated hemorrhages occurred, of which the patient died on the 26th day. In the third operation, only one ligature was used, and the parts were healed by the first intention. The cure was fpeedy and perfect. The fourth was likewife fuccefsful, but the cure was more tedious, from the formation of abfceffes, owing to the patient's bad ftate of health. The fifth was a fpeedy cure, without any unpleasant circumstances. This was likewife the cafe with an operation by Mr. Lynn at Westminster hofpital. Mr. Birch, of St. Thomas's hofpital, performed a fimilar operation in the cafe of aneurism of the femoral artery, in which a large tumour occu pied two-thirds of the thigh. The patient became feverish, the tumour burst on the twelfth day, and he died. Mr. Cline operated in the fame manner for a popliteal aneurism. Every thing feemed to be going on favourably, till the patient was feized with a fever, fuppofed to be caught from another patient in the fame ward, and died. On examination, the artery was found in an ulcerated ftate beneath the ligature, and finufes were formed upward and downward in the thigh. To thefe accounts, Mr. Earle adds one of an operation for an aneurismal tumour in the leg, the confequence of an injury, in which the attery was tied in the ham, with a probable profpect of fuccefs. On the whole, it appears that a confiderable improvement in furgery is pointed out by the idea which led to thefe operations, yet that the event of any mode of treating aneurismal tumours is ftill, and probably ever will be, hazardous and uncertain.

10. Cafe

« EelmineJätka »