opening of the brachial artery

2
52 regular state of the circulation, and the set- in of a steady convalescence, were coincident with the action of large doses of antimony, and kept up by the combination of hydri- odate of potass, digitalis, &c., already spoken of. In nervous, uterine, and biliary affec- tions, I have obtained such results from hy- driodate cf potass, that I consider it a re- medy of the very first utility. After the action of this combination on Howls, and the removal of a third pericardite in Mr. Gwynne, and of three inflammations of the chest in others, by similar powerful com- binations without venesection, I have con. ceived the hope of being able to communi- cate such " bons moyens " as will limit, if not, in many cases, supersede, blood-letting in inflammatory states of the heart and thoracic viscera. The shower-bath possesses a sedative power, which is a partial substitute for bleeding. The French use it as a last re- source in diseases of the heart, and consider it as frequently successful after the failure of all other means. It was useful in Howls’s case, and has since been beneficial to Mr. Gwynne. The seton obviated the necessity of a great deal of Sangradoism ; it was beneficial in Marshall, the case of aortic aneurysms. Dr. Jeffrey of Liverpool has given a long- standing case of palpitation, in a student, supposed to be symptomatic of organic dis- ease, from which the patient recovered after the use of a seton. Though I have seen with joy the subju- gation of a mighty disease, after the case had been turned out as incurable from un- der so many stars in our particular hemi- sphere, I am nevertheless aware " that or- ganic diseases of the heart generally last through life, and functional generally dis- appear ; that the prognosis is always un- favourable ; that the symptoms are generally suspended for a time, and then relapse, and terminate fatally." (Professor Honae.) In organic disease nothing is more common than periodic returns. The general cause of these returns is cold, and dry cold, by contracting the circumference of the body. The blood, which permeates the capillaries under a soft temperature, flows back to- wards the centre, and, if an obstruction ex- ists, it becomes relatively greater through the more energetic efforts of the principal organ of circulation. (M. Rostan.) Howls at this moment (Feb. 8) has a return of slight palpitation, with impulse, pain of brain, and hysterical nervousness, and chilly extremities, from walking too far, and getting wetted through her boots in the snow. Macintosh’s waterproof, and all other means that can preserve the balance of the circulation, are necessary to such people. Ross, Herefordshire, Feb. 1836. OPENING OF THE BRACHIAL ARTERY IN BLOOD-LETTING, AND HEALING BY COMPRESSION. I VINCENT PETIEL, aged forty years, a printer, was admitted at the Hotel Dieu, Paris, under the treatment of M. Sanson. He had fallen from the stair of his resi- dence, upon one of the last days of the month of December, by which he received contusions upon the chest, the knee, and the right foot; and also a small wound upon the integuments of the face. He entered the hospital on the 31st of December. The pains which he experienced in the chest, particularly on movement of the intercostal muscles, the strong pulse, the injection of the capillaries of the face, and the robust constitution of the patient, showed the ne- cessity of general blood-letting. Resolutive remedies were employed upon the contused parts, and bandages over the chest, in a serrated form, were employed, until the pains of the chest were removed. Blood- letting was performed on the 1st of Janu- ary. Two prickings had been made by one of the hospital pupils in the median cephalic vein, from which only a few drops of blood were obtained. He pricked the median basilic vein, placed a little to the outer side of the artery, the pulsations of which were perceived. This vein was very superficial and voluminous, and much distended. Im- mediately after the puncture was made, the blood spouted out with violence over the bed, the assistants, and the operator. The jet was readily directed to the vessel in- tended to receive the blood. The blood was brisk (vif) and strong (fort), it was also jerking. This fluid was red, lively, and frothy.* These characteristics of the jet of blood were sufficient, without doubt, to make known that an artery was opened, but it was needful to be assured of this. The vein was compressed below the puncture, and the jet diminished in volume, but the force was not diminished. The nature of the blood was not changed in appearance. This was put to the proof. The brachial artery was compressed between the opened portion and the heart. The jet diminished in volume, it waa no longer jerking, but showed a sustained arch. Above all, its force and extent were diminished. The nature ot the blood was not the same. It was dark and less frothy. In a word, it had now assumed the characteristics of venal blood. After having twice made these proofs, and ob- tained the same results, it was needful to act as if the artery were open. A plug * " Frothy," from the atmospherical air which it contained as arterial blood (?)—ED. L.

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Page 1: OPENING OF THE BRACHIAL ARTERY

52

regular state of the circulation, and the set-in of a steady convalescence, were coincidentwith the action of large doses of antimony,and kept up by the combination of hydri-odate of potass, digitalis, &c., already spokenof. In nervous, uterine, and biliary affec-tions, I have obtained such results from hy-driodate cf potass, that I consider it a re-

medy of the very first utility. After theaction of this combination on Howls, andthe removal of a third pericardite in Mr.Gwynne, and of three inflammations of thechest in others, by similar powerful com-binations without venesection, I have con.ceived the hope of being able to communi-cate such " bons moyens " as will limit, if

not, in many cases, supersede, blood-lettingin inflammatory states of the heart andthoracic viscera.The shower-bath possesses a sedative

power, which is a partial substitute for

bleeding. The French use it as a last re-source in diseases of the heart, and considerit as frequently successful after the failureof all other means. It was useful inHowls’s case, and has since been beneficialto Mr. Gwynne.The seton obviated the necessity of a

great deal of Sangradoism ; it was beneficialin Marshall, the case of aortic aneurysms.Dr. Jeffrey of Liverpool has given a long-standing case of palpitation, in a student,supposed to be symptomatic of organic dis-ease, from which the patient recovered afterthe use of a seton.Though I have seen with joy the subju-

gation of a mighty disease, after the casehad been turned out as incurable from un-der so many stars in our particular hemi-sphere, I am nevertheless aware " that or-ganic diseases of the heart generally lastthrough life, and functional generally dis-appear ; that the prognosis is always un-favourable ; that the symptoms are generallysuspended for a time, and then relapse,and terminate fatally." (Professor Honae.) Inorganic disease nothing is more commonthan periodic returns. The general causeof these returns is cold, and dry cold, bycontracting the circumference of the body.The blood, which permeates the capillariesunder a soft temperature, flows back to-wards the centre, and, if an obstruction ex-ists, it becomes relatively greater throughthe more energetic efforts of the principalorgan of circulation. (M. Rostan.) Howlsat this moment (Feb. 8) has a return ofslight palpitation, with impulse, pain ofbrain, and hysterical nervousness, andchilly extremities, from walking too far, andgetting wetted through her boots in thesnow. Macintosh’s waterproof, and allother means that can preserve the balanceof the circulation, are necessary to such

people.Ross, Herefordshire, Feb. 1836.

OPENING OF THE BRACHIAL ARTERY

IN BLOOD-LETTING, AND HEALING BYCOMPRESSION.

I VINCENT PETIEL, aged forty years, a

printer, was admitted at the Hotel Dieu,Paris, under the treatment of M. Sanson.He had fallen from the stair of his resi-dence, upon one of the last days of themonth of December, by which he receivedcontusions upon the chest, the knee, andthe right foot; and also a small wound uponthe integuments of the face. He enteredthe hospital on the 31st of December. The

pains which he experienced in the chest,particularly on movement of the intercostalmuscles, the strong pulse, the injection ofthe capillaries of the face, and the robustconstitution of the patient, showed the ne-cessity of general blood-letting. Resolutiveremedies were employed upon the contusedparts, and bandages over the chest, in aserrated form, were employed, until the

pains of the chest were removed. Blood-letting was performed on the 1st of Janu-ary. Two prickings had been made by oneof the hospital pupils in the median cephalicvein, from which only a few drops of bloodwere obtained. He pricked the median

basilic vein, placed a little to the outer sideof the artery, the pulsations of which wereperceived. This vein was very superficialand voluminous, and much distended. Im-

mediately after the puncture was made, theblood spouted out with violence over the

bed, the assistants, and the operator. Thejet was readily directed to the vessel in-tended to receive the blood. The bloodwas brisk (vif) and strong (fort), it wasalso jerking. This fluid was red, lively, andfrothy.*These characteristics of the jet of blood

were sufficient, without doubt, to makeknown that an artery was opened, but itwas needful to be assured of this. The veinwas compressed below the puncture, andthe jet diminished in volume, but the forcewas not diminished. The nature of theblood was not changed in appearance. Thiswas put to the proof. The brachial arterywas compressed between the opened portionand the heart. The jet diminished in volume,it waa no longer jerking, but showed a

sustained arch. Above all, its force andextent were diminished. The nature ot theblood was not the same. It was dark andless frothy. In a word, it had now assumedthe characteristics of venal blood. Afterhaving twice made these proofs, and ob-tained the same results, it was needful toact as if the artery were open. A plug

’ * " Frothy," from the atmospherical air which itcontained as arterial blood (?)—ED. L.

Page 2: OPENING OF THE BRACHIAL ARTERY

53

(tampion) was applied upon the orifice from ’,which the blood flowed, upon which suchcompression was made that the pulsation ofthe radial artery could scarcely be felt, andover the trajcct of the brachial arterya compress of many folds was passed, andthe whole limb was surrounded by a rolledbandage methodically applied, and conti-

nually moistened with water. Every twodays afterwards, from the 8th to the 14th,the applications were changed, and theywere laid aside on the 18th.

Nothing worthy of record took place ex-cept itching, pimples, and a slight scurfingof the fore-arm, whichwere consequences ofthe long-continued application of compres-sive bandages. These soon disappeared. Thepatient experienced no difference betweenthe arm operated upon, and his other arm.He remained in the hospital until the 10thof February, without any change occurringin the arm. No unfavourable symptom after-wards took place, and although he was seenseveral times afterwards at the Hotel Dieu,the impression was, that his recovery onthis occasion was perfect, in every sense ofthe word.-French Med. Jour.

*** If we mistake not, life has often beenlost in cases coming under the denominationof " cerebral congestion

" (apoplexy) " pul-monary congestion (apoplexy) " from a

difficulty of removing a sufficient portion ofblood from the system (the case of the lateLord Holland was probably an instance inpoint), although myriads of leeches may havebeen applied as well as cupping, and althoughthe temporal artery has been (unsuccess-fully from its small size and position) at-tempted to be opened. Why not at onceopen the brachial or its branches, the cu-bital, or the radial artery ?

ABSENCE OF THE EYES.

JAS. GEO. DAVEY, M.R.C.S.L.

To the Editor.-Sir: I forward the fol..lowing statement for insertion in your valu-able periodical.About three weeks since, Mrs. Moore,

residing in Church-path, Land-port, Port-sea, the mother of five or six children,brought her infant, then about six weeksold, to me, to know my opinion respectingit, when I was surprised to discover that thechild had no eyes. The eyelids were closed,and sunken deeply in the orbits, formingexternally a considerable concavity. Onraising the lid which concealed the lellorbit, there was seen a quantity of ap-parently condensed cellular tissue, and ncvestige of an eye. The ciliary margins ojthe iight side were fixed pretty firmly in

apposition, which appeared to have beer

recently effected by the adhesive inflamma-tion, and the same process had seeminglycommenced on the opposite side. The littlesufferer was much emaciated, and suffer-ing severely from an obstinate enteriticaffection, which I anticipate will eventuallyrelease it from the miseries which life wouldentail on it.

This morning I had a conversation with amedical gentleman of this town, who in-formed me that the same appearances(with the exception of the adhesion men-tioned) existed at the time of birth. I am,Sir. vour obedient servant.

3, Mile-end-terrace, New-town,Portsea; March 23, 1836.

CALOMEL IN SCALDED GLOTTIS.

JOACHIM GILBERT.

To the Edit-,r.-Sir: I have read the ex·

cellent and practical lecture, by Dr. Wal-lace, in a late Number of THE LANCET,wherein he speaks of the good effects ofcalomel in controlling the effects of scaldedglottis in infants. I do not take up my pento dispute the priority of administering thismedicine in such cases, but I leave the chap-let where it is, if Dr. Wallace gave calomelin scalded glottis previous to the spring of1822. I was then living with Mr. Elliot of

Kingsbridge, Devon, at the time when aperson of the name of Willing requestedthat I would immediately visit her son, whohad drunk bailing water from the spout ofa tea-kettle. I did not know for a momentwhat could be adopted to mitigate the suf-ferings of this poor child, until, recollectingthe recoveries 1 had witnessed by the ad-

ministration of calomel in croup, I wasprompted to try it on this occasion, when,as soon as the mouth became affected, I hadthe gratification of seeing my little patientbegin to recover, and in two or three daysit was at its usual gambols. 1 am, Sir,yours obediently,Bcaminster, Dorset, March 26, 1836.

SEIZURE OF A FRENCH QUACKMEDICINE.

THE Journal de Chemie Medicale, for

August last, contains the following reportrespecting some quack-medicine powderswhich were seized upon the premises of avendor (a female) in the town of Metz, inFrance :-

The powders were accompanied by a

pamphlet, entitled ’ A Treatise upon theEfficacy of the Powders of the ChevalierGodernaux, for purifying the Blood." The