dropsies; and which exhibits gonorrhea as the only disease of the “sexual function!" We must also join in protesting against the use of the term "alii morbi ;" whatever classification may be adopted, medical officers should be imperatively required to return every case of disease under its proper head. The lumping of several diseases in this way, diminishes materially the value of the returns, and is at best but a poor economy of stationery.

It is most justly remarked by our author, that

:

"It cannot fail to be a source of regret that the system of returns required from the Indian army, should not be identical with that adopted in Her Majesty's service the value of such uniformity in extending our knowledge of the medical economy of troops serving in every quarter of the extended empire subject to Great Britain; of the closer approximation to truth that would result from calculations spread over so wide a field, and deduced from numbers that would constantly tend to diminish the amount of error arising from local and accidental causes in smaller bodies of men, is almost self-evident to any one who has studied attentively the important subject of statistics."

The advantages to be derived from this uniformity in the returns have been brought under the notice of the authorities since Dr. Mouat's paper was written, and we trust will be duly considered in the arrangements which are to be made in India for collecting military statistics.

Dr. Mouat has appended to his paper, a brief analysis of the various works that have been published on the medical topography of some of the stations in the Bengal Presidency, which may prove useful to those desirous of ascertaining what information is extant on this subject. In noticing one of these, he quaintly observes "much valuable matter and careful registers of the hygiène of prisoners may possibly exist in the records of Government, but as they have never been published or made known, the information is of no practical use."

We are at all times happy to have it in our power to notice the labours of our brethren in India, because we consider them entitled to much more credit for their exertions under all the disadvantages and discouragements to which they are exposed, than we are who enjoy the bracing air of a temperate clime. We believe there is no want of zeal on the part of the officers of the Indian medical department, but that they are anxious to promote the cause of science, and contribute their quota to the advancement of their profession; and we trust the authorities will by liberal arrangements soon enable them to produce a series of statistical returns worthy of being ranked with the best works of this nature. Dr. Mouat, who is but young in the profession, is entitled to great praise for the able and zealous manner in which he has endeavoured to direct the attention of the ruling powers to the important subject treated of in his pamphlet.

T

ART. X.

Sicheres Heilverfahren bei dem Schnell gefährlichen Lufteintritt in die Venen und dessen gerichtsärztliche Wichtigkeit. Von Dr. CH. Jos. EDL. V. WATTMANN, k. k. n. ö. Regierungsrathe, Leibchirurg, o. ö. Professor der praktischen Chirurgie und der ersten chirurgischen Klinik, Vorsteher der Operations-Institutes an der k. k. Universität in Wien, &c.-Wien, 1843. A Certain Remedy in rapidly dangerous Entrance of Air into the Veins, and on the Medico-legal Importance of that Event. By Dr. CH. Jos. VON WATTMANN, Councillor to the Imperial Government and Surgeon to the Emperor of Austria, Professor of Practical and Clinical Surgery, and Director of the Institute for Operations in the Imperial University of Vienna, &c.-Vienna, 1843. 8vo, pp. 188.

THE subject both of the artificial introduction and of the spontaneous, or rather accidental, entrance of air into the veins has been several times considered in this Journal, especially in the Number for October 1838, pp. 455 et seq. Dr. Wattmann's publication again brings this very interesting question before us, so far as regards the spontaneous or accidental admission of air into the veins of man. It might indeed have been expected that little room for discussion would remain after the numerous experiments, and the nearly as numerous disputations, both oral and written, which the subject has called forth; and it certainly is to be regretted that a phenomenon of such unquestionable importance, and of which so many alleged examples have occurred in the practice of surgery, should still be a matter of doubt and dispute.* As an example of how unsettled opinions are respecting it, we may mention that in four systems of surgery, now in course of publication in Paris, three different doctrines are advanced; M. Nelaton admits, M. Ph. Boyer denies, that the spontaneous entrance of air into the human veins has ever proved fatal; while MM. Bérard and Denonvilliers take a middle course between these extremes, and think "that the solution of the problem remains doubtful, and is not decided either affirmatively or negatively." In this last opinion M. Vidal de Cassis coincides, in the second edition of his work on Surgery, which has just issued from the press. We must, however, observe that M. Vidal, the most recent of the writers just mentioned, has scarcely devoted sufficient attention to the subject. He states that MM. Bérard and Denonvilliers have collected almost all the recorded cases purporting to be examples of spontaneous entrance of air into the human veins during an operation: the fact being that they have not collected one fourth of them. He thinks it a remarkable and happy circumstance, that no new cases of the accident have been heard of since the publication of M. Bouillaud's Report, and the academic discussion thereon (examined in this Journal, Oct. 1838), and thence insinuates an argument against the reality of the event. A glance at the table of cases we have drawn up will show how much M. Vidal is mistaken in this respect. He states that the influence of exhaustion from hemorrhage in accelerating the fatal consequences of air admitted into the veins of dogs has been established by M. Gerdy particularly. M. Gerdy has,

• Since the above lines were written, we have seen that one of the questions to be submitted to the Medical Section of the Scientific Congress of France, at its meeting at Marseilles, 1st September, 1846, is as follows: "Fixer autant que possible nos idées sur l'influence de l'introduction de l'air dans les veines pendant les opérations."

on the contrary, endeavoured to show that the alleged effect of exhaustion is at the least doubtful. M. Vidal further implies that surgeons have invented spontaneous entrance of air into the veins, as an excuse for the sudden death of their patients during the performance of operations, inasmuch as no one, he says, has ever spoken of its occurring except consequent on wounds inflicted by a surgeon. In this also M. Vidal is utterly mistaken; the presence of air in the veins has been observed after decapitation, and also in some cases of suicide, and death has in some of these latter cases been attributed to its influence; again Sir C. Bell relates (Practical Essays, 1841, p. 11), that Baron Larrey, on looking over his Sketches of the Wounded at the Battle of Waterloo, "fixed with interest on the case of a young man who had been wounded in the lower part of the neck. Well, I know, said this excellent surgeon, how that man must have died. I have seen so many wounded during my campaigns, and die from air drawn into the veins." We fully admit that there has been a great deal of exaggeration respecting the entrance of air into the veins; like many other things, it had a run not merely with the profession, but even became for a time, we might almost say, a fashionable source of apprehension out of the profession. The wife of an eminent orator and leading member of the French Chamber of Deputies was bled at the arm, and having been enjoined to observe the strictest quietude, was left alone in her bedroom after a short time hemorrhage came on, and, in the absence of timely help, the lady lost a quantity of blood sufficient in her condition to prove fatal. The catastrophe was, however, attributed to entrance of air into the veins, and this explanation attaining due publicity in the newspapers of the day, produced such an impression, that for some time, in certain circles, few physicians cared to propose venesection, and still fewer patients to submit to the operation. But though we agree with Blandin, Velpeau, and many others, that sudden death during operations has been erroneously attributed in several cases to entrance of air into the veins, we shall examine whether there are not other recorded cases which establish both the reality and fatality of the phenomenon. It may seem, from the title of Dr. Wattmann's book, that we are about to travel beyond the limits of his inquiries, but such is not the fact, for though he purports only to consider how the effects of the admission of air into the veins is to be remedied, and the medico-legal import of such an occurrence, he, in point of fact, enters into a consideration of the whole subject as a question of physiological surgery.

As we have to deal solely with spontaneous entrance of air into the veins, we shall refer but little, and that only incidentally, to the experiments on injecting air into the venous system. But we may say thus much, that many of the results and theories of modern experimenters were anticipated by some two hundred years. Not only did Woepfer, R. J. Camerarius, Redi, Bohn, Ant. Heydin, Brunner, Harderus, Valisneri, and Sproegelius kill animals by injecting air into their veins, but Camerarius, Brunner, and Valisneri ascertained that a certain quantity of air might be thus injected with impunity. Valisneri also discovered that the effects of air thrown into the veins varied in different animals, as dogs were more easily killed by it than sheep. The diversity of symptoms produced, did not escape notice. Brunner observed opisthotonos, Sproegelius slight convulsions, while Camerarius never witnessed either rigidity or spasms of the muscles, but, on the contrary, found them relaxed. Camerarius and

Harderus ascertained by dissection the presence of air in both the arteries and the veins, and Sproegelius thought the blood was always preternaturally liquid. Of the theories advanced in late years to explain how air in the organs of circulation causes death, three at least were anticipated. Brunner, Camerarius, Harderus, and Sproegelius attributed death to suspension of the circulation, from the heart being so distended that its contraction is prevented, and Harderus further held the opinion, that the fibres of the heart were weakened or paralysed by extreme distension, just as is the case with the urinary bladder in certain cases of retention of urine. Morgagni too agreed that death resulted from disturbance of the functions of the heart. Finally, Bohn conceived that air proved fatal by acting as a powerful and rapid poison. (Morgagni De Sed. et Caus. Morb. Epist. v. sect. 21 et seq.)

The discovery of the spontaneous entrance of air into a wounded vein, is comparatively, indeed absolutely, of recent origin. It is true Mery observed that if the abdominal cava of a living animal is punctured, the vein becomes filled with air as it empties itself of blood, but he thought the air was contained in the radicle veins, and flowed from them towards the cava, and thence to the heart. (Mém. de l'Acad. des Sc. 1707, p. 167.) Littré not long after found air in the blood-vessels after death from hemorrhage. (Ibid. 1714, p. 330.) Redi and Caldesi had seen air circulating with the blood in some cold-blooded animals, as vipers and tortoises, and thought it existed naturally in their blood-vessels, but Haller pointed out that air was not present, unless some vessel had been opened. Nysten remarks that he several times saw the veins and right auricle of persons who had been decapitated distended with air (Recherches de Physiolog. et de Chim. Patholog. 1811, p. 5), but failed like his predecessors to surmise its real origin. Verrier, a veterinary surgeon, seems to have been the first who, in 1806, recognized the spontaneous entrance of air into the veins of an animal. Magendie subsequently (Journal de Physiolog. 1821) inferred the occurrence of the event in man from M. Beauchene's case, and sought to establish it by experiments on animals; but as he allowed the air to enter through a tube passed into a vein, its admission in those experiments cannot be termed spontaneous. Subsequent to Magendie's first researches, several cases were observed in which air was supposed to have accidentally entered the human veins, but those cases did not attract very much attention at the time, and their interpretation was and still is disputed. M. Amussat, we believe, was the first who actually demonstrated the spontaneous passage of air into an open vein. His first communication on the subject is a short and incidental, but very explicit, passage in his memoir on traumatic hemorrhage, read to the Academy of Medicine in 1835, and published in their Memoirs, t. v, pp. 68 et seq. For his subsequent researches we refer to the Number of this Journal already mentioned, and to his 'Recherches sur l'Introduction accidentelle de l'Air dans les Veines,' &c.

We would now willingly proceed to examine the alleged cases of this accident in man, but as their import must be tested by comparing how far the circumstances attending them agree with the causes which produce entrance of air into the veins, and with the phenomena observed in animals that have undoubtedly died from its effects, we must first advert to those causes and phenomena, the more especially as considerable difference of opinion and statement exist respecting both.

The experiments of Barry, modified and confirmed by those of M. Poiseuille, fully establish the influence of atmospheric pressure on the venous circulation. There is no question that during inspiration, the flow of venous blood towards the thorax is facilitated in the great venous trunks in the vicinity of that cavity, while, during expiration, a partial reflux occurs in the same vessels. It is further generally assumed, from the experiments of Poiseuille, that the suction thus exerted on the contents of the veins extends to but a very short distance from the superior aperture of the thorax, because the veins being flexible tubes,-with very delicate yielding parietes, incapable of contracting in the direction of their length,-communicating with a cavity which tends to exhaust them by suction,—and exposed to atmospheric pressure external to that cavity, the suction cannot act beyond certain limits. For just as when we attempt to empty with a syringe a flexible tube full of liquid, and fixed at both ends, a small quantity of liquid only enters the syringe, because atmospheric pressure forces the sides of the emptied portion of the tube into contact, so do the veins when similarly circumstanced collapse. The diastole of the right ventricle of the heart is admitted by some to exert an influence on the venous circulation, quite similar in kind to, but less in amount than that of the expansion of the thorax during inspiration. MM. Gerdy, Velpeau, and others, indeed deny this influence of the heart, because opening one side of the thorax has been found to immediately arrest the entrance of air into an open vein, but we think that its reality is established beyond a doubt. In M. Bouillaud's Report, already referred to, it is expressly stated that the flux and reflux of blood was sometimes observed to be synchronous with the action of the heart, and in some experiments the characteristic sound of air entering the veins coincided for a time with inspiration, but then became more rapid, and was obviously isochronous with the action of the heart. M. Barthélemy independently made similar observations, (Bull. de l'Acad. t. i, p. 904, and t. ii, p. 368); and Dr. Wattmann, in one case in man, distinctly observed the venous pulse in the internal jugular vein coincide with the action of the heart. (p. 114.) But whatever may be the influence exerted by the action of the right cavities of the heart, the aspiration of the venous blood does not extend beyond certain limits, and M. Poiseuille having found that the external jugular vein of a dog when laid bare collapsed to within 4 centimeters (1 inch) of the thorax during inspiration, this was thought to give an approximate measurement of the sphere of the phenomenon. Wherever then this suction, manifested by the venous pulse, exists, it is admitted that air may and frequently does enter a vein when wounded; and as the obstacle to the entrance of air into a vein beyond the limits of the venous pulse, is the obliteration of the canal of the vein by atmospheric pressure, the sphere within which air can enter a vein may obviously be extended if the collapse of the vein is prevented. As regards a considerable extent of the internal jugular vein, the whole length of the subclavian vein and the upper half of the axillary vein, M. Berard has shown (Archiv. gen. t. xxiii, pp. 169-71) that they are united to the adjacent bones and muscles by fibrous attachments, which prevent their collapsing under atmospheric pressure, and consequently they are liable to admit air when opened. Again, the committee appointed to report on M. Amussat's experiments, found that air entered the axillary vein beyond the limits of the venous pulse when