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TO CORRESPONDENTS.

NOTICE. All communications for the Editor must be addressed, pre-paid, to his house, No. 25, LLOYD SQUARE.

THE EDITOR is at home every day until One o'clock; and on the evenings of Monday, Wednesday, and Friday, from Seven till Nine.

VOLS. I. and II. of the PEOPLE'S MEDICAL JOURNAL are now ready, price 4s.
each, bound in strong and elegant cloth, gilt lettered.
CASES for binding Vols. I. and II. may be obtained of all news-agents,
price 1s. 3d. each, in strong and elegant cloth, gilt lettered.
ALBERT (Limehouse).-Any Sunday, before one o'clock.

JOSEPH HOLDEN (Newport Street, Bolton).-Cannot be answered otherwise
than privately.

E.

M. G. (Chelsea).-Your remark, that "physicians prescribe very little medicine and apothecaries a great deal," is quite correct. The amount charged for mixtures and powders during the short indisposition of your child, appears to us to be excessive. Measles will be treated of in an early number, under the head of FEVERS.

WILLIAM JOHNSON (Fleet Street).-First, the lumps are the result of scro-
fula. Second, asthma is hereditary. Third, we cannot give any opinion
on your "weak eyes," only knowing that they are weak. Fourth, read
the articles on COLDS, in the first three numbers. Fifth, as a general
rule we do not approve of the wearing of flannel next to the skin, espe-
cially in a youth of your age.

M. G. (Acton Street).-Received, and will be attended to.
DELTA.-Public credulity and public ignorance constitute the knowledge of
quacks. What an excellent motto for a patent medicine!
AZAEL (Loughborough Road, Brixton).-Medicine was cultivated and prac-
tised for 1600 years before the Christian era, as we find in the 50th
chapter of Genesis.-The first legislative enactment passed in England,
regulating its practice, was in the third year of Henry VIII. The laws
for "qualification are now in a disgraceful jumble.
WORKMAN (York Road, Lambeth).-Read carefully the article on "Irri-
table Bladder and Incontinence of Urine," in the papers on THE DIS-
EASES OF ARTISANS, in No. 48.

G. W. O. The "prospectus" you forwarded to us breathes quackery and ignorance in every line. The absence of dates to the testimonials proves the imposition; the titled names referred to are like the stereotyped "Earl of Aldborough" of Professor Holloway-those of personages who have been defunct twenty or thirty years. It is impossible that the same "solvent" can dissolve every variety of calculus. Con- A sult a qualified medical man-not a quack.

C. J. DENNIS (Derby).—According to the recent Pharmacopoeia, the compound tincture of aloes is thus directed to be prepared. Take four ounces of bruised socotrine or hepatic aloes, four ounces; saffron, two ounces; tincture of myrrh, two pints. Macerate for seven days, and strain. This is a valuable preparation; but we fear, from the expense involved, only first-rate houses will dispense it genuine.

F. A. (Oxford Street).-For the period at which the human frame attains "perfection," see answer to T. H. L. (Pickering) in No. 69.

A POOR CLERK (Bristol).-Apply to the leg a lotion, composed of two parts water, one part vinegar. All greasy applications-as ointments and salves-are improper.

ROBERT JENKINSON (Wisbeach).—Read the article on CHRONIC BRONCHITIS, in No. 9.

A COUNTRYMAN.-The rascals are Jews, quacks, extortioners, and swindlers. Burn the filthy book and forget it. Candidly state your case to any qualified physician.

A SUFFERER-CUTANEOUS.-Why date from "Clapham," whilst your letter bears evidence, as far as the post-mark goes-that you reside in the

"

ALFRED.-Before one o'clock. A guinca.

N.

GENDRIN (Canterbury).-Chloroform should never be administered by other than a medical man. The dentists-of course we mean the mob of unqualified dentists-are quite incompetent to employ it, and death may, as it has already too frequently done, follow its unguarded use. Under proper management it is a most merciful agent.

P. D. (Goodge Street, Tottenham Court Road).-We will not venture to direct you without examining you.

D.

H. P. (Artillery Place, Finsbury).-We are obliged by your letter. If you can comprehend and adapt to practical use "The Process of Thought," recently published by Longmans, you are a remarkably clever fellow. We admit our inability. "Tis a great pity that really clever men should always have one ridiculous fad.

HECTOR MUNRO (Argyll Street, Glasgow).-If you give the order to Mr. Love, Nelson Street, he will obtain the first two volumes for you in three or four days.

neighbourhood of Goswell Street? The man who deceives his physician P. (Eastgate, Pickering).-Rub the chest with simple soap liniment, every

or his lawyer, is a very foolish man. See answer to A Pook CLERK
(Horsleydown) in this number.

H. P. S. (York Street, Lambeth).-We cannot advise without examining you.
FANNY (Portsea).-Read the Chapter on "Nervous Headache," in the
Editor's work on HEADACHES.

D. R. (Skinner Street, Whitby).-We have no knowledge of you or your

case.

A POOR CLERK (Horsleydown).-Invalids resident within a distance not
greater than is your's from our own, must call for the advice and in-
structions they ask for.
DDF- —————R (Thirsk).-We do not profess to give advice, indiscriminately,
without fee; there is a wide difference between honest poverty, and
poverty of spirit. The former will always meet with the utmost con-
sideration at our hands, and our services will be cheerfully rendered.
Will your lawyer preserve your property without "charges"? Why
should a medical man, who preserves your health, be the only man who
is expected to work,-brain and hand, without recompense? "The la-
bourer is worthy of his hire," whether he be a baker, a tailor, or a
"doctor."

P. M. M. D. (Ashton-under-Lyne).—The thing is too ridiculously absurd to
notice.

C. O. T. (Birmingham).-You have detailed the symptoms too superficially.
The liver appears to be the origin of your indisposition.

HENRY LAWSON (St. Bees).-The tongue is composed of muscles, and is pro-
vided with a vast multitude of vessels and nerves, and covered with a
humid epithelium, or membrane.

INQUIRER. We published the GLOSSARY with No. 65, and the PEOPLE'S MEDICAL DICTIONARY, for the purpose of removing the necessity of such applications. Refer to either.

D. R. S. (Exeter).—Your question arrived remarkably à propos. We were at the moment describing to a friend the admirable invention of Major Little, to supply the loss of the right hand. It is in the Exhibition, Class 10, No. 196. As your son is unfortunately situated, the examination of that apparatus alone will repay you and him for the journey. When we have digested the wondrous scene we witnessed on the 1st instant, we shall describe the many valuable inventions to alleviate pain and corporeal disqualification, and the various instruments to assist the physician and surgeon in the treatment of disease or accident, that British and continental science and ingenuity have presented to the world, in the marvellous Crystal Palace.

night, and take the cough mixture prescribed in No. 8, page 60, Vol. L DAVID D (Pontypridd).-You have no remedy. You have parted with your money to a quack, and we can only advise you to be thankful that "the usual consultation fee of one guinea" is your greatest loss. Some persons are duped out of ten times that amount for the purchase of the same knowledge that you have acquired.

GRACE H. (Bristol).-It is infectious.
ROBERT TURNBULL (Reading).—The common "acid lotion" or "vinegar
wash" is made by mixing one fourth of vinegar with three fourths of
water. If the pain be very severe, to a pint of the lotion add a table-
spoonful of laudanum.

A

TYRO.-Berzelius, the celebrated chemist, was a native of Sweden. He died August 18th, 1818.

J. J. (Elizabeth Street, Liverpool).-We have received your letter, but really cannot comprehend what you mean.

ROBERT HARRISON (Halifax).-Take thirty drops of the compound aromatic spirits of ammonia, in a wine glassful of Sir James Murray's solution of camphor, twice a day. As summer approaches, use the shower bath. ROBERT HALL (Deritend, Birmingham).-See answer to A REPORTER (Dublin) in No. 35.

JAMES COLE (Great Yarmouth).-We do not think you have referred the symptoms to a right cause; write again, and describe the cause with greater candour.

ALBERTUS (Knightsbridge).—Kosso, or Kousso, may be obtained at Jacob Bell's, Oxford Street; Hooper's, Pall Mall; and at Apothecaries' Hall. HEALTH OF LONDON DURING THE WEEK.-The deaths registered last week were 1075. Measles have been very prevalent and carried off 67 children: scarlet fever, 10; small pox, 8. Typhus was fatal in 32 cases; diarrhoea in 21, influenza in 7, and hooping cough 66. Considerably more than the usual number of children are still dying from this last-mentioned complaint, which at this period of the year does not usually exceed 43 in its weekly measure of fatality. Last week the births of 771 boys and 732 girls, in all 1503 children, were registered.

London: Printed by JOHN CATCH POOL, of 35, Great Percy Street, Pentonville, at his
Printing Office. Pemberton Row, Gough Square, for the proprietor, T. H. YEOMAN,
Lloyd Square; and published by GEORGE VICKERS, 28 & 29, Holywell Street, in
the parish of St. Clement Danes, Strand.-Saturday, May 10, 1851.

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Femur, or os femoris, is a large and strong cylindrical bone, slightly arched backward, having a round head at its upper extremity, which is received into the acetabulum, or cup-like cavity of the pelvis, and forms the most perfect ball and socket joint in the body. The obliquity of the shaft of the bone is necessary to bring it more

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FIGURE XXXVIII.

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lating surface which enters into the construction of the knee. The expansion of the bone is terminated by two eminences, with smooth surfaces, termed condyles, which, articulated with the tibia and the patella, form the joint of the knee (fig. xxxviii).

THE KNEE JOINT,

Formed by the articulation of the tibia, or large bone of the leg, with the extremity of the thigh bone, is firmly knit and well secured by ligaments, being also protected, in front, by a bone called the patella, or knee cap. This bone may be re

immediately under the centre of gravity, and to ANTERIOR AND LATERAL VIEW OF THE garded as a moveable olecranon, the process of

render our steps not only more direct, but more quick and secure. It has been remarked, that whilst a man stands on both his legs the thigh bones are oblique to the gravitation of the body; but when one foot is raised, the whole body then being balanced on one foot, a change takes place in the position of the thigh bone, and the obliquity of that bone is diminished; or in other words, now that it has the whole weight to sustain, it is perpendicular under it, and has therefore acquired greater strength.

KNEE.

a. The femur, or thigh bone. b. The patella, or knee pan. c. The tibia.

d. The fibula.

haf

k

FIGURE XXXIV.

THE BONES OF THE Foor.

a. The tibia. c. The os calcis. d. The astragalus.

b. The fibula.

e. Navicular bone.

From the external surface of the thigh bone, nearly in a line with its axis, proceeds the largest and strongest bony process of the body, which gives insertion to its most powerful muscles, namely, those that extend the thigh, and that enable it to turn on its axis. From its power and . The first cuneiform bone. size it is called the trochanter major, or great. The cuboid bone. trochanter (7, fig. ii.); at the inner and under . The metatarsal bones. 7. The phalanges. part of the neck of the bone, at its back part is a similar but much smaller process, called the lesser trochanter, or trochanter minor, into which are inserted the muscles that bend the thigh.

g. h. The two other cuneiform bones.

The head of the thigh-bone is firmly braced down in the cuplike cavity of the pelvis, by various strong ligaments; and in particular by one, the ligamentum teres, or round ligament, which arises from the top of the head of the bone itself, and is affixed to the bottom of the cavity of the acetabulum; so that when the hip-joint is dislocated, this ligament must be necessarily ruptured.

The inferior extremity of the femur is much broader and thicker than the superior, and enlarges into a pulley-like articu

bone at the elbow joint,-enveloped by the tendon of the powerful extensor muscles of the leg, which tendon is inserted into the exterior part of the top of the tibia. It is a remarkably light but strong bone, and follows the motions of the tibia, to which it is attached. It is lodged, when the knee is extended, in a cavity formed for it in the femur; when bent, in a cavity formed for it at the fore part of the knee. The anterior surface is convex and rough, from the adhesion of the fibres of the tendon spread over it; its posterior surface is divided by a perpendicular ridge, into two slightly concave articular surfaces. The patella gives to the tendons which bring forward the leg, a very considerable mechanical advantage, by altering the line of their direction, and by advancing it out from the centre of motion, and this upon the principles of the resolutions of force, upon which principles all machinery is founded.

THE LEG.

The bones of the leg, two in number, consist of the tibia and fibula. THE TIBIA,

or shin bone, next to the femur, is the longest bone in the body. It derives its name from its resemblance to an ancient flute. The upper part, or head, has two semicircular concavities for the reception of the condyles of the thigh bone; and in the centre of the front aspect of the bone is a tubercle to which the ligament of the patella is attached. At the lower extremity there is a projection which forms the inner ankle, called the internal malleolus.

THE FIBULA,

or small bone, or splint bone, is placed on the outside of the leg: it is slender and of a triangular shape; at its upper and inner part it presents a smooth articular surface where it joins the tibia; and its lower extremity projects to form the outer ankle, or

external malleolus.

THE ANKLE JOINT.

The ankle joint is strengthened and defended from injuries by those remarkable prolongations of the tibia and fihula which we name the outer and inner ankle. If the joint is in danger of dislocation outwards, it is curbed by the inner projection, namely, that of the tibia; if inwards, by the outer projection, that of the fibula; between both it is locked in its position.

THE FOOT.

Like the hand, it is divided into three parts, a basal part, termed tarsus; an intermediate part, termed metatarsus; and the phalanges of the toes. The tarsus, in the human foot, consists of seven bones: the astragalus (d, fig. xxxiv.); the os calcis (); the os naviculare (e); the os cuboides (i); and three euneiform bones, (f, g, h). These bones constitute the instep, with the arched contour of which we are well acquainted. The cuboid bone on the outside, and the three cuneiform bones succeeding, make up the anterior row, or that on which the metatarsal bones are based. The tibia and fibula conjoin with the astragalus-a large irregular bone having a polished, and somewhat depressed, articulating surface-to form the ankle-joint. Among themselves, like those of the carpus, the tarsal bones are all compacted together in solid array. The os calcis, or heel bone, is situated below and behind the astragalus; it is the largest bone of the tarsus, and receives the tendon Achilles, to which we shall presently refer. The os naviculare interposes between the astragalus and the three cuneiform bones; the cuboid bone rests against the anterior projecting part of the os calcis. The metatarsal bones are larger and stouter, in proportion to the toes, than the metacarpal are, as compared with those of the fingers; otherwise they resemble them in shape and general character. The first or great toe, analogous to the thumb (though not antagonizing with its fellows), consists of two phalangal portions; the others of three.

before it is brought to the ground, the heel of the other foot is raised by the action of the muscles of the calf, so as to throw the weight of the body momentarily on the toes. Hence the strain on the tendon Achilles-the powerful tendon attached to the heel-in walking; a strain which is increased in running, leaping, or dancing; or on dropping from any height upon the toes (a mode dictated by instinct, in order to break the consudden and violent effort has occasioned the rupture of this cussion); and there are not infrequent instances where a tendon, into which the muscles of the calf converge. 1827; it was occasioned merely by suddenly slipping from the A personal friend of our own suffered from this accident in 1827; it was occasioned merely by suddenly slipping from the curb on to the road way; he was confined to his chamber for many months, and was compelled to walk with crutches for a considerable period afterwards.

The action of the muscles of the calf is that of flexors of the ankle-joint; they draw the foot backwards, and, in this position, retain it with great power, and more or less permanently, as the occasion may be. If we stand on tip-toe for a length of time, we begin to feel the muscles of the calf aching with fatigue; and the same sensation, succeeded by stiffness, results after a toilsome walk; after skating, dancing, and similar exercises. (To be continued.)

THE TREATMENT OF WOUNDS. (Continued from page 147.)

PRICKS-PUNCTURED WOUNDS.

A PUNCTURED Wound signifies one that is made with a narrow pointed instrument-as by a pin, a sword, bayonet, scissors, hooks, points of broken bones, &c.

Wounds of this description are in general infinitely more dangerous than cuts, notwithstanding the latter have the appearance of being far the most extensive. The most simple form of punctured wound is that produced by running into a part of the body, as the hand or foot, a splinter or thorn. After such an apparently trivial accident, which may not, perhaps, cause a single drop of blood to flow, serious results may follow, and more or less pain is a certain consequence. If the splint or thorn can be readily seen, which is not always the case, the person pulls out the intruder, if he can; or if he cannot, he leaves it to "work out," as it is called, which it sometimes does after being painful for two or three days, and matter forming around it. But occasionally, whether the splinter or thorn be pulled

Besides the bones we have described, there are others seldom preserved in the skeleton; such are the sesamoid bones, which are very small, and found at the roots of the first joint of the thumb and of the great toe. These are under, or rather in, the flexor tendons; they serve as pulleys for increasing the angle of in-out or not, at first very serious inflammation is set up in the sertion, therefore add considerably to the force of the muscles, and protect the articulation.

In man alone are the lower limbs the sole organs of progression; and in him they are exclusively appropriated to this purpose. Walking erect, his posterior limbs have to bear the whole of the body's weight, and to maintain its due equilibrium. Let him run, or leap, or walk, whether slowly or rapidly, these organs sustain him, preserve him steadily and firmly in his usual attitude, and obey him, as far as the power with which they are endowed will admit. It need hardly be observed, that the feet are incapable of grasping, being destitute of an opposable thumb, and that they are plantigrade; that is, so constructed as to allow the sole, from the heel to the toes, to be fairly applied to the surface of the ground; while, at the same time, the arched form of the instep contributes with the action of the large muscles of the calf (the tendons of which are inserted into the heel), to secure an elastic step, and a free yet firm progression. No other animal but man possesses a well-formed calf, because no other animal walks as he does; at each step, while one foot is in the act of advancing, and just

part, and symptoms of a slight degree of locked-jaw may come on; or the person may be destroyed by irritative fever without or with well-marked locked-jaw. I have known instances, says Mr. South, in his very clever work, "Household Surgery," where the jaw-muscles were stiffened, in one instance, for an hour and a half after a thorn had been run into the finger and been pulled out; and in another, locked-jaw continued several days, after the running in of a splinter which also had been removed at once. And some years since a musical man died of locked-jaw not many hours after having pricked himself with a thorn, whilst out shooting.

If the splinter or thorn can be easily got out at once, this should be immediately done. But very frequently serious injury occurs from vain attempts to remove it, "poking" after it with forceps, or the point of a needle or knife, or squeezing the part violently, than if it were left alone. If it be determined to have it out at once, and it cannot be readily got at, it is much better to make a cut, with a knife or lancet, along the course the splinter seems to have taken, so as more completely to expose and better to get hold of it. But even then much squeezing and

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nipping should not be persisted in, as matters are thereby made worse; whilst, on the contrary, the wound has been improved by converting it from a prick into a cut, by making a more ready escape for the splinter and for any matter that may form, and thus lessen the probability of constitutional excitement. After the splinter has been removed, a poultice should be immediately applied, and continued until all inflammation ceases: after which the wound may be dressed with sticking plaster, as directed in former papers.

incautiously holding the hook between the lips or fingers, and
jerking the line by treading on or tangling it upon a bush or on
the boat's side, as may be. Persons unskilled in such matters
think it proper to wriggle the hook about and then pull it out,
as they would from a fish's mouth. This, however, is as unfit-
ting as it is a painful mode of treatment, for the barb of the hook,
manage as well as you may, cannot be freed from the flesh, and
can only be pulled out by dragging away some of the soft parts
in which it is tangled. The best, readiest, and least painful
mode of managing this accident is, first to grasp the stem of the
hook tightly, and with a sharp knife rip off the line and clear
the stem of the binding silk; then make no attempt to with-
draw the hook by the wound through which it has entered, but
press the blunt end downwards, so that the point should be made
to travel onwards till it penetrate the skin and free the barbed
point, which is then to be taken hold of and drawn further out,
in such way that the remainder of the hook follows through the
last-made wound. Rarely inconvenience, beyond a few hours
smarting, follows the accident, if thus managed; but if the finger
be painful, put on a poultice."
(To be continued.)

TRANSFUSION.

IT is not often that an opportunity is afforded to watch the effects of transfusion upon the human subject. Our readers will therefore understand that we felt extremely interested in a case where Mr Simon resorted to this operation at St. Thomas's Hospital. There are several examples of injection of blood into the veins of females on the point of expiring from hæmorrhage after delivery, the experiments of Dr. Blundell (Medico-Chirurgical Transactions) having contributed in no small degree to create confidence in the minds of surgeons; but transfusion has been less frequently used to combat the effects of hæmorrhage in male pat ents, and we thus feel much pleasure in giving publicity to the case lately under the care of Mr. Simon, where every exertion was made on the part of the surgeon and his pupils to counteract the fatal result of extensive loss of blood.

The greatest degree of danger, in cases of punctured wounds, always depends on the additional injury and rough violence which the fibres have suffered, besides being divided. Some of the disagreeable consequences, apt to follow, are also to be imputed to the frequent great depth to which punctured wounds are liable to extend, in consequence of which important parts and organs are often injured. These cases are likewise less easy of cure, owing to the difficulty of extracting any extraneous substance, which may happen to be lodged within the wound. All punctured wounds and stabs are dangerous, inasmuch as they are liable to induce inflammation, and be followed by fever, deep-seated abscesses, sinuses, &c. The degree of constitutional irritation they create has been attributed to the extent of the wound being in depth, instead of in surface, so that the consequent effusions are pent up from the inextensibility of the tissues, instead of being allowed readily to escape. The greater degree of pain which is usually experienced may depend also upon the larger size of the nerves which have been injured by the penetrating instrument. In the treatment of punctured wounds we must endeavour to prevent the formation of matter, suppuration, as it is technically called, by the application of leeches and evaporating lotions; when, however, we are unable to prevent this, and the wound does not go on favourably, the parts in the neighbourhood become very painful and tender, with a violent shooting or throbbing; there is much swelling and redness, which may extend to two or more thread-like lines, running from the limb to the trunk of the body. These are serious symptoms, and demand prompt attention. To subdue the absorbent inflammation and constitutional derangement by general and local remedies, the application of many leeches may be necessary; the limb should be buried in some emollient poultice, or constantly fomented with warm applications, and the most absolute rest is imperative. A smart dose of calomel, as four or five grains, for an adult, should be ordered, to be followed in two or three hours with a Seidlitz powder, or castor oil; small and re-operation was condemned by the Supreme Court (Châtelet), and peated doses of James's Powder, or of "Fever Mixture," containing antimony, should be prescribed, and the diet regulated according to the degree of excitement or depression under which the patient may labour. In some cases the irritability of the whole system is so great as to demand the free but cautious use of opium. When we have reason to suppose that matter is formed in deep-seated parts, there cannot be a question of the propriety of making an incision, so as to permit its escape, and this operation is invariably followed by great relief. The discharge of healthy matter should be encouraged by poultices and strict attention to the patient's general health-supporting him by generous diet, if the discharge be profuse; allaying excessive arterial action, if he be inflammatory. As the abscess (for the seat of the wound has now become an abscess) discharges its contents, healthy granulations fill up the place of the destroyed parts, and the wound may be then treated on the principles we pointed out in the last number.

For the benefit of anglers we beg to extract from Mr. South's book, to which we have already referred, the following excellent advice. He says, "Those who come to go a angling,' occasionally make a catch they did not intend, by hooking themselves, whilst

Transfusion was practised for the first time upon man by Denis and Emmeret, in France (1666); in 1667 Lower and King operated in the same manner, and their example was followed in Italy, in 1668, by Riva and Manfredi. Denis and Emmeret's tranfusion interdicted, until the faculty should approve of the procedure; but this approval was never given, as several fatal cases had occurred. Among these may be mentioned that of a lunatic, who was operated upon three different times, to cure his mental derangement; at the third transfusion he cried out, “Stop! I'm choking!" and died instantaneously.

It appears that Drs. Waller and Doubleday thus succeeded, in three cases, saving lying-in women from imminent death by hæmorrhage; and several instances have since been recorded, among which is a case of Mr. Green, who by means of transfusion revived a man on the point of dying from traumatic hæmorrhage. Among the physiologists who have declared themselves in favour of transfusion is Majendie. We should, however, observe, that Dieffenbach looked upon the operation as capable of causing instantaneous death. A case of transfusion lately occurred at the Hôpital St. Louis, in Paris, under the care of M. Nêlaton; the danger was of a pressing description, and in this instance, as well as in the case we are going to relate, the blood was generously given by a dresser, and the immediate effects were very satisfactory. The case was one of uterine hæmorrhage; and though the patient died of metro-peritonitis a few days after the

operation, it proves that transfusion may, when used under certain circumstances, be of immense benefit.

L'Union Médicale lately mentioned another case, published in the Spanish medical papers, in which a young woman, aged twenty-three, six months advanced in pregnancy, suffered from severe hæmorrhage, from bursting the vena saphena during a violent effort unconnected with parturition. She became so weak that Dr. Cazo Sacristan injected six ounces of blood at the bend of the elbow. Abortion took place twelve hours after the operation, and the patient recovered in a very short time. The last case is that of Mr. Masfen, who, in this country, injected twelve ounces of blood three different times, in a case of uterine hæmorrhage. No sensible effects were noticed from the first two operations, but the patient revived on the third, and finally regained her health and strength. We now proceed to give a few details of Mr. Simon's case.

*

The patient was an engine-driver, about forty years of age, who met with an accident by which he suffered a severe lacerated wound of the thigh; the soft parts were, on the outer side of the limb, very much disorganized, but there was no fracture, and no vessel of importance seemed to have been wounded. He was admitted March 6, 1851, into Abraham's ward, under the care of Mr. Simon. As the man was in tolerable health, and some hope of active reparative efforts might be anticipated, Mr. Simon resolved to do his best for saving the leg. The patient was well nourished and supported by stimuli, when suppuration begun; several abscesses, however, now formed, and though these were opened gradually as they appeared, extensive sinuses formed in the thigh and leg; erysipelas attacked the limb, diffuse suppuration of the cellular tissue took place, and the mischief was so great that Mr. Simon suspected the knee-joint was involved in the destructive process. The discharge continued for several weeks, sloughing of the areolar tissue and fascia took place in several points, and the purulent matter discharged was extremely offensive.

This state of things naturally weakened the patient very much; he was allowed a good diet and a sufficiency of stimulants, which acted so favourably that some improvement took place in a few days previous to the series of events which we are going to relate. At this period two sinuses were discharging rather profusely; one opened on the internal part of the thigh, a little above the knee, the other on the outer side of the calf of the leg. On the 9th of April, being about a month after admission, the patient, who had considerably lost in flesh and strength, called to the nurse, saying that he was bleeding. Assistance was soon procured, and when the dresser reached the ward the patient was found in a pool of blood. Compression was immediately applied to the femoral artery in the groin; this measure commanded the hæmorrhage; and when Mr. Simon arrived he found the patient very weak-in fact almost expiring. The only means of recalling the vital spark, on the point of being finally extinguished, was evidently transfusion, and to this extreme means Mr. Simon had at once recourse, the pressure being at the same time continued. Inquiries were made of the students assembled as to who would part with a few ounces of blood. Mr. Charles Chaldecott having, to his great credit, volunteered, a vein was opened in this gentleman's arm, and sixteen ounces of blood were injected into the dying man's circulating system, through a delicate tube placed in one of the veins at the bend of the elbow.

Evident faintness was now the share of Mr. Chaldecott on the one side, renewed life being instilled into the patient on the other. The improvement was most marked and very satisfactory,

* See the PEOPLE'S MEDICAL JOURNAL, No. 70, p. 141, Vol. III.

both to Mr. Simon, who had suggested the transfusion, and to Mr. Chaldecott, who had generously lent himself to this useful proceeding. The compression upon the femoral artery had been continued during this operation, and the patient having now revived to a great extent, complained very much of the pressure made by the fingers. Mr. Simon therefore resolved to tie the femoral artery in the groin, with the intention of removing the leg as soon as the patient had recovered sufficient strength to bear the shock of the operation. Indeed amputation had been contemplated for some time past, and had only been postponed on account of the weak state of the patient.

It was naturally suspected either some large branch of the femoral artery or the popliteal had given way. Mr. Simon tied the femoral artery almost in the groin two hours after the transfusion, hardly a few drops of blood being lost during the operation. Stimulants in the shape of wine, brandy, and strong beeftea, were now plentifully administered, and the patient rallied to such an extent that Mr. Simon amputated the thigh a little below the ligature two days after the first occurrence of hæmorrhage. In order that the blood lost should be very small in amount, Mr. Simon directed his two dressers to compress the soft parts and flaps with both hands on either side of the bone, and this pressure being effectually carried out until all the vessels were tied, the amount of vital fluid lost was quite trifling. The operation was performed in the ward, the patient having previously been placed under the influence of chloroform.

Some hesitation might have been felt as to the use of the latter agent, viewing the very weak state of the patient; but Mr. Simon considered that it was all-important to protect the poor man from the shock of the operation, (which shock might in hisenfeebled condition be immediately fatal,) in spite of the risk which might attend the use of the anaesthetic agent. The immediate result of the amputation proved that the administration of chloroform acted beneficially, the patient recovered well from its effects, and the shock of the operation had been avoided. The limb was carefully examined, and found in a highly-disorganized state, extensive abscesses and sinuses having undermined and destroyed the soft parts in different directions. Search was principally made for the source of the hæmorrhage, and after a complete dissection of the parts, it was found that the anterior wall of the popliteal artery had given way to the ulcerating process, and that from this vessel considerable loss of blood had taken place. This circumstance will be an additional proof of the power of resistance with which arteries are endowed, for the vessel was completely surrounded by suppurating parts; and it likewise shows that arteries will at last give way, and the hæmorrhage create a very perplexing complication.

Very close watch was kept by the pupils of the hospital, who relieved each other by the bed-side; and an abundance of stimulants was given to the patient. Though very weak, his state held out some hope of recovery; and as transfusion had already, as it were, snatched him from the grave, Mr. Simon had made preparations for a renewed operation of the kind, should it be found necessary, after the amputation. The patient went on pretty favourably until Sunday, the 13th, being five days after the removal of the limb, when extreme weakness came on; and as dissolution seemed at hand, Mr. Simon attempted to ward off the danger by a second transfusion, though feeling very doubtful about the result.

The blood was taken first from a labourer attached to the hospital, but it coagulated so instantaneously that injection was impossible. In this dilemma, Mr. Complin, one of the dressers, very kindly offered his services, and about ten ounces of blood, drawn from a vein at the bend of the elbow, were injected into the patient's left arm (the right had previously been operated

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