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1847) Effects of inhaling the Vapour of Water. 359 expectoration ; actually hæmorrhage! We must subdue the inflammation.” P. 59.
One of these "young females" is thus most interestingly described :
“ But the state of the chrysalis being at an end, a new field is open for Mademoiselle to range in. She makes her debut in society; she may be wondrously delicate and beautiful, and like Sylvia, all the world may admire her ; she may be
* Like all that poets fancy, like all that lovers dream,' but still possessed of an acquired or hereditary susceptibility of constitution, which soon becomes augmented by various descriptions of excitement. The ball, the theatre, late dinners, midnight suppers, form the category of her sphere of action. Her exhausted frame, after exposure to the chilling damp of a nocturnal air, seeks on a soft, luxurious bed, repose ; but a feverish sleep, amidst the freshest hours of morning, is her fate.” P. 75.
Among other remedies, Dr. Deshon mentions inhalation as a valuable agent in the treatment of phthisis. Among its advocates," says he, "in more modern times, appear the names of Laennec, Drs. Copland, Elliotson, Corrigan, Willson, Ramadge, Hastings, and Maddock."
The name of Scudamore is not so much as hinted at! By-the-bye, we doubt much whether our friend Dr. Hastings ever occupied so strange a position as that here accorded to him, between two such honourable worthies. Dr. Ramadge, we may mention, is repeatedly quoted by our author as a most esteemed authority; and, on one occasion, he appeals to the testimony of another notorious writer, who has declared that, “ with quinine and other chronothermal remedies, he has cured or arrested at least 500 cases of consumption, many of them, too, apparently in very advanced stages." The modus operandi of inhalation-nothing but the vapour of tepid water, to which a piece of camphor may be added, is used—is thus described :
« The benefits resulting from the inhalation of watery vapour, at the highest temperature that can comfortably be borne, which would range from 160° to 180° Farenheit, is two-fold. By entering and expanding the circumjacent pulmonary vesicles, a most salutary pressure is exercised upon the walls of the excavation, and the more or less partial or complete approximation of its sides is effected : while, at the same time, the faculty of aspiration and expiration of the sound aircells being augmented, a state of the lungs is induced unfavourable to the further development of the disease.
“ But this is not all, for the direct application of heat and moisture to the ulcerated cavity has a most soothing and beneficial influence upon the nerves and vessels of the part; alleviating, in a remarkable manner, morbid irritation, and increasing the circulation to the highest pitch consonant with health, favouring to the utmost, reparation of the pulmonary lesion.” P. 140.
As a matter of course, Dr. Deshon can quote cases in illustration of the success of his practice. Sir Charles Scudamore will perceive, from the following narrative, that tubercular excavations can be cured without his favourite lodine and Conium drops.
« Within the last twelve months a person sought my advice upon whom the good effects of inhalation, in healing a cavern, were so evident as to justify my introducing the case here. This patient manifested great debility and emaciation, and had night perspirations and profuse expectoration; he also suffered much from pains in the chest and larynx, which I expected to be ulcerated, to which nothing was so soothing as inhalation at a high temperature. Auscultation elicited pectoriloquy, and at once determined the nature of the case, which, indeed, was so marked, that a friend, who visited the patient for me, thought every hope of recovery forlorn, and advised a removal to his relatives and native air; yet this individual recovered, and now follows his usual avocations. It is not to be denied that inhalation, aided by appropriate medicines, saved this man's life, and that his continued health devolves upon his living judiciously, and using cold affusion and friction, to dispel occasional congestive pains which threaten, and would otherwise distress him." P. 141.
A most satisfactory and convincing case indeed! And now we have done with our painful and humiliating task. Would that it might with fairness have been avoided ! But such cannot be, if the dignity and honour of the medical profession are to be upheld ; for, assuredly, in no way is its character more signally tarnished than when any of its members are allowed to escape public censure and rebuke, when they bring discredit on its rightful claims. And here we are constrained to confess that there has been much in the medical literature of recent years, that is utterly in. consistent with the requirements not only of good taste and honourable feeling, but even of common truth and honesty. Scarcely a day passes over our heads but we meet with some flagrant example of the ill-directed love of public notoriety over-mastering the plain dictates of these tooinuch neglected guides. Numerous are the instances that might be quoted in proof of this charge. When we find a Fellow of the Royal Society lending himself to this sorry game, and condescending, for example, to borrow from the pages of the Court Journal a recommendatory dotice of his work on a subject connected with the toilette graces of the person, what may we not expect from others who are more in the shade ?
A SYSTEM OF SURGERY. By J. M. Chelius. Translated from
the German, with additional Notes and Observations. By John F. South. Two vols., 8vo., pp. 1823. Analyt. Index, clxx. Renshaw, 1847.
Although we have noticed this work more than once during its progress of publication in parts (which have been issued with exemplary regularity), we do not deem it right to withhold our expression of congratulation from the translator upon the satisfactory conclusion of his really laborious task. It will supply a want hitherto felt of a due exposition of the present condition of German Surgery in this country; for, as Mr. South observes, no standard work relating to this has appeared in English since the publication of Heister's book a century since. In his preface, and incidentally during the work, he speaks somewhat too disparagingly of French Surgery, “ with its showy, but somewhat too hazardous operations;" but we are of opinion that not only are English students and practitioners more familiar with this last than with German surgery in consequence of the greater
1847) Elementary Proceedings of Surgical Operations. 361 diffusion of a knowledge of the French language, and the greater intercourse between Paris and London, but also because of its intrinsic superiority to that of any continental nation whatever. And in proof of this, we need not go farther than the book now before us ; for while a translation of a work from the pen of a French surgeon and teacher occupying a position similar to that of Chelius might easily and advantageously be presented to the British public in puris naturalibus, we do not hesitate to say, in regard to the present one, that had it not been for the valuable and numberless additions of the translator, in the shape of amplifications, illustrations, protests, corrections, and emendations, it would have infallibly fallen still-born from the press. Shorn of these, it is incomparably inferior, and in some respects half-a-century behind, our own manuals. Mr. South has, however, so hedged in his author's text by notes upon notes derived from his own experience or reading, that, however uncomplimentary such a procedure may be to his author, and however undesirable such a precedent is for general imitation, he has succeeded in converting the original meagre “Handbuch der Chirurgie” into a tolerable complete System of Surgery, which both students and practitioners will find very useful as a work of reference, and the employment of which is facilitated by the addition of an admirable index, of dimensions seldom seen now-a-days, amply compensating for the defective arrangement of the matter of the work.
We may now present our readers with a few specimens of the contents.
Of the Elementary Proceedings of Surgical Operations.-Considering the economy of space aimed at in the “Handbuch,” (a principle utterly repudiated by the translator however,) one cannot help being somewhat amused at some of the unnecessary and Germanic details entered into, concisely enough it is true, in this section.
“ There is scarcely a surgical operation which can be fully perfected on a diseased body by one single, simple act. All rather consist of several manæuvres following, according to determined rules, and distinguished by the name of Steps of the Operation. One of these is the special object of the operation, and the others must necessarily precede or follow, to effect this object, and bring about the restoration of the patient. The object of the operation is always the same, but the manner and way of attaining it may be very different, and this difference may consist either in the difference of the several steps of the operation, or of the entire way by which the attainment of the object of the proposed operation may be effected.' Hence arises the distinction between Operative Proceedings and Methods of Operating.
“ The Method of Operating is the compass of the regulated modes of proceeding, by which the object of an operation in any peculiar way is attained. In the various methods of operating, therefore, not merely are different parts cut through and in very different directions, but the practice of the methods of operating is so peculiar, that the one method does not exclude the other. Upon the choice of the method of operating depends, for the most part, the successful or unsuccessful result of the operation, just as upon the choice of the operative proceedings rests the facility of its execution. The choice of the mode of proceeding is therefore of little consequence, and depends commonly on the operator himself. Hence, also, the variety of opinions as to the mode of proceeding in general, is greater than upon that of the method.
" In deciding upon the preference of the various methods of operation, the following circumstances must be attended to. First. The least important organs must be injured, consequently the loss or destruction of organic parts caused by the operation, the pain and the traumatic reaction depending thereon is least. Second. The better method must always be most fitting for the greater number of cases. Third. This must consist in the manæuvres, which do not make the operator dependent upon accidental circumstances, but which rest completely on the will of the operator. Hereon and upon the nature of the parts to be wounded, are founded safety and facility in the execution of the method of operating. Fourth. The quickest cure which can be effected by the operation." Vol. II.,
The following circumstances require attention for the securing a probability of a successful result. 1. The disease to be removed should not be so connected with any general ailment, that this may act on it as a cause to keep it up continually. This would only be to remove the product of general disease, leaving the producing cause. The best results however follow when the general disease terminates in a local disease capable of removal. 2. The patient's weakness or sensibility should not be so excessive as to endanger life hy the operation. 3. The local disease must not, by its long-continuance or other relations to the constitution, have acquired the rank of a secreting organ, or have removed any previously existing disease, or have checked it in its earlier development. Cases may occur, however, where, in spite of a cure not being anticipated from an operation, this may be employed as a means of mitigating suffering or prolonging existence.
It respect to the patient's condition, in those who can bear pain quietly and patiently, are operations least dangerous. Those, too, who have been long accustomed to, and enfeebled by, painful disease, through the moral influence of the desire for the operation, and the less amount of traumatic reaction, bear them best. Persons of plethoric temperament, full of apparent health, or such as are very stout, of tall and strong make, bear them ill. Nervous persons may be placed in two categories—those “who are very sensitive and excitable, and those who, on the slightest cause, drop into moral despondency and nervous stupidity"—the former, although much affected by the pain, soon rally under the influence of hope and encouragement, which is not the case with the latter. The young bear operations better than the old, although in advanced age operations are not contra. indicated, and even often succeed better, in consequence of the less amount of traumatic reaction. In gouty subjects they are dangerous, and in the scrofulous the removal of a diseased part may be followed by the active development of scrofula in some internal organ. The nature of the preparation the patient is submitted to will depend upon the prevalence of any of the above circumstances—according to which we may endeavour to counteract general disease, raise his powers, depress augmented sensibility, &c. Robust and full-blooded persons should be kept some time on spare diet, and bleeding resorted to if this seems indicated. Great sensibility may be somewhat suppressed by opiates given before, and soon after, the operation.
As a general rule, the translator is, however, and we think properly, opposed to the use of opium or other sedative, owing to the difficulty of distinguishing between the effect of the medicine and the symptoms arising from constitutional excitement; and he believes that, even in the case of
Treatment after Operations.
persons habituated to the use of opium subjected to operations, the drug may be diminished or withheld sooner than is usually believed. The mere absence of the torturing pain they have been so long accustomed to seek its aid against sufficing to allow of sleep. If, however, the patient do not sleep, as the obtaining this is paramount, he does not withhold an opiate, whether the individual has been in the habit of taking it or not—while free livers may even require its repetition two or three times a day during the whole course of their case, keeping the bowels open at the same time with an occasional dose of three or four grains of calomel, which acts upon, without irritating the canal. Mr. South adds
“ Another very important point in the treatment of operations is the use of porter, wine, or spirituous liquors. Even where the patient has been prudent and temperate, it is occasionally necessary that one or other of these should be given soon after an operation. But for persons who have been accustomed to take large quantities of porter or spirits, or both, and who, in consequence of severe accidents, are subjected to the amputation of a limb, or who have severe lacerations, which, however, do not require operation, it is absolutely necessary for their safety that the stimulant should not only be not entirely withdrawn, but even somewhat very near the quantity they have been accustomed to, must be allowed, or they either sink at once, are attacked with erysipelas, or are violently affected with delirium tremens, in which condition they speedily die. The quantity taken may often seem enormous under the circumstances; three or four glasses of gin or brandy, and as much or more wine, and sometimes porter besides, in the course of the 24 hours, is by no means an unfrequent allowance ; and I have just the recollection of one of the younger Cline's patients, a porter in the Royal Exchange, who required a pint of brandy daily after having suffered amputation of his leg after an accident. This man was saved by this treatment, and lived many years after, doubtless following the same free course of living which had required treatment, at that period thought exceedingly bold and almost marvellous in its result, although at present every day's practice, and no wonder at all.” Vol. II., p. 855.
The restriction of operations to particular times of the year, Chelius observes, is no longer considered necessary, although very sultry weather is unfavourable to their issue. Where they can be deferred, a bright light is
necessary for their execution, or the patient is liable to rheumatic and gouty affections, they should be delayed until steady weather may be cal
The elementary acts of every operation consist in Division, Apposition, or Dilatation. Of these, Division is the most general and important, and may be effected, 1, by a cut or incision; 2, by a stab or penetration; 3, by tearing asunder; and, 4, by ligature. All instruments employed for division of soft parts by cutting, must be placed in two classes ; those having but a single cutting edge, knives, bistouries, and scalpels, and those " consisting of two cutting edges, connected crosswise in their middle, and terminating in handles,” the same forming our old familiar friend a pair of scissors. Then the different kind of knives (and scissors) are described according to the mode in which they are set in the handle or the form of the blade ; a mere waste of words which a moment's glance at an instrument-maker's case would render needless. The straight-edged bistoury is stated as the only one with which a regular cut can be made, and this is defined as follows:—"A regular cut must have the same depth from