duce some illustrations, both novel and important to English. medical literature.

Practical Observations on the Medical Powers of the most celebrated Mineral Waters, and of the various Modes of Bathing. Intended for the Use of Invalids. By PATRICK MACKENZIE, M.D. Licentiate of the Royal College of Physicians of London, and Assistant Physician to the Fever Institution, &c. 12mo. pp. 151. London, Burgess and Hill. 1819.

1

ALTHOUGH this work is intended for popular use, we introduce it to our readers; since it is well calculated to supply a deficiency in our literature on the subjects of which it treats, which most medical practitioners must have had occasion to observe. On recommending patients to go to watering and bathing places, it is usual to find them advance many questions respecting the qualities of the various mineral waters, and their regimen during their use; when a work like the present to refer them to, will be found very convenient. These are subjects on which some degree of popular medical information will be really beneficial, and we are much pleased with the way in which it is conveyed in this work; for, though the author has here chosen to confine his views to the objects to which we have alluded, it is evident that he is well qualified to treat the subjects in a more profound and comprehensive manner: what he has advanced is therefore solid, although adapted to the comprehension of general readers.

We may observe, that Dr. Mackenzie has treated of the dif ferent mineral waters with a view to their medicinal, rather than their chemical, qualities; although a general account of the latter is also adduced. He divides them into the cold diJuent waters, the chief of which are those of Malvern; tepid diluent waters, which are the Matlock, Bristol, and Buxton; diuretic waters, as the Seltzer; cold stimulant waters, the Spa and Pyrmonte; hot stimulant waters, those of Bath; tonic waters, Tunbridge and Hastings; tonic and aperient, the Cheltenham and Scarborough; tonic, aperient, and diuretic, the Vichey and Carlsbad waters; tonic and astringent, the Hartfell, Brighton, and Sandrocke waters; the purgative, the Seidlitz, Epsom, Leamington, and common sea-waters; alterative and detergent, those of Harrowgate and Moffat; and the hot alterative and detergent waters, those of Aix-la-Chapelle and Bareges.

CRITICAL ANALYSIS

OF

RECENT PUBLICATIONS, IN THE DIFFERENT BRANCHES OF MEDICINE AND SURGERY;

SELECT MEMOIRS, AND HISTORIES OF CASES;

In the Literature of Foreign Nations.

Πατρίδες ἄρα

Ανδράσιν, ὦ παραῖς ἄνδρες, ἀγαλλόμεθα.

The Medical and Surgical Register; consisting chiefly of Cases in the New-York Hospital. By JOHN WATTS, jun. M.D. VALENTINE MOTT, M.D. and ALEXANDER STEVENS, M.D. 8vo. pp. 163. Collins and Co. New-York. 1818.

THE

HE most important part of this volume is that which comprises a history of the application of a ligature to the arteria innominata in a man, by Dr. V. MOTT. We remark in the first instance, in order to show at once the object of our strictures on this history, that it is by no means clear, or indeed probable, that the disease for which the ligature was employed was an aneurism of the subclavian artery, as supposed by Dr. Mott; the gratification we have experienced from viewing in this case an effort of the art of surgery that may hereafter be employed with the most beneficial effects, is, therefore, accompanied with sensations of painful regret, from a fear that this knowledge has been obtained by the sacrifice of the life of a human being. Having made this statement, we feel obliged to enter much into detail in our account of this case: we shall therefore, in the first instance, wholly transcribe the history of it previously to the operation.

"Michael Bateman, aged 57 years, was born in Salem, Massachusetts, and by occupation a seaman. He was admitted into the NewYork Hospital, on the 1st of March, 1818, for a catarrhal affection, having at the same time his right arm and shoulder much swollen. At the time of his admission, the catarrh being thought the most considerable disease of the two, he was received as a medical patient, and placed under the care of the physician then in attendance. During the three first weeks of his residence in the house, the catarrh had greatly yielded to the remedies prescribed. The inflammation, which had produced an enlargement of the whole superior extremity, extending itself to the muscles of the neck on the right side, was also gradually subsiding.

"A tumefaction, however, situated above and posterior to the clavicle, at first involved in the general swelling, and not to be distin. guished from it, began to show itself. This resisted the remedies which were effectual in relieving the other, and became more distinct and circumscribed as the latter subsided; at length assuming the form of an irregular tumor.

"The history which he gave of the case is as follows: He said, No. 246.

U

about a week before he entered the hospital, while at work on shipboard, his feet accidentally slipped from under him, and he fell upon his right arm, shoulder, and the back part of his head; that he felt but little inconvenience from the fall, and after a short time returned to his duty. Two days subsequent to this, however, he felt pain in the shoulder, and the succeeding night was unable to lie upon it in bed. The whole arm and shoulder then began to swell, and became so painful, that he was unable any longer to perform his duty as a seaman. The ship having arrived in New-York, he was admitted into the hospital.

"For some time after the general swelling had subsided, leaving the tumor distinct and circumscribed, no circumstance occurred which gave rise to a suspicion of its being aneurismal. The enlargement was thought to be a common indolent tumor, and was repeatedly blistered, with a view to discuss it. The tumor gradually diminished under this treatment, though a considerable time elapsed before any very striking change took place.

"At length a faint and obscure pulsation was perceived: still it was a matter of doubt whether the tumor was aneurismal, or whether the pulsatory motion was communicated to it by the subclavian artery, immediately over which it was situated. From its firm, unyielding nature, upon pressure, the latter was considered as the most probable, and the blisters were continued as before. During the whole of this time the patient had worn his arm in a sling, the motions of it being very limited, and always attended with pain.

"The patient remained in this state for several days, without any marked change either in his feelings or in the appearance of the tumor.

"On the 3d of May, at six o'clock in the afternoon, the patient complained that he felt something give way in the tumor;' that his shoulder was very painful, and that he was able to raise it only a few inches from his side. The tumor at this time suddenly increased about one-third, and a pulsation was distinctly perceptible. Its most prominent part was below the clavicle, at which place the pulsation was most distinct. The portion above the clavicle was also much enlarged; it still however had its usual firmness, except in one point near its

centre.

"May 4th.-The tumor is evidently increased, that portion of t more particularly which is below the clavicle; it is not as firm and resisting as it has been. Pulsation is not so distinct as yesterday, but appears to be more diffused.

"He was this day transferred to the surgical side of the house, and became my patient. The cough having become comparatively slight, the tumor appeared to be the most urgent disease, and, in my opinion, to call for prompt attention. The arm is now perfectly useless, and any motion at the shoulder-joint gives him severe pain. The patient is naturally of a spare habit; and, from the nature of his disease, and the confinement to which he has been subjected, has become much reduced in strength.

May 5th and 6th.-The tumor is still progressing, and the pain

in the shoulder is also more severe. During the three last days his medicines have been discontinued, except that he is allowed to rub the parts about the clavicle with volatile liniment.

"On the 7th, I directed a consultation of my colleagues to be called, consisting of Drs. Post, Kissam, and Stevens. I now stated to them that I wished to perform an operation which would enable me to pass a ligature around the subclavian artery, before it passes through the scaleni muscles; or the arteria innominata, if the size of the tumor should prevent the accomplishment of the former. This I was permitted to do, provided the patient should assent, after a candid and fair representation was made to him of the probable termination of his disease; and that the operation, though uncertain, gave him some chance, and, as we thought, the only one, of his life.

"Dr. Post, at my request, communicated with him privately on this subject; and, after a full explanation of the nature of the case, my patient requested to have any operation performed which promised him a chance for his life, saying, that in his present state he was truly wretched.

"May 8th, 9th, and 10th.-The tumor is acknowledged by all to be increasing, and it is thought proper not to defer the operation any longer: I therefore requested that preparation be made for performing it to-morrow.

"It is difficult to give an idea of the size of a tumor so irregular in its form, and so peculiarly situated. A thread passed over it, from the lower part of that portion of it which is below the clavicle, extending upward obliquely across the clavicle toward the back of the neck, will measure five and a quarter inches. Another crossing this at right angles one inch above the clavicle, will measure four inches; two and a half inches of the thread are on the sternal side of the former, and one and a half on the acromial. It rises fully an inch above the clavicle; which, added to the depression below the clavicle on the opposite shoulder, will make the size of the swelling above the natural surface about two inches."

When we consider, that this tumor appeared with, or immediately subsequent to, the inflammation of the arm, shoulder, and neck; that it, for some time after it was first discovered, diminished in volume, and was without pulsation; that it was of an irregular form, and of a “firm, unyielding nature, on pressure;" that, when pulsation became evident, this pulsation was only in the centre of it, the rest of the tumor being of "its usual firmness;" that, at length the pulsation suddenly became less distinct and more diffused, the tumor increasing onethird in size, but retaining its firmness, except in one point near its centre; and lastly, the great bulk it acquired in so short a period; we are utterly at a loss to conceive how Dr. Mott could have imagined it to be an arterial aneurism. There is not a phenomenon or symptom amongst those he has related, that, in our opinion, should have made him alter his original idea of the nature of the disease: the whole of the latter series of symptoms only indicated that suppuration had taken place in a tumor situated upon the subclavian artery. The "something that give way in the tumor," noticed in the report of the 3d of

May, was probably the bursting of the tunics of an abscess: this is indicated by the whole of the report of that and the following day.

But, as the reader must be anxious for the remainder of the history of this case, we proceed in its relation : our further remarks will then follow.

We need not describe particularly the preliminary steps of the ope ration, since every anatomist must be acquainted with those which are proper on such an occasion: it may suffice to observe, that an incision was first made from just above the right clavicle and upper end of the sternum, extending over the trachea, three inches in length; then an. other incision, about the same length, extended from the termination of the first along the inner edge of the sternocleidomastoid muscle; the integuments were then dissected from the platisma myoides, which, with the sternal and part of the clavicular portion of the sterno-cleidomastoid muscle, the sterno-hyoid and thyroid, were separated from their lower attachments, and reflected upwards over the tumor. sheath containing the carotid artery, par vagum, and internal jugular vein, was thus exposed a little above the sternum; the artery was then exposed, and the vein and nerve separated from it; and, tracing it from this point, the subclavian artery was readily laid bare, about half an inch from its origin.

The

"On arriving at the subclavian artery, it appeared to be considerably larger than common, and of an unhealthy colour; and, when I exposed it to the extent of about half an inch from its origin, which was all that the tumor would permit, to ascertain this circumstance more satisfactorily, my friends concurred with me in opinion, that it would be highly injudicious to pass a ligature around it. The close contiguity of the tumor would of itself have been a sufficient objection to the application of the ligature in this situation, independent of the apparently altered state of the artery. Art, in this case, could not anticipate anything like the institution of the healthy process of adhesive inflammation in an artery in the immediate vicinity of so much disease.

"With this appearance of disease in the subclavian artery, it only remained for me either to pass the ligature around the arteria innominata, or abandon my patient. Although I very well knew that this artery had never been taken up for any condition of aneurisms, or ever performed as a surgical operation, yet, with the approbation of my friends, and reposing great confidence in the resources of the system, when aided by the noblest efforts of scientific surgery, I resolved upon the operation.

"The bifurcation of the innominata being now in view, it only remained to prosecute the dissection a little lower behind the sternum. This was done mostly with the round-edged knife, taking care to keep directly over and along the upper surface of the artery. After fairly denuding the artery upon its upper surface, I very cautiously, with the handle of a scalpel, separated the cellular substance from the sides of it, so as to avoid wounding the pleura. A round silken ligature was now readily passed around it, and the artery was tied about half