The second experiment is still more important: we shall abridge it. Both the crural arteries of a middling-sized dog were tied in the usual manner; the knot was not drawn tight; and the edges of the wound were brought together with adhesive plaster. At the end of the third day, on attempting to cut away the ligature, a little blood appeared. Supposing that the artery was cut through, the dog was immediately killed, in order to ascertain the state of the parts. The artery was found not to be cut through: the bleeding came from a small branch. There was one small clot of blood above the knot; the parietes of the part tied were not adherent, and they presented less resistance in this place than in other parts of the vessel, and a less force was necessary to break them. From these experiments, our author concludes that the arterial coats may be cut through without drawing the ligature very tight, and that the compress and ligature may serve to maintain the coagulum in its situation, and to avert the danger of hemorrhage. To clear up other doubts, the following experiments were instituted :-A sheep, of large size, and aged, had the carotid and crural arteries of the same side tied. On the fourth day, the ligatures were removed from both the vessels: the edges of the wounds were scarcely swollen. Five days afterwards, the sheep was killed, and the body examined. The wound in the throat was much lessened, and covered with a dry scab, under which there was a trifling quantity of matter. Above and below the part tied, the coagulable lymph was found surrounding the artery; the part where the ligature had been was surrounded by matter. On opening the vessel longitudinally, both above and below the part tied, the usual coagula were found, the upper one of greater length than ordinary, both adhering very firmly to the sides of the vessel. These coats, at their posterior parts, and exactly where the ligature had acted, were corroded; but the close adhesions of the coagula had prevented the escape of the blood. The crural artery presented precisely the same appearances, but there was no erosion in any part of it: it was, however, evidently less firm in the point where it had been tied than natural, and was torn more easily than in other parts. The right carotid artery of a broken-winded mare, twelve years of age, was tied as usual; the wound was closed by straps and sutures. On the fourth day the ligature was removed, and the straps re-applied. On the thirteenth day, reckoning from the day when the artery was tied, the wound was much lessened, but not healed: it still suppurated, and the mare was killed. The matter was found chiefly at the spot where the kuot had been placed: neither the jugular vein nor the eighth 3 1 pair of nerves were comprehended in it. Both above and below the ligature there was much lymph, which united it to the ju gular vein and to the adjacent parts. The artery immediately under the compress presented a black spot, which, upon opening the vessel longitudinally, was found to be formed of a thick clot of blood, evident to the eye of the examiner; for in this point the artery was evidently corroded. This coagulum extended itself a great way, both above and below the part tied; and was single, and not double, as in all the preceding instances. Strong adhesions were formed on all points of the arterial parietes. This disposition of the coagulum, a novelty to M. Vacca, convinced him that the knot, in this case, had not been drawn tight enough to place the sides of the artery in contact. The internal coat of the vessel, in the neighbourhood of where the ligature had been, was of a dark colour, and was more easily ruptured than the parts in the vicinity. Our author is convinced, from the above experiments, that the difference between the results of those of Scarpa and his own neither arose from the different size of the animals, from the different structure of the arteries, nor from the degree of tightness of the ligature; but from the examination of the bodies, in the experiments of M. Scarpa, having been made either too late or too soon, that is, either before the division of the vessel has taken place, or when cicatrization has so far advanced as not to permit us to see, or to decide with certainty upon the state of the parts. To clear up this doubt, he made the following experiments: On The right carotid artery of a young and robust sheep was tied in the usual manner; the knot was very loosely tied. The crural artery of the same side was secured in the same manner. In the neck, the wound was brought together with adhesive straps; that in the thigh with sutures. The sheep went on well for three days: on the fourth, it was seized with pains in the belly, and died of mortification of the intestines. examining the arteries, the usual appearances were found: the parietes of the artery were not corroded; the internal coat only was a little tumefied, and somewhat softened on the spot which had been tied. Immediately under the knot, the sides of the vessel were not in perfect contact; a small clot of blood placed between them served to unite the superior and inferior coagula together. The following quotation we give in M. Vacca's own words, and with it we shall conclude our analysis of this little work, which we have extended to this length, partly on account of the importance of the subject, and partly because we believe the work is not much, if at all, known in this country. "To convince myself (says M. Vacca,) more thoroughly of the impossibility of distinguishing, after the cicatrix is formed, whether an artery has been divided, and has afterwards united, since it is then surrounded by much lymph, which has become solid, and which binds and confounds it with the neighbouring parts, I submitted a lively dog, of two years of age and of middling size, to the following experiment: -I tied the carotid and crural arteries of the same side in the usual manner. On the fourth day, the ligatures fell off from the ueck and thigh; an evident proof of the recision of the arteries. At the end of twenty-one days, the wounds were entirely healed. At this period I tied the right crural artery, and removed the ligature on the third day: the artery was entire. After eighteen days, this wound was also healed. I caused the dog to be killed two days after the perfect cicatrization of the parts, and I requested the dissector of our university to make the examination of the arteries that had been tied, in my presence. The following were the results of this examination:-The cicatrix was adherent to the parts beneath. Much hardened lymph was effused round the part which had been tied, and extended about the breadth of eight lines above and below this spot. This lymph bound the carotid artery and the eighth pair of nerves firmly together. The dissector succeeded, by dividing this lymph longitudinally, in separating it into two cords; one of which corresponded to the artery, the other to the nerve. These two portions appeared perfectly entire, and not interrupted in any part of their continuity. The artery was obliterated to the distance of a few lines from the part which had been tied, at its lower extremity; at the upper part, the obliteration extended somewhat farther: the whole distance together obliterated amounted to about eighteen lines... The coagulum did not exist at the lower extremity; it was found at the upper, and was even still coloured. With a very fine probe, the dissector removed the substance which filled the cavity of the artery, and which had become a cord: he laid open the vessel longitudinally, and none of us could determine the spot where this cord had been divided by the ligature. There could be no doubt of this division having taken place, as the ligature had fallen off spontaneously. The same appear. ances presented themselves on examining the crural artery of the same side. The right crural artery, from which the ligature was removed on the third day, appeared, as usual, surrounded by a good deal of coagulable lymph, confused with the neighbouring parts; but, on separating this lymph, (which, being more recently formed, had less tenacity and consistence than in the other instances,) it was clearly seen that a portion of this lymph had insinuated itself into an aperture in the coats of the artery, and which was made apparent as soon as the lymph was removed with the forceps. This lymph had formed strong adhesions to the sides of the vessel, but they were not yet so strong as to be inseparable. "From this experiment it is apparent, that, although arteries are cut through by the ligature, they re-unite, after a certain time, in such a way, and are so surrounded by lymph, that it is not possible to distinguish the spot where the division has been; and that arteries, from which the ligatures have been removed on the third day, present the same appearances: for it was entirely by accident, and from not having given the lymph time to consolidate, that we were able to discover the erosion of one portion of the parietes of the vessel. If the examination had been delayed a few days, it would have been impossible to have found any traces of erosion." STATISTICAL MEDICINE. ART. I.-Quarterly Report (No. 3,) of the Medical and Surgical Practice of the St. George's and St. James's General Dispensary, 14, Old Burlington-street; from January 13, to April 12, 1823, inclusive. By GEORGE GREGORY, M.D. Senior Physician to the Dispensary, &c. &c. Acute Constitutional Fever, Common Continued Remittent, of Children 44 7 1 3 1 Nephralgia Incontinence of Urine ..... Diseases of the Urinary Diseases of the Testicle System Diseased Prostate Strieture ..... 1 1 12-87 2 2 ...... 9 ........ 2=16 The admissions during the last quarter have been more than commonly numerous; and, from the preceding table, it will be seen that disease has presented itself under a very great variety of aspects. Catarrhal and bronchial complaints, attended with unusually severe symptoms, have been prevalent in all parts of the town; and these, therefore, constitute a very large proportion of the admissions during the last quarter. The disorder possessed many of the characters of genuine influenza. It was distinguished by its sudden accession, the great debility and languor which attended it, and the tedious convales. cence by which it was followed. In many cases the mucous membrane NO. 291. 3 L |