As we have, in the present and in our late Numbers, been Very much led to the consideration of securing arteries, we shall offer a few words on this part of the work. We are by no means satisfied of the necessity of taking up so many arteries, still less of the propriety of forcibly removing from a small artery a piece of coagulum so firmly fixed as to require the nails of the fore-finger and thumb for its separation. In military surgery we are aware of the necessity of greater security than in private practice. In the latter, the surgeon will remain long enough with the patient to meet any accident of that kind. We would also recommend, that, after the larger arteries are secured, the cut surface should remain some little time exposed before the sides of the flap are brought together. By these means, a greater stimulus for retraction and contraction appears to us imparted to the smaller arteries, and the blood over their extremities coagulates more firmly. There is no danger of preventing union by the first intent from this delay. Such a process is, in our opinion, rather retarded than accelerated by that very high inflammation which is likely to follow the immediate apposition of the cut parts. In many cases, too, we would rather encourage than prevent the loss of blood from the smaller vessels, should it continue to flow after the larger ar teries are secured. The caution concerning twisting the ends of the ligatures appears to us unnecessary, as we have never found any inconvenience from their remaining even after the ulcerative process had separated the noose, and granulations had formed so as to detain the ligature when pulled. On all these occasions, we have left the parts to separate this extraneous body in their own way; and had no occasion to repent, however tardy the process may have seemed. On the proposed mode of cutting the ligature close to the noose, we have already given our opinion much at large. What we have now offered will be considered as a mere opinion, which the author cannot be offended at if it differs from his, especially as we admit the useful hints we have received from the rest of his directions.

The remarks" on forming the stump" are all very judicious. We particularly recommend them to the attention of the naval surgeon, but they are applicable to every kind of practice. Equally satisfied are we with the general difections concerning the subsequent" exposing and dressing the stump." But we conceive that from the time of the operation to the fifth or sixth day, when the dressings are to be first examined, some instructions are necessary to prevent too high inflammation in the parts brought into contact. Instead of the quantity of roller and woollen night cap at

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one time in use, and some of which is still retained, we would advise that the parts should be covered as slightly as possible, their temperature often examined; and, when the latter is too great, they should be left uncovered by the bedclothes; for, while any thing more than the standard heat is excited, we repeat it, there is much more danger of too great than too little inflammation.

"The medical treatment after amputation" is unexceptionable. In this, as in all other cases, we can only attend to the symptoms as they occur, and direct our remedies accordingly. Some well-related cases follow, all of which afford useful instructions to the young practitioner, and hints by which we may all gain something. After this concession, we conceive the author cannot be offended if we refer the case of Farrol [see page 61] to those in which the loss of blood might have been greater, certainly without injury to the patient, who is described as a strong muscular man.

A case follows of "Amputation of the foot at the tarsometatarsal articulation." The subject was a young African, whose feet were frost-bitten. The operation succeeded.

The case in which amputation was performed during the spreading of mortification, we consider so important, that we should gladly give it in the author's own words, if our limits would permit.

A chapter follows on a most important subject in military surgery, particularly in the navy, namely, the treatment of erysipelatous inflammation.

"During the period (says Mr. H.) that the surgical department of Deal Hospital had been under my superintendance, I find, on a reference to the hospital books, and my own private notes, that upwards of forty cases of erysipelas had been admitted ;* and, with three or four exceptions, it has, according to my judgment, been that species of the disease styled by nosologists and systematic writers Erysipelas phlegmonodes."

"The epidermis or rete mucosum has been supposed by some writers to be the particular seat of erysipelas, whilst others confine its morbid action alone to the cellular substance; and a third class to both these parts. My own observation, however, has afforded me convincing proofs that, in the species of the disease now under consideration, its active and destructive influence will be found

"# I say the hospital books and my own private notes,' because the greater number of cases admitted had either other disEases marked against their names, or merely the very general one, inflammation, from some inattention in filling up the sick tickets which accompanied the men on shore."

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more especially directed to the reticular, or condensed cellular substance, forming the aponeurosis of the muscles, &c.

"In the genuine erysipelas phlegmonodes, pus is seldom formed in the substance of the adipose part of the tela cellulosa, exterior to the aponeurotic expansion, that is, between this membrane and the skin: its most common position is beneath these parts, and in immediate contact with the muscles. Those conversant with ery sipelas phlegmonodes, must have frequently witnessed the destruc tion of the aponeurotic coverings as soon as suppuration or effusion had taken place, by discovering large portions of that membrane detached, and floating in these secretions when liberated by punc ture or other means."

Here again we are under the necessity of expressing our objections to every premature attempt at an artificial ar rangement of disease, usually called nosology. We are the more inclined to do so, because our author, with less than his accustomed candour, seems disposed to accuse his bre thren, from whom he received these subjects, of inattention, in using only the general term inflammation. Setting aside the hurry with which these tickets are sometimes made out, we are ready, not only to acquit these gentlemen, but to ap prove of their caution; and we shall see that Mr. H. speaks with some hesitation as to nomenclature, but with none as to the indications for treating the disease as inflammatory.

In conjunction (says he) with the usual medical treatment in such cases, topical blood-letting, by means of cupping, followed by fomentations, was the plan I pursued in the first few cases that came under my care;* and, in the very incipient stage of the dis ease, this may be all that is required to effect a cure by resolution; but, should the disorder advance to suppuration, insulation of the integuments, as has been before stated, will not unfrequently be the consequence."

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In the more advanced stage of the disease, nothing was found so serviceable as longitudinal incisions down to the muscles, or wherever the pus or other fluid was lodged. For the more accurate detail of symptoms and treatment, we must refer to the work itself, selecting only the following passage, connected as it is with several most important questions.

"This is not a new practice. Cupping and fomenting the affected parts in erysipelatous inflammation, is recommended by Wiseman, in his Chirurgical Treatise, vol. i. published in the middle of the 17th century.-Sydenham also recommends repeated bleedings and fomentations to the parts affected. See his Opera Universa cap. vi. p. 279."

"The bark, so strongly recommended by Drs. Fordyce and Wells, and more recently by Sir Gilbert Blane, I have never prescribed in this species of the disease, previous to the reduction of the attendant fever, and the abatement of inflammation by the above-stated remedies; but, in the only two cases of erysipelas erraticum § that came under my care, the early exhibition of the bark was attended by the most salutary effects. These two lastmentioned patients were, at their admission into the hospital, extremely emaciated, old, and worn out in the sea service.”

When we find a remedy recommended by such respectable names, and, most of all by the author of " Diseases of Seamen," we cannot fail to treat it with due respect; and we can only account for the difference of modern practice by suspecting, as Sydenham so often reminds us, that some unknown property in the air alters the form of diseases, and renders a different mode of treatment necessary. It appears, by that sagacious philosopher, that such was the case even in the exanthemata, where the cause and nature of the disease could not be questioned.-We conceive that the condition of Mr. H.'s two last patients, under erysipelas erraticum, would have been sufficient to indicate the use of the bark without any reference to the name given by Dr. Bateman to a disease, one character of which is, that it usually "termi nates favourably in a week or ten days."

The remaining subjects treated by Mr. H. are,-"History of a Popliteal Aneurism-The use of the Probe in any Ope ration in which a punctured Artery is tied-On NecrosisCase of Abscess and Hydatids in the Liver-On Lumbar Abscess- -On ununited Fractures. On all these we must be short, excepting the case of aneurism, "in which a new me thod of applying the ligature was practised,"-a subject so much connected with our late enquiries, that the reader will expect our opinion upon it.

Mr. H. begins with the mention of Dr. Jones's experi ments, informing us, that, before Mr. Travers's "valuable papers published in the Medico-Chirurgical Transactions," his [Mr. H.'s] case had occurred, and was written; and that he had repeated Dr. Jones's experiments, with corresponding success, on the brachial arteries of two dogs, as far back

"See the Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge, vol. i. page 290.

"+ See also vol. ii. of the same work, page 213 to 229. "Sir Gilbert Blane's excellent work on the Diseases of Seamen, page 600.

§ See Dr. Bateman's Synopsis on Cutaneous Diseases, page 130,"

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as the year 1800. Notwithstanding this, however, from what to us appears an ill-judged caution, the author was induced to adopt Mr. Travers's improvement of leaving the ligatures on the arteries for six hours, in order" to afford sufficient time for the first process of adhesion to be affected." The issue was, that hæmorrhage followed first from the inferior cut end of the artery, and afterward from the superior: the limb was taken off, and the patient died.

"The above statement goes to prove the important fact, as far at least as the authority of a single case can vouch,* that adhesion and obliteration do not follow the application of ligatures on the femoral artery of the human subject, when subsequently removed, and even after having been continued on for some few hours. How far this conclusion may be applicable to vessels of smaller dimensions, remains to be proved by those who may be inclined to put it to the test of experiment. It is a well-known fact, however, that the parietes of the smaller arteries are thicker and more dense, in proportion to their diameters, than those of larger dimensions. It is, therefore, reasonable to presume, that a stronger barrier will be opposed to the transmission of blood in the former than in the Jatter, after the consequences resulting from the constrictive powers of the ligature applied in the manner described; and hence the probability of the experiment being attended with greater success in the one than in the other."

This case is particularly interesting, and related with great candour. We therefore think it highly deserving our notice, and beg to solicit the very close attention of the reader.

Dr. Jones, in a passage to which we are referred, informs us, "that, in making experiments of this sort, the restoration of the circulation through the vessel should always be obtained, although, in a practical point of view, it may be an advantage for the internal parietes to adhere; and thus their wounded surfaces may escape that impediment to their adhesion, which a stream of blood passing between them must occasion in a greater or less degree." "I determined, however," says Mr. Hutchison, "not to trust to this reasoning." It is with great pain that we feel obliged to ask Mr. H. what he means by this reasoning? Is it not a matter of fact to which we are referred? and can it be said that "Dr. Jones's experiment has failed of success," because a supposed im

"Since this case occurred, the operation has been twice performed in one of the London hospitals; and, although the patients recovered, the operation was found objectionable on two accounts -first, that seventy hours were required for the obliteration of the artery-secondly, that the artery ulcerated where the ligature was applied, and secondary hæmorrhage ensued."

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