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Medical and Physical Journal.
40F VOL. XXXVIII.]. OCTOBER, 1817.
“ For many, fortunate discoveries in medicine, and for the detection of nume.
“rous errors, the world is indebted to the rapid circulation of Monthly " Journals; and there never existed any work to which the Faculty in “ EUROPE and America were under deeper obligations than to the “Medical and Physical Journal of London, now forming a long, but an
d. For the London Medical and Physical Journal. On the Wind of a Cannon-ball; by Captain BAGNOLD, of the
for June last, an account of the death of a naval officer by" the wind of a shot," I beg leave to offer the following observations and facts on the subject.
When in battle a man falls dead without any apparent injury, the seamen universally attribute it to this active but invisible agency; and as, from the prejudices of that class of men, dissection cannot often be had recourse to, the real cause remains undiscovered, and the killed are committed to the deep without much philosophical reasoning on the subject. But, if this cause could possibly produce so violent an effect; how is it in the course of war that we meet with frequent instances of men having their arms carried from their sides by.cannon-shots from the wrist up to the very shoulderjoint, and yet escape with life? At the taking of the Island of Bourbon, an officer lost his epaulet in this way; a friend of mine part of his hat; a soldier in Sir Thomas Picton's divi. sion, at Waterloo, his knapsack; and a still stronger case is that of Colonel J. W, who, about thirty-six years ago, at St. Lucia, lost his eye-sight from the close passage of a balt.-Surely, in all these cases, the projectile must have passed sufficiently close to the nobler parts to have done all the injury of which it was capable. I shall now abandon ipference, and submit the four following cases; the first three occurred under my own eye ; and the fourth is from the nar. ration of a scientific friend, a former surgeon of his Majesty's ship Imperieuse, a gentleman whose acquirements and accu. rate observation entitle him to every attention. From these cases I infer, first, that death may be produced by a wound, No. 224.
which (in the confusion always attendant on such scenes) may escape the eye of a careful examiner ; secondly, that parts of the buman body, and other substances directly exposed to the lateral action of a shot, frequently suffer less in, jury than those immediately under them; and that injury sufficient to destroy life may be inflicted while the integue ments remain sound.
CASE I.-- In the year 1800, being employed in the boats of his Majesty's ship Retribution, cutting out a brig from Trinidad in the Island of Cuba, within pistol-shot of the batteries, a short time after we had gained possession of
of her, one of my men, John Freize, was found in the cabin apparently dead, and expired soon after. - On the return of the boats, the body was taken on board the ship, and, being carefully examined, no external injury could be found. The surgeon, however, determining to satisfy his mind on the point, had the head shaved, when a wound was discovered scarcely one-tenth of an inch in diameter; on dissection, the point end of a small nail was found lodged in the brain, with a considerable quantity of extravasated blood; the nail must have been driven there from the vessel's side by one of several shots that passed through her.
CASE II.-On the 18th of July 1805, his Majesty's ship Arab, being in action with a division of the enemy's flotilla, within five hundred yards of Cape Grisney, near Boulogne, a thirteen-inch shell was thrown on-board. The velocity of its descent was mitigated by the resistance it met with in passing through the main-top, the treple-trees, jeer-block, and, finally, through the booms down to the main deck, where it made a considerable concave indentation on a large oak. beam. A seaman, named Armstrong, was squatting down at the moment in the act of pointing a gun, the shell fell close behind him, and the man dropped motionless. He complained of pain in his back and inability to move or sit upright, yet there was not the slightest injury or discolouration of the in. teguments visible. On examination, post mortem, it was evident the shell in its descent must have grazed down the lower part of the back, as the spinal processes in that organ were destroyed; the enemy having thrown the shell so short a distance with a long fuse, it was thrown overboard by the heroic exertions of the late Mr. Edward Wogan Mansel, assisted by some of the crew, for which gallant exertion they were liberally rewarded by the Patriotic Fund.
Case III. - In the same action, a seaman, named Woodcock, received a severe injury, as was supposed, from a shot grazing across his stomach. Symptoms of severe inflammation of that organ supervened, and the next day the integu. 3
ments assumed a bruised coffee-coloured appearance; his cloaths were not in the least injured.
ÇASE IV.-A seaman in his Majesty's ship Imperieuse, commanded by Lord Cochrane, whilst firing at a battery on the coast of France, fell from the effect of a shot passing across the abdomen. The blood immediately showed itself through his canvass trowsers, which remained uninjured; on removing this part of his dress, the muscular substance of the parietes were found nearly destroyed.
If the foregoing facts should throw any additional light on this hitherto controverted subject, I shall feel much pleasure,
For the London Medical and Physical Journal. On Tying the internal Iliac Artery; by JAMES ATKINSON,
Esq. Surgeon to his Royal Highness the Duke of York, Se. nior Surgeon to the York County Hospital and Dispensary,
(With an Engraving.) TH THE operation of tying the internal iliac artery, the sub
ject of this paper, had been performed for the first time, as far as was known in any country, by Mr. Stevens, of the island of Sta. Cruz, on the 27th of December, 1812, upon a negress-slave from Banbara. It was attended with com: plete success; and the greatest praise is due to him for the skill, novelty, nerve, and good management of the case.
In absolute deference to the public, I offer the recital of an unsuccessful repetition, under my hands, of this interest ing operation. I offer it as a land-mark of practice, to be accepted, amended, or avoided, by those practitioners who in future may be compelled to travel that way. We are all more or less ashamed (and, perhaps, ought to be) of the want of success in those instances where we presume upon our skill, or put our adroitness to the trial. * I shall, upon this occasion, cheerfully submit to whatever imputation a wise medical public may lay to my charge. The motive for my undertaking it, was pressing, was vital;—I neither braved it spontaneously, nor did I abandon the operation,for pain and circumstances were urgent, the tumour was ready to burst,-in surgical truth, the man was dying. So situated, (fatal as was the instance,) the patient's death in reality was suspended ; in other words, his life was prolonged by it.
The following is the case : Thomas Cost, aged 29, presented himself at the York County Hospital, April 2yrh. Mm 2
He was a tall, strong, active bargeman, not corpulent, but of marked muscle. He was enduring great pain from a large renitent pulsating tumour situated under the glutæus of the right side, an obvious aneurism. It had existed about nine months, and was the consequence of a blow from a stone. In hopes of abating tension, and of palliating pain, it was deemed right for a while to enjoin strict quiet, and to use a local application. For three or more days it had the effect, but a recurrence of the symptoms drove me to an immediate consultation, Dr. Lanson, Dr. Wake, and myself, (then present at the Hospital,) saw no alternative but death or the operation.
The novelty, danger, and want of experience, in the practice and performance of it, were duly considered. Loss of reputation on my side, absolute possibility of failure in the execution, and such like feelings, presented themselves to
But it appeared a duty to wave these considerations, when the chance of preserving a fine young man, in the vigour of life, with a dependant wife and child, were put into the balance. May I, therefore, hope to find justification on this point, for an attempt which had once succeeded, and was, in our opinion, the one thing needful.
The operation was performed on the 12th of May last, without any material difficulty or interruption, except such as was the consequence of the division of, and discharge fron, the small muscular arteries, in a subject where they had been much used and exerted, in his occupation of bargeman. Having got command of the internal iliac artery, within the pelvis (which required the complete length of the fingers to accomplish), it was tied. Sufficient proof of its being the identical artery was repeatedly taken-by the absolute and sensible command it afforded me over the pulsation; and by as repeated evidence of the simultaneous subsidence of it, on pressure. Dr. Wake, Mr. Ward (the house-apothecary), and all the pupils, were requested to be assured beyond a doubt of this circumstance, on repeated trials. The artery being then tied, Dr. Wake keeping his fingers and hand upon the tumour, we were then again perfecily satisfied of the pulsation being stopped-completely stopped, as far as sense could justify the perception. could also very distinctly ascertain the interruption of it, by haying the artery so decidedly within my fingers, and as much so as in any operation for popliteal or other aneurism which I had ever performed; whereas, in traversing the exterpal iliac, I was sensible of an evident, though feeble, pul. sation. Some delay was occasioned by the inaptness of the
"needle, which was not sufficiently pliable in passing it around the artery. It happened to be one which I had used on other occasions, and a particular instrument I had ready prepared was, by an accident, unfortunately rendered of no avail
The practical analysis of the above case may comprise two periods--the first, or the immediate stage from the operation (a time of trace); the second, when the consequences of it had a threatening aspect, i.e. when the discoloured discharge began to forewarn us of the probable and fatal termination. | During the former period, all was calm and encouraging ; the face was occasionally somewhat flushed, but no other sinister symptom was present. The man no longer suffered pain, having been instantly relieved from it, and from the pulsation by the operation; and the tumour was soon very sensibly diminished. His cry was for food, and to be permitted to get up. The pulse, I think, never exceeded i30; and after awhile sunk to about 85 or 90, not exceeding it until the discharge of pus, serum, ichor, or of more fluid blood, exhausted and destroyed him.
In the first instance be continued many days without any pain, or, as he expressed it, as easy as ever he was in his life. The discharge, when it did commence, and apparently only from the ligatures of the skin, (which, in future, I would not make use of,) set in kiridly, increasing, however, by de. grees in quantity, and deteriorating in quality. After the discoloured discharge had commenced, which was about eight or ten days, I think, before his decease, it was followed by the extrusion of small lumps of conjesta, and of coagulum, which grew more and more abundant, but retaining, for some days, that character. As his dissolution, however, approached, it had a more florid and Auid appearance, and once or twice indicated a more recent and copious hæmor. rhage: still he was not visited by faintings or deliquia, sa consequent on active bleeding.
He died quietly, and completely of exhaustion, on May Sist, wanting two days of three weeks from the time of the operation.
The medical treatment was simple, and chiefly directed to keeping the bowels in order.
Being uncertain whether he might not be soon removed from the hospital, by his friends, for interment, I lost no time in opening the body. Many circumstances made me impatient so to do, which will be readily anticipated by any person in the habit of performing either interesting or novel