general features, than by resting on any particular character. The "purring thrill," for instance, or the "whizzing" said to be diagnostic of aneurism, are now well known to be produced by pressure on any artery of large dimen

sions.

A word or two may be permitted on the operation itself. To say that it redounds to the surgical reputation of Mr. Guthrie, would be merely to express, in imperfect language, the feeling which all must entertain. We may add two remarks of that gentleman upon the subject.

"It was not formidable from the bleeding, but from the circumstance, that room could not be got for the introduction of the two hands; and, strange as it may appear, the whole safety and ease in doing the operation consist in the incision being so large at the fore part of the belly, that the bowels and the peritoneum may be freely turned over by the two expanded hands, so that you can see what is going on underneath. In the former case, the whole parts could be seen in the peritoneum distinctly, and several gentlemen not in the profession saw the iliac artery in its natural situation. I have no hesitation in saying, that, in the manner I have described, the operation of applying a ligature on the aorta might be accomplished without the least difficulty. I could as easily have tied the aorta as the common iliac artery; it was only necessary to have gone an inch higher. If at any future period it is necessary to pass a ligature round the aorta, it is in this way the operation should be performed.

But this operation will lead to another important result; I believe it will prove that it will never be necessary again to put a ligature upon the aorta. It has been twice attempted, and in both cases the patients lost their lives, just as they would have done if the operation had not been performed. If you examine the parts in the dead body, you will find that, if you can only apply a ligature threequarters of an inch from the termination of the iliac on one side, that it re

quires little knowledge to pass one over the iliac artery of the opposite side; so that, when an aneurism has been formed, and you cannot tie the iliac artery of the side in which the disease is situated, you may be enabled to do it in the way I did this operation -from the opposite side, and it is not rendered necessary to tie the great trunk of the aorta at all. That is one of the most important results which I think may be deduced from the operation I have described."

Mr. Guthrie indulges in an observation on the consequences of the application of the ligature to the artery, to which we shall venture to allude.

"A little opening was made in the artery above and below where the ligature was tied, in order to observe the state of the vessel; and it appeared that it was pervious to within the eighth of an inch on each side of it; so that the ligature just cut the artery through, and the two cut edges united by adhesive inflammation above and below, without forming a coagulum, and without diminishing up to the next collateral branch-a fact which I have said always existed-but which is quite contrary to the received opinions of the present day."

If Mr. Guthrie intends to affirm that coagulum is never deposited in an artery, between the part tied and the nearest branch, there are numerous well-attested facts that might be mentioned, which establish the occurrence. Surgeons have also been aware, that at times no coagulum of this sort is formed, and yet that secondary hæmorrhage does not follow. We presume that the fair interpretation of the passage is, that Mr. Guthrie has long been inclined to deny the necessity, and disbelieve the frequency, of the deposition of such a coagulum. The present case is remarkably in point.

Before we quit the case, we must venture to observe, that we cannot understand how the common iliac artery could be carried forwards with the peritoneum. Its anatomical relations would seem, à priori, to forbid such a displacement.

Again we offer Mr. Guthrie our con

gratulations on the manner in which he performed the operation. Much as it does him honour, his candid narration of the issue of the case is calculated to increase his genuine reputation.

important and novel an operation, with the entire restoration of the patient's health, was a rich reward for the anxiety I experienced in the case, and, in a measure, compensated for the unexpected failure of my operation on the arteria innominata."

While justice to American surgery

Esq. WITH REFERENCE ΤΟ THE OPERATION OF TYING THE COMMON ILIAC ARTERY.

We cordially publish the following letter from Mr. Valentine Mott, one whose reputation should be dear to America. It is singular that it should arrive at a time, when the result of the operation performed by Mr. Guthrie on the common iliac artery has been such, as to give the palm of success to Mr. Mott. But success is, after all, a false touchstone of merit; and the character, both of Mr. Mott and Mr. Guthrie, will be measured by a fairer and a higher standard.

New York, 25, Park Place, June 10th, 1834. SIR,-As the individual upon whom I operated, in the year 1827, for ligature of the arteria iliaca communis, is still living, may I ask of you the correction of the following sentence, in the "Medico-Chirurgical Review" for Jan. 1834. "Thus this most formidable operation has been successfully performed for the first time, and while it adds a wreath of laurel to the brows of the distinguished surgeon, it exhibits a splendid triumph of British surgery."* It is worthy of remark, that Mr. Guthrie has committed the same error in his work, p. 365-" on the Diseases and Injuries of Arteries," especially as the case is quoted from the "American Journal of the Medical Sciences," the last paragraph of which is in the following language:-"The gratification his visit afforded me is not to be imagined, save by those who have been placed under similar circumstances. The perfect success of so

Mr. Guthrie's case. The patient having come twenty

ment, I shall always be ready to award to the British school the merit it is so justly entitled to, and of which I am proud of acknowledging myself to have been a pupil.

With great respect, I have the
honour to be,

Your obedient Servant,
VALENTINE MOTT.

TO JAMES JOHNSON, M. D.
Physician Extraordinary
to the King.

FRACTURE OF THE SKULL, WITH DEPRESSION. OCCURRENCE OF CONVULSIONS, AND CURE.

Mr. Cotton, an intelligent surgeon of Bagshot, has communicated an interesting case of this description to the Lancet.* We shall briefly state the particulars.

Case. A boy, æt. 14, was thrown against a gate, and trodden by a horse, at 10, a. m. of the 4th July. There was a lacerated scalp-wound above the external canthus of the left orbit-a puffy swelling on the zygomatic arch-and a simple fracture of the parietal bone, embracing its posterior half, and extending obliquely forwards, to the junction of the squamous portion of the temporal with the greater ala of the sphenoid bone. The bone was depressed, and the scalp much puffed. There was bleeding from the nose and mouth-there was a state of drowsiness, alternating with shrieking, and

efforts to remove himself from the byestanders the pulse was labouring and quick. The head was shaved, and cold lotion was applied, shortly after which the patient was seized with violent convulsions, and distressing attempts at vomiting. These symptoms continued for an hour and a half, and ended in complete insensibility. The pulse was now labouring, irregular, 56 -the pupils permanently dilated, and insensible to the application of a lighted candle the respiration stertorous. VS. ad 3xxx. 9j. of Calomel, placed upon the fauces. Enema of muriate of soda, colocynth, and jalap.

Several copious evacuations were procured, and at 2, p.m. four hours aftor the accident, the symptoms were somewhat relieved. At 7, p.m. the patient was sensible on being roused, and complained of excruciating pain in his head. Pulse soft, 76-skin warm -tongue furred. The slightest pressure on the seat of fracture produced convulsive movements. Lemonade was ordered as a drink, and salines with Epsom salts were prescribed as medicine.

He passed a restless night, repeatedly attempting to get out of bed, and talking incoherently. Next morning, the skin was hot and dry-the pulse sharp and 86-the tongue furred-the pupils sluggish and dilated. He was drowsy, but conscious when moved and still complained of severe headache.

VS. ad x. Calomelanos, gr. ij. o. 3tiá horá. P. c. aliis.

In the evening, the symptoms were sensibly relieved, and after that time, the amendment of the patient was progressive, though slow. We need not pursue the details. The report of Mr. Cotton concludes upon the 21st, seventeen days from the reception of the injury. The wound of the scalp was then healed. No unpleasant symptom remained, excepting a slight deafness. There was no perceptible depression of bone, "but an evident callosity in the course of the fracture."

Whatever the nature of the fracture

*It seems difficult to reconcile the two conditions.-REV.

and extent of the depression may have been, a careful consideration of the particulars of the case will convince the experienced surgeon, that moderate pressure on the brain existed. That the pressure was moderate, is proved by the presence of convulsion, and concomitant absence of long-continued stertor and coma. The observations of Mr. Brodie, the records of facts, and the study of the symptoms and pathology of hydrocephalus, establish the important fact, that convulsions are a consequence of comparatively slight compression of the brain.

The treatment of the case before us was as judicious as successful. We may equally approve the early and the secondary management-the application of cold, the venæsection, and the purging in the first instance the steady exhibition of calomel, when the symptoms of fever and the pain in the bead became indicative of the supervention of inflammatory action. This is the practice we have taken repeated opportunities to recommend, and it gives us great pleasure to offer Mr. Cotton the advantage, small as it may be, of the cordial approbation of this Journal.

THE CHOLERA.

Our readers may probably remember that, when the cholera prevailed, we devoted much space and some trouble to the subject, and endeavoured to lay before the medical public all that was interesting, important, or novel with respect to it. We see no reason to regret the course we thought it prudent and right to pursue. We endeavoured to allay unnecessary apprehensions, and dispel unreasonable terror-we denied the virulent contagiousness of the malady, and doubted its power of extensive mischief in this country-we denounced vexatious quarantine regulations as useless, and, consequently, bad-we reprobated the attempt to coerce the dearest feelings and the prejudices of the people by legal enactments and the interference of police— we ridiculed the mummery of fasts and

fumigations, and midnight burialsand last, not least, we did our best to expose the enthusiasm, or the quackery, of "legally qualified" gentlemen, who confidently published their nostrums and their cures, at a time when the mortality was notoriously at its highest.

We do not intend to re-argue the nature and the causes of cholera. Of the former, we know as little as we ever did and the latter are enveloped in equal obscurity. Extreme opinions have, we trust, been softened downthe bitterness of party has expired with the occasion-and we think we may assert, that the majority of well-educated, practical, and reasonable men have arrived at nearly the same conclusions, and act on very similar principles. None dream at present of advocating quarantine-few entertain the idea or the wish of alarming the public with the notion of contagion-all are convinced that, in the great mass of cases, care on the part of the individual affected, and judgment on that of the medical attendant, will be amply sufficient to obviate the occurrence of malignant symptoms, or of serious consequences-and most are convinced, also, that when, from imprudence, from inattention, or from any other cause, the worst features of the malady have appeared, remedies of all descriptions are too generally powerless. The common sense of intelligent practitioners has led them to regard the vaunts of successful treatment, in such cases, as idle fancies or unblushing falsehoods.

Those who are familiar with the history of cholera are probably aware, that at the time when it was committing its greatest ravages in Hindostan, the newspapers of that province teemed with the accounts of successful remedies. So fatal were the consequences of these daily cures, that the government was compelled to prohibit their publication. We do not know that the evil has been quite so formidable in this country; but, whenever the disease has been most prevalent and fatal, we have always remarked that most specifics, or pseudo-specifics, are made public. In the Autumn of 1832, the weekly, the

monthly, and the quarterly medical journals were rife with proposals of the most opposite descriptions, resembling each other only in their success. Mr. A. amazed the public with a series of cases of the most malignant cholera, triumphantly treated with calomel and opium-Mr. B. looked with horror on that murderous practice, and effected all his cures with cold water-Mr. C. was successful, by preventing his patients from slaking their agonizing thirst, although, like Dives, they implored but one drop to wet their lips. Dr. D. administered fluids by bucketsfull through the mouth, the anus, and the veins. All were sanguine, all victorious, and the difficulty was, not to discover a specific, but to choose one. Some simple persons were delighted with all this, and rapturously received each Shiloh as he came. But the rapid succession of miracles and prophets at length proved too much for even the most credulous digestion. The true believers were forced to confess that they had thrown away their faith on false divinities, and were compelled to fly for comfort to the fond idea, that a genuine specific existed somewhere, though, like Solomon's seal, its possessor was unknown. It is not impossible, said the Lancet of that day, "that a specific for cholera has already been discovered."

It may seem that we are talking of things that were, of follies irrevocably past, and of credulity not likely to revive. A moderate acquaintance with mankind is sufficient to stamp the truth of the remark, that experience seldom instructs the mass. The deceived and abandoned credulity of yesterday is enacted on the stage of to-day, and the same performers are often seen to play again their proper parts. His Majesty's medical subjects are, at this very moment, exhibiting a pantomime of this description.

When the epidemic cholera first commenced its career in this country, the practice in which most confidence was placed was venesection, and the exhibition of calomel and stimulants. A brief experience was sufficient to convince all unprejudiced practitioners,

that cases of a really formidable character were not amenable to these remedial measures, however rational their employment might appear. Then succeeded, at a rapid pace, the advocacy and the trial of innumerable modes of treatment, some more and some less plausibly supported, but all, without exception, brought forward by their parents as successful, in cases of the worst description. It would be tedious, and it is unnecessary, to recount in due order the rise and fall of these successive methods; but a brief enumeration of the principal may be of service. Waiving a very strict attention to chronology, they may constitute the following list:-Stimulants and frictions-large doses of calomel -small doses of calomel-calomel and opium-emetics of mustard, of common salt, and of tartarized antimony -salines by the mouth, by the anus, by the veins-water of all temperatures and in all quantities-no water at all—the application of heat-the application of cold-drugs beyond number, and of every conceivable mode of operation-bandages on the abdomen. We will not fatigue our readers nor ourselves by attempting to extend this heterogeneous catalogue. But one observation may be usefully permitted. Each successive contributor of a method or a drug denounced the mischiefs, or deplored the inertness, of those which had already been proposed. The water doctor cried "murder" when calomel and opium were employed -the patron of emetics pitied the weak ness of the water doctor-and the sturdy advocate of calomel or of stimulants look ed with derision upon both. Amongst the audience that surveyed the perform ance of this play of many parts, some individuals looked on with philosophical incredulity and apathy; but the multitude were caught by each clever

*

*This is no idle flourish of words. Every observation in this article, sarcastic or rhetorical as it may appear, is founded on the recollection of circumstances that have occurred.

juggle, and rapturously cheered each dexterous actor.

From the hasty sketch of what has occurred, let us turn for a brief space to the present scene.

Early in the Autumn, many cases of diarrhoea, and some of cholera, were observed in the metropolis. Towards the latter end of August, a sudden and a great alteration took place in the temperature and in the weather. The thermometer sunk rapidly fifteen or twenty degrees, and sultry days were followed by nights of actual coldness. The attacks of diarrhea multiplied, and insulated instances of malignant cholera soon became whispered abroad. Few medical men, in extensive practice, failed to see decided cases of the malady, and, about the close of August, its prevalence and its severity had become incontestable. Now came the private panic and the public gossipdietetic leaders in the weekly Journals —and a dinner of the market-gardeners, at which fruit was ostentatiously devoured, and cholera boastingly defied

and now, above all, came the insulated cure or the general specific-the drama, in short (a tragedy and farce), of the previous years were advertised again, the old dresses furbished, and the old actors rouged.

It seemed as if the fond illusion of the Lancet was realized at last—as if the specific which it thought might exist, but had not been discovered, was at length presented to the public. In the Number of that Journal for the 23d of August, a communication appeared from Mr. Beaman, announcing a remedy "so extremely successful," that he laid it before the profession and the public. That remedy is applicable, and Mr. Beamen desires that it may be thought so, to cholera, in its worst and most aggravated form. In that form, it had cured "no less than eleven consecutive cases." It must be owned, that a remedy which can lead to a happy issue so great a number of malignant cases must, indeed, be a boon to afflict ed humanity. It is emetics of com. mon salt!

Many might deem that the plan of