1
533 get up for a while, and under careful supervision to take exer- cise. Mr. Hutchinson added that he had known several cases of the kind alluded to, in which t few days of exercise in the ward had been followed by rapid cure on returning to the com- pressive treatment, which latter previous to the exercise had for long been attended with only partial success. In all such experiments the tumonr ought to be carefully supported by cotton wool and bandage. GUY’S HOSPITAL. ANEURISM OF THE POPLITEAL ARTERY; COMPRESSION; LIGATURE OF THE FEMORAL; CURE. (Under the care of Mr. COCK.) THE notes of the following case were taken by Mr. Martin, one of the hospital pupils :- James C-, aged thirty-six, a fine, powerful-looking man, an engine-driver, was admitted into Naaman ward, on the 9th of January, for a popliteal aneurism. His history of it is as follows:-On the 17th of December last he jumped off an engine on to the ground when going at the rate of fifteen miles an hour (a thing he very commonly did). This time, unfortunately, instead of pitching on his toes, and thus break- ing the shock, all his weight fell on his heels. He instan- taneously felt a very severe pain run up the leg and lower part - of the thigh; so great was it that his first impression was that he had broken " the small bone of his leg." He rested for a few hours, when his leg and foot began to swell, and the pain subsided. The next day he resumed his work, and con. tinued at it for the three or four following days, until his suf- fering was so acute as to oblige him to give up work. He then, for the first time, noticed a small swelling at the bend of the knee, which, when he felt it, " beat like his pulse." He be- came alarmed, and went off to a surgeon, who explained to him the danger of his case, and advised him to go to the hospital. The tumour, on his admission, was of the size of a large wal- nut, soft, and had a remarkably strong pulsation. Mr. Cock resolved to give him a chance by compression, re- marking, however, that his expectations were far from san- guine as to the result, on account of the unusual power of his .arteries. On Jan. Ilth, treatment by pressure was begun; first - of all by a weight over the femoral artery, where it passes over the pubes, and then relieving him by a tourniquet below, and so on for four days and nights without intermission, at the same time applying ice to the tumour. At the end of this time it was impossible to continue this treatment, as the weight and tourniquet had caused abrasion of the skin. The tumour at this time had become very much harder, and gave every ap- pearance of a clot having formed. Mr. Cock, therefore, deter- mined to try pressure again as soon as the wounds were healed. After the lapse of three days the weights were again tried, and kept on for forty-eight honrs; but they were obliged to be taken off, as they caused him excruciating pain and consequent exhaus ion. He begged that they might not be again tried, and wished to have the artery tied. Mr. Cock, on Feb. 5th, ligatured the femoral artery. The man did remarkably well without a bad symptom. The ligature came away on the twenty-third day after the operation. There was very little swelling of the limb, which was due, no doubt, to the collateral circulation having been previously so well - established by the compression. The wound healed very rapidly, and the man went out well on March 13th. ST. GEORGE’S HOSPITAL. ANEURISM OF THE POPLITEAL ARTERY, SUCCESSFULLY TREATED BY COMPRESSION. (Under the care of Mr. POLLOCK.) FOR the notes of the following case we are indebted to Mr. James Rouse, surgical registrar to the hospital :- William S--, aged thirty-three, admitted Feb. 1st, 1861. Hé.was formerly a soldier in the Guards, and had always been a sober man. In the winter of 1854 he was at Balaklava, and While carrying a sack of barley on his back from the harbour to place it upon the back of a baggage pony, his left foot sank into the mud, and in endeavouring to extricate himself he gave his leg a violent wrench. lie had considerable pain at the time, but it gradually subsided during the day. From that -time he always telt pain in, and tnere was some slight but constant swelling of, the ham, which increased when he was on sentinel duty. He returned to England in 1855; there was then more pain in the ham, and shght increase of the swelling; he found also that after a day’s duty the whole leg became eedema- tous. He left the army in March, 1857, and became a points- man on the North-Western Railway. The symptoms remained much the same until March, 1860, when one day, suRt’ring severe pain in the ham and knee, he carefully examined the part, and discovered that there was a hard, circumscribed, pulsating swelling, as large as a hen’s egg, in the popliteal space. The symptoms from this period increased in severity, so that in June he consulted a surgeon on the subject, who told him that he had an aneurism, and advised perfect rest and pressure to the femoral artery. From that time pressure was kept up more or less for twelve hours a day, but he occasion- ally walked about with the instrument made use of to com- press the artery. On admission (Feb. 1st) there was an aneurism found to be situated in the popliteal space extending from the internal condyle of the femur half-way across that region; it was about three inches in length, and appeared to commence at quite the upper portion of the artery. The tumour was defined, and evidently contained a very large amount of fibrin There was . no general swelling of the limb. The pain, which was at times severe, was raferred to the patella. The superficial veins of the leg were enlarged. On a careful examinatidn being made, it became evident that there was no general expansion, but - simply upheaving of the tumour. Pressure by means of a spring tourniquet was at once applied, and kept up for twelve hours a day until the llth. The pressure caused considerable pain, but being a very intelligent man he was able to hift the = instrument from place to place. On the llth flexion was tried for three hours, but it caused such intense pain that at six P.M. the limb was unbandaged and the tourniquet again applied. This instrument was kept on until two P.M., of the 13th; it was then removed. On examination, the tumonr was found harder and smaller, and there was much less pulsation. The pressure was then resumed, and continued without intermission until half-past eleven of the 15th, when upon being removed for two hours the pulsation could scarcely be felt. At half- past one A.M. of the 1 th the tourniquet was again made use of, and on its removal at half-past one r.M. of the same day the tumour was found to be much smaller and the pulsation had entirely ceased; no pulsation could be felt either in the posterior tibial or in the dorsal artery of the foot. On the 17th the recovery appeared to be perfect; no pulsation could be felt. Medical Societies. ROYAL MEDICAL & CHIRURGICAL SOCIETY. TUESDAY, MAY 14TH, 1861. DR. BABINGTON, PRESIDENT, IN THE CHAIR. CASES OF DISEASE OF THE PONS VAROLII. BY HERMANN WEBER, M.D. THE first case was that of P. S-, aged twenty-five, affected’ = with tubercles of the lungs. In March, lb64. vertigo and weak- ness of the limbs of the right side were observed, without altera- tion of sensibility. In June the paralysis of movement in the right arm and leg was increased, in addition to which imperfect an2es-’ thesia in the left side of the face and tongue was noted, as also contraction of the pupils, especially the right. In July, after = bodily exertion and drinking, rapid increase of the motor para--,. lysis in the limbs of the right side took place, followed by con- traction and rigidity in the same, and also by diminution of sensibility. The limbs of the left side became likewise weaker; mastication, deglutition, and articulation defective. The sen- sibility in the right side of the face remained unaff cred ; in the " left as mentioned before. On July 24th. paroxysm of vertigo and convulsions, wirh only momentary loss of consciousness, but with permanent loss of power of articulation, deglutition, and protrusion of tongue. The paralysis of the limb 3- of the right side was complete, of the left almost sn ; there was aneasthesia in those of the right, distinct diminution of feeling in those of the left side. Reflex function of limbs no- quite destroyed. Both pupils contracted. Death eighteen hours after seizure, under the phenomena of paralysis of respiration. Post-mortem. -In the substance of the-left half of the pons

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get up for a while, and under careful supervision to take exer-cise. Mr. Hutchinson added that he had known several casesof the kind alluded to, in which t few days of exercise in theward had been followed by rapid cure on returning to the com-pressive treatment, which latter previous to the exercise hadfor long been attended with only partial success. In all such

experiments the tumonr ought to be carefully supported bycotton wool and bandage.

GUY’S HOSPITAL.

ANEURISM OF THE POPLITEAL ARTERY; COMPRESSION;LIGATURE OF THE FEMORAL; CURE.

(Under the care of Mr. COCK.)

THE notes of the following case were taken by Mr. Martin,one of the hospital pupils :-James C-, aged thirty-six, a fine, powerful-looking man,

an engine-driver, was admitted into Naaman ward, on the9th of January, for a popliteal aneurism. His history of it isas follows:-On the 17th of December last he jumped off anengine on to the ground when going at the rate of fifteenmiles an hour (a thing he very commonly did). This time,unfortunately, instead of pitching on his toes, and thus break-ing the shock, all his weight fell on his heels. He instan-taneously felt a very severe pain run up the leg and lower part- of the thigh; so great was it that his first impression was thathe had broken " the small bone of his leg." He rested for afew hours, when his leg and foot began to swell, and the painsubsided. The next day he resumed his work, and con.

tinued at it for the three or four following days, until his suf-fering was so acute as to oblige him to give up work. He then,for the first time, noticed a small swelling at the bend of theknee, which, when he felt it, " beat like his pulse." He be-came alarmed, and went off to a surgeon, who explained to himthe danger of his case, and advised him to go to the hospital.The tumour, on his admission, was of the size of a large wal-nut, soft, and had a remarkably strong pulsation.Mr. Cock resolved to give him a chance by compression, re-

marking, however, that his expectations were far from san-guine as to the result, on account of the unusual power of his.arteries. On Jan. Ilth, treatment by pressure was begun; first- of all by a weight over the femoral artery, where it passes overthe pubes, and then relieving him by a tourniquet below, andso on for four days and nights without intermission, at the sametime applying ice to the tumour. At the end of this time itwas impossible to continue this treatment, as the weight andtourniquet had caused abrasion of the skin. The tumour atthis time had become very much harder, and gave every ap-pearance of a clot having formed. Mr. Cock, therefore, deter-mined to try pressure again as soon as the wounds were healed.After the lapse of three days the weights were again tried, andkept on for forty-eight honrs; but they were obliged to betaken off, as they caused him excruciating pain and consequentexhaus ion. He begged that they might not be again tried,and wished to have the artery tied.Mr. Cock, on Feb. 5th, ligatured the femoral artery. The man

did remarkably well without a bad symptom. The ligaturecame away on the twenty-third day after the operation. Therewas very little swelling of the limb, which was due, no doubt,to the collateral circulation having been previously so well- established by the compression. The wound healed veryrapidly, and the man went out well on March 13th.

ST. GEORGE’S HOSPITAL.

ANEURISM OF THE POPLITEAL ARTERY, SUCCESSFULLY

TREATED BY COMPRESSION.

(Under the care of Mr. POLLOCK.)FOR the notes of the following case we are indebted to Mr.

James Rouse, surgical registrar to the hospital :-William S--, aged thirty-three, admitted Feb. 1st, 1861.

Hé.was formerly a soldier in the Guards, and had always beena sober man. In the winter of 1854 he was at Balaklava, andWhile carrying a sack of barley on his back from the harbour toplace it upon the back of a baggage pony, his left foot sank intothe mud, and in endeavouring to extricate himself he gave hisleg a violent wrench. lie had considerable pain at the time,but it gradually subsided during the day. From that -time he

always telt pain in, and tnere was some slight but constant swelling of, the ham, which increased when he was on sentinelduty. He returned to England in 1855; there was thenmore pain in the ham, and shght increase of the swelling; hefound also that after a day’s duty the whole leg became eedema-tous. He left the army in March, 1857, and became a points-man on the North-Western Railway. The symptoms remainedmuch the same until March, 1860, when one day, suRt’ringsevere pain in the ham and knee, he carefully examined thepart, and discovered that there was a hard, circumscribed,pulsating swelling, as large as a hen’s egg, in the poplitealspace. The symptoms from this period increased in severity,so that in June he consulted a surgeon on the subject, whotold him that he had an aneurism, and advised perfect rest andpressure to the femoral artery. From that time pressure waskept up more or less for twelve hours a day, but he occasion-ally walked about with the instrument made use of to com-press the artery.On admission (Feb. 1st) there was an aneurism found to be

situated in the popliteal space extending from the internalcondyle of the femur half-way across that region; it was aboutthree inches in length, and appeared to commence at quite theupper portion of the artery. The tumour was defined, andevidently contained a very large amount of fibrin There was .

no general swelling of the limb. The pain, which was at timessevere, was raferred to the patella. The superficial veins ofthe leg were enlarged. On a careful examinatidn being made,it became evident that there was no general expansion, but -simply upheaving of the tumour. Pressure by means of aspring tourniquet was at once applied, and kept up for twelvehours a day until the llth. The pressure caused considerablepain, but being a very intelligent man he was able to hift the =

instrument from place to place. On the llth flexion was triedfor three hours, but it caused such intense pain that at six P.M.the limb was unbandaged and the tourniquet again applied.This instrument was kept on until two P.M., of the 13th; itwas then removed. On examination, the tumonr was foundharder and smaller, and there was much less pulsation. Thepressure was then resumed, and continued without intermissionuntil half-past eleven of the 15th, when upon being removedfor two hours the pulsation could scarcely be felt. At half-

past one A.M. of the 1 th the tourniquet was again made useof, and on its removal at half-past one r.M. of the same daythe tumour was found to be much smaller and the pulsationhad entirely ceased; no pulsation could be felt either in theposterior tibial or in the dorsal artery of the foot. On the 17th .

the recovery appeared to be perfect; no pulsation could be felt.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 14TH, 1861.DR. BABINGTON, PRESIDENT, IN THE CHAIR.

CASES OF DISEASE OF THE PONS VAROLII.

BY HERMANN WEBER, M.D.

THE first case was that of P. S-, aged twenty-five, affected’ =

with tubercles of the lungs. In March, lb64. vertigo and weak-ness of the limbs of the right side were observed, without altera-tion of sensibility. In June the paralysis of movement in the rightarm and leg was increased, in addition to which imperfect an2es-’thesia in the left side of the face and tongue was noted, as alsocontraction of the pupils, especially the right. In July, after =bodily exertion and drinking, rapid increase of the motor para--,.lysis in the limbs of the right side took place, followed by con-traction and rigidity in the same, and also by diminution ofsensibility. The limbs of the left side became likewise weaker;mastication, deglutition, and articulation defective. The sen-

sibility in the right side of the face remained unaff cred ; in the "left as mentioned before. On July 24th. paroxysm of vertigoand convulsions, wirh only momentary loss of consciousness,but with permanent loss of power of articulation, deglutition,and protrusion of tongue. The paralysis of the limb 3- of theright side was complete, of the left almost sn ; there wasaneasthesia in those of the right, distinct diminution of feelingin those of the left side. Reflex function of limbs no- quitedestroyed. Both pupils contracted. Death eighteen hoursafter seizure, under the phenomena of paralysis of respiration.

Post-mortem. -In the substance of the-left half of the pons