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press the flatulent tumour; and, through’the same hole, a styptic and carminative hy-dromel may be injected to restore by itsstypticity the tone of the membranes, anddiscuss by its aromatic acrimony the windy) Bspirits or air retained in the lungs." Of;about the same value is the recommenda- .tion of Mr. Parkinson to feed with hay andcom wetted with chamber-lye ; and to pourshot down the throat, " which will drivethe bowels so far from the midriff, that thedisease will not be discernible." Linseedoil given in large quantities has been ex-tolled as a cure. It may act as a purgative,and so empty the stomach and bowels, andgive temporary relief. Mr. Knowlson says,that « two or three cloves of garlic beinggiven in each feed, or three ounces bruisedand boiled in a quart of milk and water, andgiven everv morning for a fortnight, hasbeen found very serviceable. So easy aremedy should never be neglected, for bywarming and stimulating the solids, and at thesame time dissolvin the tenacious juices whichchoke up the vessels nf the lungs, it greatlyrelieves this complaint." Enough of this

foolery!Food.-If we cannot cnre, we may in some

degree palliate broken-wind; and first ofall we must attend carefully to the feeding.The food should lie in little compass,-plenty of oats and little hay-no chaff.Chaff is particularly objectionable, fromthe rapiclitwvith which it is devoured, andthe stomach distended. Water should begiven in moderate quantities, and the horseshould not be suffered to drink as much ashe likes until the day’s work is over. Greenmeat will always be serviceable. Carrotsare narticutarlv useful. They are readilvdigested, and appear to have a peculiarly Ibeneficial effect on the respiratory system.

It is from the want of proper attention tothe feeding that many horses become broken- Bwinded, even in the straw-yard. There is Ilittle nutriment in the provender whichthey there find, and to obtain enough forthe support of life, they are compelled tokeep the stomach constantly full, and press-ing upon the lungs. It has been the samewhen they have been turned out in coarseand innutritive pasturage. Here the sto-mach was perpetually gorged, and the ha-bitual pressure on the lungs, cramped andconfined their action, and inevitabiv rup-tured the cells, when he gambolled with hiscompanions, or was wantonly driven about.

Exercise.—Next in importance stands ex-ercise. The pursive or broken-winded horseshould never stand idle in the stable a sin-gle day. It is almost incredible how much

may be done by attention to food and exer-cise. There is scarcely a hunt in whichthere is not a thick or broken-winded horse,that by judicious feeding and training, is

enabled to acquit himself very respectablyin the field. The broken-winded horse maythus be rendered comfortable to himself, andno great nuisance to his owner,-but inat-tention to feeding, or one hard journey—theanimal unprepared, and the stomach full;may bring on inflammation, congestion, anddeath. Occasional physic, or alterative me-dicine, will often give considerable relief.

ST. GEORGE’S HOSPITAL.

CLINICAL LECTURE

BY

MR. BRODIE,

Delivered Vlai-ch 24th, 1832.

LIGATURE OF THE EXTERNAL ILIAC.

Pulsating Tumours not always Aneurismal.—Secondary Anetsrismal kemoi-rhage.

GENTLEMEN,—The case of Batchelor(the man on whom I operated for aneu-rism on the 1st of this month) is a very in-teresting one ; I shall therefore make a fewremarks to you upon it to-day. He was an

innkeeper at Windsor, and was ssalt here byMr. O’Reilly, who thought the man’s casewas a formidable one, in which he was per-fectly correct. He was admitted with alarge pulsating tumour in the groin, in the

situation of the line of the femoral artery,and you know that pulsating tumours in thegroin usually denote aneurism. There were,however, some circumstances in this casewhich led me to doubt the fact of the tu-mour being aneurismal. it had existed fora long time, and fourteen months ago itfirst began to pulsate. After a time the

pulsations ceased, and then they came onpulsations ceased, and then they came onagain. The history of the case altogetherdid not resemble one of aneurism; but ifit be decided that this pulsating tumour wasnot an aneurism-why then what was it?Oh, but the cellular membrane around an

artery may be inflamed, thickened, and in-filtrated, and the pulsations of it may bemistaken for those of an aneurism. Therewas a case some time ao in this hospital,which was supposed to be an aneurism-there was a large tumour in the thigh ;but, on examination, I found that the patienthad had disease of the hip-joint, and thatthe swelling had extended down around thecoats of the artery, which had caused thispulsating tumour.

Solid tumours may pulsate sometimes.These are either medullary tumours, or tu-mours of fungus hematodes ; these latterones you know are vascular, and have muchblood running to them, and they pulsate ;

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and if any very considerable artery suppl3,-, iing these tumours gives way and bursts,there is a cavity, and an aneurismal swelling 1formed, and, consequently, a pulsating tu-mour, but by attending carefully to the

history of the symptoms, you may oftendistinguish very clearly between a pul.sating tumour which is an aneurism, andone which is not an aneurism. If a tumourexists before pulsation comes on-if youcan diminish the size of the tumour, butnot completely-if there is no whizzingaound denoting the rush of blood into a

cavity, then it is not an aneurism. If youapply your ear to a fungous tumour, thereis not the same sound given to it as in ananeurism, and in doubtful cases you maylearn much by applying the ear, or thestethoscope, over the tumour. I had a pa-tient in this hospital who had a large pul-sating tumour of the abdomen, which I andthe house-surgeon believed to be an aneu-rism. We made a very careful examina-tion, and were fully satisfied that it was one,but every one else who examined it differ-ed in opinion from us; the stethoscopehad however just at that time been intro-duced into this country, and we applied itto the patient’s abdomen, and no one didfor a moment after that doubt the tumour

being an aneurismal one. The patient died,and on opening the body after death, a

large aneurism of the great iliac artery wasdiscovered. You may sometimes distin-

guish these real aneurisms from false ones;this, in some cases, is easy; in others,however, it is very difficult and intricate.I knew of a case where the femoral arterywas tied in a supposed case of aneurism.The tumour was found to be one of fungushematodes; the surgeon who operated inthis case was nevertheless a very cleverand skilful man. A case occurred in theAsylum for the Recovery of Health, wherethere was a tumour in the upper part of thethigh. Mr. Keate and I examined it veryaccurately, and I tied the femoral artery;it proved to be a medullary tumour, andnot an aneurism. In this case, both Mr.Keate and I had paid the greatest attentionto the case ; yet we were deceived. A casewas sent up to London (which I saw) by avery clever man who was surgeon to a verylarge hospital in the country. The patienthad a pulsating tumour in the neck, whichwas supposed to be an aneurism of a carotidartery. I saw her, and I pronounced thetumour to be an aneurism. Sir AstleyCooper saw her also, and he decided thatit was an aneurism. Every other surgeonin London, however, who saw the case,said that it was not aneurism. The patientvery wisely believed them, and would notbe operated upon. She left London, andwent down again into the country, and this

case eventually turned out not to be a caseof aneurism. Such cases as these, however,are of rare occurrence. I merely mention. them, in order to show that you are not tojump to the conclusion that a tumour naneurismal, because it pulsates. In tLis

case, whether the tumour was one of aneu-rism or not, it would bleed ; if it were me.

dullary it would bleed, somewhat slower toba sure, but not the less fatally for that,Of whatever nature however the tumourmight be, it was highly necessary that someoperation or other should be performedupon it. I was doubtful about the tumour,not about the point of practice.

Well, now, of the operation. As the manwas placed on the operation table, the thinskin covering the tumour broke, and a jetof scarlet arterial blood issued from theorifice. Mr. Keate held a sponge, dippedin cold water, over the tumour during theperformance of the operation, and all fur-ther bleeding was thus checked. The tu.mour was a larger one than I had ever seen

. in an inguinal aneurism. The trunk of the’ iliac artery was never tied in this country untilthe beginning of the present century. Mr.: Hunter was the first to propose this ope.ration in this country. Mr. Abernethy wasthe first who tied the external iliac artervin inguinal aneurism; it was considered ’agreat exploit in surgery. The patient,however, died from some accidental causenot at all connected with the operation. Mr.Abernethy was not, however, disheartenedby the result. "Oh," said he, "I will per-form the operation again." He did so, and

again the patient died. In this latter casethere was inflammation of the cellular tex-ture around the artery ; and it was difficult,therefore, to apply the ligature. "But thelimb was nourished," said Mr. Abernethy,"and the operation will therefore suc-ceed." The third operation which he per-formed did succeed, and the patient WMcured. I have performed the operationnow myself three times with success; andin the case before us, I hope I may add withsuccess also. The external iliac arterygives off no branches until it reaches Pou-part’s ligament, and, therefore, you maytie it with a greater chance of success thanyou can the femoral artery, where you arenot sure but that a small arterial branch

may be given off just about the ligature,thus preventing the formation of a longcoagulum, which is necessary to perfect thecure of aneurism, and to plug up the artery.Mr. Abernethy’s method of performing theoperation was, to divide the abdominalmuscles high up, and to push the perito.neum inwards from the artery. Sir Asdev

Cooper, however, divides the muscles lowerdown, and pushes up the peritoneum. Inone patient, Qn whom I have oper1!tP,1, ac-

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cording to Mr. Abernethy’s method, a ven-,’tral hernia occurred. Whatever difference Iof opinion may exist with regard to the two Imethods of performing the operation inthese cases, there was no doubt whatever’.in this case but that the tumour was situatedabove Poupart’s ligament, and I thereforeperformed the operation according to Mr.Aberuethy’s method. I made the incisionhigh up; lest I should have to tie the trunkof the great, as well as the external, iliac. I.I cut the abdominal muscles singly or i

doubly, according as they lay ; I separatedthe peritoneum, traced the iliacus internusmuscle, up to the psoas magnus, and foundthe artery pushed down into the pelvis,from the bulk of the tumour and from theskin being so much elevated. I was obligedto make a fresh incision, and carry it in-wards over the tumour. I reached the ar-

tery, and passed an nneurismal needle under 1

it, drew the ligature tight, and tied the ves-sel. This part of the operation requiresgreat care, from the neighbourhood of theiliac vein, which, if you were so unfor-tunate as to wound, would prove fatal toyour patient from excessive hemorrhage.In this case the cellular membrane aroundthe artery was not inflamed ; and I had not,therefore, the same difficulty to contendwith that Mr. Abernethy had, and it onlyrequired care and caution. The arteryshould be detached as little as possible fromthe surrounding parts, for much of the sub-sequent danger to the patient depends uponthis. Sir Everard Home, who followedMr. Hunter’s method of performing theoperation, never separated the artery fromthe surrounding substance more than hecould help, and this plan has been followed iuniversally ever since the publication of ’ifDr. Jones’s experiments. If you separatethe artery much from the surrounding cel- Ilular substance, ulceration and sloughingmay come on ; and in cases where the old

surgeons used to lift up the trunk of the

artery on the handle of the scalpel, andshow it to the pupils, they, of course,

separated the artery very much from thesurrounding textures, and ulceration and

sloughing were invariably the result. Mr.Cline, senior, used to include a piece ofcork in the ligature. Scarpa, I think, re-commends a bolster for the same purpose.In the present day, as you know, nothing’ ofthis kind is done, for the artery is separatedfrom the surrounding parts as little as pos-sible. The ligature should not be too broad,but of such size and strength as, when drawntightly, will cut through the inner coat,and vou then of course bring together twocut surfaces. The surgical course of lec-tures which is delivered here in the even-ing will inform you upon all these pointsmore at length than I can do in the present

lecture ; and I may also at the same timerefer you to Dr. Jones’s work on the subject.In this case when the ligature was tied,all pulsation in the aneurismal tumour ceasedimmediately, and the hemorrhage stoppedalso. The ligature was tied between theorigin of the external iliac and Poupart’sligament. The patient was not purged ashe ought to have been before the operation,for he

was not in the house long enough.

From the time of the operation the tu-mour decreased in size ; the ligature cameaway on the sixteenth day. It might have

come away sooner, but I did not pull it, asI was fearful of hemorrhage ; and when itdid come away it required no force to detachit. The only other interesting facts con-

nected with the case are those which oc-

curred to the tumour after the operation.On the 10th March, the coagulum of thetumour turned out, and excessive hemor-rhage came on from the lower part of thetumour. I did not think that the anastomosisof the epigastric and circumflexa ilii ar.teries could bring it on. But was I to apply aligature in this case There was a con-

fused mass of bloody slough and hemor-rhage ; and in the midst of all this, I couldnot tell where to tie the artery. 1 thoughtthe hemorrhage might be restrained bypressure. In some private cases whichl had, and in which secondary hemorrhagecame on, I applied strips of adhesive plas-ter all round the thigh, with a compressover the surface whence the hemorrhagetook place. In this case I began from theknee, and laid on strips of adhesive plasterall round the thigh up to the groin, andplaced a bolster over the tumour; this wasdone ten days ago; no recurrence of thehemorrhage or sloughing has taken placesince, and good healthy granulations arenow springing up, which I am in hopes willstop up the orifice of the bleeding vessel,and prevent any recurrence of the liemor-

rhage—at all events it seems now com-

pletely under control. For my other patientsI had a leather strap made, with a padaffixed to it to press over the tumour whichcould command aud control the hemorrhage

in an instant. 1 have had one applied onthis man, but have not had occasion to useit. And here let me observe upon hemor-

rhage from aneurism, that I have seen manycases of it. In one case I tied the arteryabove, and still the hemorrhage continued,and the patient died. You will, in general,find that slight pressure will be sufficientto restrain it. In a case of aneurism whichoccurred in this hospital, Sir Everard Hometied the artery, and secondary hemorrhagecame on. However, there was an old nurse atthat time in the hospital, who, from long ex-perience, understood these matters, and shetied a piece of tape around the limb, and the

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hemorrhage completely stopped. In a case ofamputation I tied the vessels and cut offthe ends of the ligature, and the woundunited by the first intention. On the tenthdav it burst, and secondary hemorrhagecame on. I put on a roller and bandage,and it completely stopped. In this casethe hemorrhage completely ceased. The

hemorrhage did not arise from the liga-ture, but from the aneurismal sac. Inever knew this to happen but once before,and then there was an abscess in the sac;here perhaps it was better that the hemor-rhage took place from the sac (although Ishould have preferred that it had not takenplace at all) than from the ligature, as itwould not have been practicable to applyeither pressure or a ligature higher up. I

hope there will be no further return of thehemorrhage, but still the man is not yet outof the wood,-not totally free from danger.

REMARKS

ON THE

INVESTIGATIONS AND ALLEGEDDISCOVERIES

OF

PROFESSOR DELPECH,

IN THE PATHOLOGICAL ANATOMY OF THE

MALIGNANT CHOLERA.

By J. WATERS, Esq., Licentiate of the Collegeof Surgeons in Ireland.

As there has been a considerable degreeof attention excited bv the statements latelypublished by Professor Delpech on thepathological anatomy of cholera, I beg leaveto state a few facts connected with his in-vestigations in Glasgow, which I had anopportunity of witnessing.

Shortly after the disease appeared inGlasgow, Professor Delpech arrived, hismind being occupied by a preconcerted in-genious theory, determined to make all

appearances in the dead body coincidewith his views. Completely blind to anychanges of structure which could at allmilitate against them, he immediatelycommenced by most ingenious and plau-sible arguments to convince those withwhom he had an opportunity of conversing,of the correctness of his idea of the proxi-mate cause of the disease-viz. that it con-sisted in an inflammation of the ganglionicportion of the nervous system, producingderangements of the functions of sanguifi-cation, nutrition, respiration, and circu-lation.

j I was first inclined to coincide with hisview of the disease, supported as it was

by all his wonted talent and ingenuity, andcorroborated as he said by appearancesafter death, indicative of such an affectionof the ganglia, but unfortunately for the

validity of his speculations, an opportunityat the moment existed in the hospital, ofreferring the matter to the test of in-

spection.Upon examining the body of a woman

who had died a few hours previous, the fol.lowing appearances were found :-

On removing the calvarium, the super-ficial vessels of the brain and its mem.branes were found quite empty; even at theposterior part they were free from the usualcongestion from gravitation. The surfaceof the serous membrane was quite destituteof moisture throughout its whole extent.The substance of the brain was perfectlyhealthy. The spinal marrow unaltered.On examining the ganglionic apparatus,

more particularly the semilunar ganglia,solar plexus, and splanchnic nerves, to theeyes of Professor Delpech they presentedan intense degree of vascularity, thick-ening of their neurilema, and tumidity oftheir substance," the whole indicating ahigh degree of inflammation, quite sufficientto account for the death of the patient, " onaccount of the delicate and easily destruc-tible texture of the organs concerned."

I should feel considerable diffidence in

taking’upon myself to contradict the state-ments of an individual so eminent in hisprofession as Professor Delpech, did I notthink myself quite competent to form anopinion as to the state of those parts, fromhaving had for some years very extensiveopportunities of pursuing post-mortem m-vestigations, and acquiring a peifdCt fami-liarity with the natural appearance of ti,e

organs in question. I can therefore withconfidence assert, that there was not the

slightest deviation from their natural healthystructure. The ganglia presented their usualpale, fleshy, appearance, and on being cutinto, no blood or fluid of any kind could beexpressed from them. The neurilema was

perfectly free from any increased vascu-

larity or thickening, and when wiped with adry towel, was perfectly white, and destituteof the inflammatory blush ascribed to it byProfessor Delpech.The mucous membrane of the stomach and

intestines, however, presented more de-cided and characteristic appearances. Inthe stomach the vascularity was not muchincreased, but the membrane was reducedto a state of pulpy softness, having lost allits usual tenacity. In the duodennm themembrane commenced acquiring an in-creased degree of vascularity, which gradu-ally became more intense as it proceeded