subject of many treatises expressly devoted to their consideration, and it may seem unnecessary for me to increase the number of these productions. But the progress of modern pathology and surgical practice has introduced many improvements that have not yet been fairly brought together, and explained in their application to the management of those complaints which are at present more particularly in view. I have attempted to supply this defect; and by a plain statement of the seat, nature, symptoms, and treatment of different affections which are met with at the extremity of the rectum, endeavoured to assist practitioners in discharging their duty to the patient, and to protect patients against unprincipled or reckless practitioners."-Preface, p. iv.

How the author has accomplished this task, the readers of the "Library" have an opportunity for judging.

The work is divided into six chapters,―embracing respectively, fistula in ano, hemorrhoids, prolapsus ani, polypus of the rectum, stricture of the rectum, and spasmodic stricture of the rectum.

Ellis's Medical Formulary.1

The number of editions through which the "Formulary" has passed sufficiently indicates its usefulness. It is still capable, however, of improvement. Many of the formulæ admitted into it are unworthy of retention; and there are several of the new remedies especially-which might have been added with advantage.

The value of the "Formulary" to the young prescriber cannot be contested.

Tracheal Concretion without Croup.-That the other symptoms of croup are often present without the occurrence of any exudation of lymph in the trachea, is matter of frequent remark; but the reverse case, in which a film is formed in the trachea and thrown off, without any accompanying croup, is of much rarer occurrence. In a number of a late foreign journal is an instance of this kind. The patient, about thirty years old, was subject to cough and mucous expectoration. This was aggravated in the present instance by unusual exposure in hunting; three days after he expectorated a considerable quantity of white stringy concretion with relief. After this, at intervals of from eight days to as many weeks, he had attacks of cough, accompanied with hoarseness; and under the influence of these symptoms. brought up similar concretions, without pain, and rather, as is described, with a sensation of tickling. These concretions are described as resembling polypus, of a white colour, except when mixed with coagula, and then reddish, without smell, in rounded masses of various size, but in one instance as large as a hazelnut. By throwing them into cold water, they could generally be made to assume the form of the bronchial tube. Small portions of similar matter were sometimes separated without cough. After a course of warm bathing, which relieved the general symptoms, the expectoration was renewed at shorter intervals, was preceded by rattling and followed by hoarseness. No serious inconvenience appears to have been experienced.

The Medical Formulary; being a collection of prescriptions, derived from the writings and practice of many of the most eminent physicians in America and Europe. To which is added an appendix, containing the usual dietetic preparations and antidotes for poisons. The whole accompanied with a few brief pharmaceutic and medical observations. By Benjamin Ellis, M. D., Professor of Materia Medica and Pharmacy in the Philadelphia College of Pharmacy (with a motto). Fifth edition, with additions. 8vo pp. 231. Philadelphia, 1838.

2 Wochenschrift für die gesammte Heilkunde, Mai 13, 1837.

Intermittent cured by Injections.-A case of this kind is given, occurring in a German soldier. The subject was twenty-two years of age, and of good constitution. The employment of quinine internally produced nausea and stricture, that of cinchona was without effect. Twelve grains of quinine were thrown into the rectum in solution, combined with the yolk of an egg and a few drops of laudanum. The second injection checked the paroxysms. Ascites, which was present at the same time, gradually disappeared under the use of frictions over the renal region with spirits of turpentine. After an interval of two weeks from the date of the apparent cure, the symptoms returned, and were again dissipated by a renewal of the remedy. To prevent a second relapse, the injections were employed every fourteen days for some weeks, and a permanent cure followed.

Jefferson Medical College.-At the recent session of the legislature, an act of assembly was passed, separating the Jefferson Medical College from all connection with the parent institution at Canonsburg, and erecting it into an independent establishment, under the title of the "Jefferson Medical College of Philadelphia." The new charter is of the most extensive kind, giving to the college all the powers possessed by the University of Pennsylvania.

It also provides for the appointment of five additional trustees, to be elected by the members of the old board, who, together, comprise the board of trustees of the new institution.

At a recent meeting of the board, the Rev. Ashbel Green, D. D., L. L. D., was elected president, and the Hon. Judge King, secretary. The following additional trustees were appointed. The Hon. Judge John R. Jones, Hon. Jesse R. Burden, Colonel Samuel Miller, Alderman John R. Vogdes, and J. B. Smith, Esq.

Louisville Medical Institute. We observe by a recent Lexington Intelligencer, (April 13,) that Dr. Charles Wilkins Short, Professor of Materia Medica in the Medical Department of Transylvania University, has accepted the same chair in the Louisville Medical Institute.

British and Foreign Medical Review.-Messrs. Adlard and Saunders, of New York, are appointed agents for this review. They have made arrangements to receive the work in future by the first packet after its publication in London, and will supply it at the London price.

BOOKS RECEIVED.

From Prof. T. R. Beck, of Albany.-Transactions of the Medical Society of the State of New York, Vol. IV., No. 1. 8vo, pp. 24. Albany, 1838. On Diseases of the Rectum. By James Syme, M. D., F. R. S. E., Professor of Clinical Surgery in the University of Edinburgh. 8vo, pp. 138. Edinburgh, 1838.

From the Author.-The Annual Report of Dr. Francis T. Stribling, Physician of the Western Lunatic_Hospital, made the 29th of May, 1837. Published by order of the Court of Directors. 8vo, pp. 19. Staunton, Va., 1837.

Hints on the subject of Interments within the city of Philadelphia, addressed to the serious consideration of the members of councils, commissioners of the districts, and citizens generally. By Atticus. 8vo, pp. 22. Philadelphia, 1838.

From the Author.-Annual Address before the New York State Medical Society, Feb. 6, 1838. By James McNaughton, M. D., President of the Society. 8vo, pp. 32. Albany, 1838.

I Berlin. Medicin. Zeitung, Jan. 4, 1837.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. II.

May 15, 1838.

No. 4.

ART. I.-ON THE INTRODUCTION OF AIR INTO THE VEINS.

BY M. VELPEAU.1

This subject has recently excited a good deal of interest in France, and has given occasion to various discussions in the Académie Royale de Médecine, of Paris, which were not rendered the less interesting by the presence of our distinguished friend, Professor Warren, of Boston, whose contributions on this point of surgical pathology are full of interest. It will be seen that they are referred to by M. Velpeau.-Ed.

The numerous incidental questions which have been raised on occasion of the discussion concerning the introduction of air into the veins, have made the original point be lost sight of. It was desired to know if air can spontaneously enter the human veins during surgical operations; if science possesses facts tending to establish the reality of this accident; and lastly, whether art has any method calculated to prevent or to remedy it; such were the points first debated. In spite of my efforts to keep the discussion within its proper boundaries, it left them almost at the outset, never more to return within them. As I shall not be able to treat the subject again, I think it will be useful to my colleagues, if I publish in detail my researches on the direct question of the introduction of air into the human veins.

Surgical practice had long afforded examples of almost sudden death taking place during certain operations; but these occurrences had been attributed at one time to hemorrhage; at another to the exhaustion of the patients by excess of pain; at other times to terror, and sometimes to syncope. I know myself that patients have died in a few minutes, while the operator was endeavouring to remove a diseased thyroid gland, or a tumour in the axilla; or, to give another instance, that the accident has taken place during tracheotomy, and that no explanation has been attempted except those which I have just given. Modern surgeons, however, not satisfied by these explanations, and recollecting the experiments of physiologists upon animals, have explained such cases by supposing that air entered the veins. The facts of this kind which I have met with are about forty in number. The question is, whether they can be really compared with those which are furnished by experiments on animals, or whether, in any other manner, they contain the proof of the fact in favour of which they are quoted. I consequently think that it will be useful to review them, and give an abridged analysis of them. I shall take care to point out the work where they are to be found, that the reader may refer to all the details, if he thinks proper.

CASE I. The first instance of the kind which was published in France, occurred in the practice of Bauchêne, at St. Antoine's Hospital, in July,

1 Gazette Médicale, Fevrier 24, 1838, and Lond. Med. Gaz: March 17, 1838, p. 953. VOL. II.-4

1818, (Piédagnel. Thèse, No. 250, Paris, 1827.) He was removing a large tumour on the right shoulder of a young man of twenty-three; but little blood had flowed, and the clavicle had been turned outwards, when M. Piédagnel heard a noise like that which is caused by the entrance of the air through a small hole into the chest of a living animal. The patient cried out, "My blood is falling into my heart; I am dead." The same sound was heard a second time, and the young man fainted, and died a quarter of an hour after the operation, which, moreover, had been long. The body was opened eighteen hours after death, and it was found that the external jugular vein had been wounded; there was no blood in the heart; its right cavities were flaccid and thin; all the vessels contained a considerable quantity of air-bubbles.

Here the external jugular vein was wounded. There was a hissing noise, followed by syncope, but no mention is made of convulsive movements; and there was air every where, except in the heart. Experiments made on living animals show precisely the reverse; in them the heart contains air more than any other part, and when air enters the veins, animals do not sink in this manner.

CASE II. Before the fact just related had drawn public attention, another occurred at the Hôtel-Dieu. On the 19th of November, 1822, Dupuytren had to extirpate a large tumour from the right supra-clavicular region of a young girl, aged about twenty (Arch. Gén. de Méd. t. v. p. 430). During the dissection of this tumour, and before it was completely separated, a hissing noise was heard, as if air was entering a pneumatic apparatus. The patient, who had lost only a few drops of blood, exclaimed, "I am dead,” sank upon her chair, and expired instantly.

The body was opened twenty-four hours after death. The right auricle, which was tense and elastic, was filled with air, but contained no blood; fluid blood, however, was found in the other cavities of the heart. All the vessels in the rest of the body contained a large quantity of air, mixed with a certain proportion of blood.

It cannot be denied that a fact like this has something strange about it; nevertheless, if we compare it with what happens in experiments upon animals, we see immediately that the cases are dissimilar. In fact, there is nothing to show that the internal jugular, or even the external jugular vein, was opened during the operation; which, besides, was not finished. There was air alone in the auricle, and blood alone in the ventricle. But we have seen in animals that there was always a close union of blood and air, in the form of a bright red froth, both in the auricle and the ventricle. In the case just detailed, death occurred suddenly, and without convulsions; but it never occurred in this manner in our experiments. Hence the case leaves much to be desired, even taking it as it is narrated.

CASE III.-At the same period it was said that a similar accident had happened to Gräfe, of Berlin; but I cannot find the particulars of this case any where, and believe it to be a mere on dit; unless, indeed, the name of Gräfe was confounded with the journal which he edits, and a case by Klein was really meant.

CASE IV. We find, indeed, in Gräfe and Walther's Journal (vol. i. p. 120), that Klein, of Stuttgard, while extirpating the thyroid gland in a deaf and dumb child, lost his patient in less than a minute. But, in 1814, when this occurred, the danger of the introduction of air into the veins had not been thought of; and it was not till long afterwards that this case was referred to, in order to support Dupuytren's.

CASE V.-Dupuytren also quoted an instance of the same kind, as occurring in Sir Astley Cooper's practice; but nothing of the kind is to be found in his works, and M. Olivier, of Angers, alone has thought it necessary, the strength of an on dit, to mention the case briefly in the Dictionnaire de Médecine, tom. ii. p. 70.

on

I think I need not add, that, in so important a question, evidence of this kind is of no value.

CASE VI.-In 1826, M. Castara, a surgeon of Luneville,' while dissecting out a tumour situated in the sub-spinal fossa of the right shoulder, suddenly heard, at the bottom of the wound, a sound like the gurgling of a narrownecked bottle which is being emptied (this sound is called, in French, glougou). The patient, who was twenty-one years of age, fainted, and died suddenly, without any convulsive movement. Twenty-four hours after death, the right cavities of the heart were found filled with fluid blood, mixed with a great quantity of air-bubbles. The left cavities also contained some. The whole venous system of the right arm (including the fore-arm) was filled in the same way. The only vein which had been opened was a branch of the sub-scapular, and the incision in it was less than a line in diameter.

There are some very remarkable peculiarities in this case; it is the only one of those we have hitherto narrated which can be compared with the results of experiments upon animals, with regard to the state of the blood in the heart. But the patient died suddenly; and this never occurred in direct experiments. So small an opening, and that too in a vein beyond the axillary, does not allow of the entrance of air enough to cause real danger, either in dogs or horses; nor can one understand how the air should be present in the veins of the right fore-arm, when none was found either in the vena cava inferior, or in the left arm. Hence M. Castara's case, though one of the most authentic, leaves some doubts in one's mind.

CASE VII.-Two years afterwards, in 1828, Dr. Mott, a celebrated surgeon of New York, who is now in Paris, published an account of the extirpation of a tumour, which extended from the parotid region to the face; (Journal of Surgical and Medical Science, Nov. 1827, p. 127.) During the operation the facial vein was opened; a peculiar sound was heard; the patient uttered a cry of distress, and nearly fainted; but death did not take place. Hence there is nothing to show that the symptoms were caused by air entering the veins, especially as the facial vein does not seem capable, anatomically, of allowing it.

CASE VIII.-Delpech, while extirpating the arm for a fungous tumour in a patient of about thirty, heard two snuffing sounds (ronflemens) before he had got through the joint. The patient fainted twice and died instantly. There had been but little hemorrhage. The dead body was placed under water, and a considerable quantity of air-bubbles were found in the right cavities of the heart, (Memorial des Hôpitaux du Midi, deuxième année, pp. 231, 634.)

Here, again, we are immediately stopped by a number of serious difficulties. First of all, it is neither the axillary nor the subclavian vein which is in question, but merely the veins of the stump of the humerus: and we have already seen that, at this distance from the thorax, the absorption of air appears to be impossible. Then it is not a snuffing sound which is heard in animals, nor do they sink suddenly; moreover, we do not learn what was the state of the air which filled the right cavities alone of the heart.

M. Clémot, of Rochefort, happening to be at the Hôtel-Dieu, told Dupuytren (who had just been attempting to remove a tumour from the thyroid gland,) the three following cases :

CASE IX.-A woman, from whom he had removed a cancerous breast weighing twelve pounds, died a few hours after the operation; and air was found in the veins running from the wound to the heart, as well as in its right cavities, (Putegnat, Thèse, No. 156, Paris, 1834.)

CASE X.-In another instance M. Clémot, while dissecting a tumour out of the axilla, suddenly heard a respiratory sound. It was thought that the chest had been opened; the patient fainted, but soon came to himself again. Is it not clear that no one can be convinced by facts so vaguely set forth, and which, in addition, have not been published by their author?

1 Saucerotte, Thèses de Strasbourg, March 1828.

2 That is to say, in the experiments on animals.-Translator's note.