The Lung, which may be considered as a series of tubes, some conveying blood, and others air, is often wounded; but the blood immediately stops the leak, from its tendency to coagulate when out of the vessels; and no harm ensues. Occasionally, however, a circumstance occurs, which, until it is understood, appears curious and alarming. Either from the extent, the scratching of the surface, or some other peculiarity in the wound of the lung, the air escapes from it, and the patient is as it were blown up, as to the chest, neck, and face, by the air impelled from the lung beneath the skin into the connecting tissue, exactly in the same manner as the butcher does when he is preparing veal. This blowing-up is called, from the Greek word for it, Emphysema; and it was on this feature in these accidents that Mr. Abernethy wrote a short paper.
There is not much which is absolutely new in it. It is chiefly remarkable for the clear manner in which it places before us what is required, as distinguished from what is officious and unnecessary, and, in fact, reduces the treatment to that of ordinary cases, with one clearly defined modification.
He shows his familiarity with Pneumatics, so far as they are touched by the case, just as he does his knowledge of Chemistry elsewhere. The exceptional cases, in which the air is confined in the chest, the mode of procuring it an exit by operation, and the condition regulating this proceeding, are very simply and clearly laid down.
The paper also contains remarks on the collapse of the lungs when the chest is opened, and on certain exceptions which have been observed, which, from their general interest and suggestive character, will well repay an attentive perusal.
He next offers a few remarks on those mothers' marks, as they are popularly called, and which are technically styled nævi. They are generally little more than clusters of enlarged blood-vessels, and are usually removed by excision or other operative proceedings. As the essential character of these marks is increased action and size of vessels, Mr. Abernethy thought that, if well-regulated pressure were made on them so as to impede the flow of blood into them, and this were conjoined with Cold (which represses vascular action), many of them might be got rid of in this manner. He found his idea realized, and published three cases of its success. The value of these suggestions consists, first, in the opposition they offer, pro tanto, to that absurd tendency there is to remove everything like a tumour; and the impediment thence arising to any searching inquiry into the causes on which they depend.
But there is another inconvenience which occasionally renders the excision of these nævi very inadvisable. It sometimes happens that they are so situated that they cannot be removed, without making the disfigurement greater, or from some other still more serious objection; as, for example, when small ones occur in the face, or when they are placed near the eye. Under such circumstances, the contraction consequent on a wound of any extent is a serious inconvenience; in some of these cases, the adoption of Mr. Abernethy's plan allows us to dispense with the operation by excision, as I have myself experienced. As it illustrates the advantage of the plan in a case where it was particularly applicable, I will briefly refer to one example. A young lady had one of these marks at the root of the nose, where, from the position, as well as from the contiguity of the eyes, any dragging from the contraction of a scar, would have been particularly undesirable. She was brought from the country to have it removed; but, on representing the objections to that course, it was agreed to try Mr. Abernethy's plan, which was completely successful.
At this period, Mr. Abernethy published sundry other interesting papers, showing, in his observations of all that was passing around him, that his views were not less circumspect and comprehensive than they were clear. His "surgical cases" are all excellent; and if they do not contain so full an account (the great vice of medical records) of all the circumstances which preceded them, as are sufficient to furnish future investigators with the elements of accurate generalization, they are remarkably valuable for the qualities of clearness and candour.
We may have an opportunity of briefly alluding to some of these papers in our summary; but they are hardly practicable subjects for popular analysis, although they form some of the most valuable contributions to the practical literature of the profession. They show also that he was as penetrative and efficient in regard to the operative department of practice, as he was in those higher and more extended views, which, in enlarging the science of surgery, has tended to diminish, of course, the number of operations.
About the year 1785, John Hunter had invented his celebrated improvement in the treatment of a disease of the arteries called "Aneurism." It was a very simple deduction from observations on the state of the arteries; and although it was one of those inquiries which had been made the subject of experiments on living animals, it was one on which not the smallest light had been thrown by such investigations.
Mr. Hunter had found that, in addition to many other serious objections to an operation which had been usually performed for the relief of this disease—which consists either of a giving way of a portion, or a general enlargement, of a vessel (for it is sometimes one, sometimes the other)—a great cause of failure had been, that the ligature which was placed round the artery was too near the disease, and, in fact, involved a portion of the tube which was unsound. He accordingly proposed tying the artery a little farther off, and thus substituted, for an operation which was extremely severe, very hazardous, and too commonly fatal, a comparatively short and simple proceeding, which, under moderately favourable auspices, is almost uniformly successful.