Should subsequent experience confirm this experiment of M. Amussat, this simple measure will be a most valuable substitute for those dangerous measures hitherto resorted to for retention of urine, in cases where the obstruction arises from thickened mucus, from small calculi closing the orifice of a stricture, from inflammation, or from what are termed, (justly or not,) spasmodic strictures.
51. Tracheotomy.—In the Amer. Med. Review for April, Dr. John Atlee, of Lancaster, mentions that on Wednesday, Aug. 11th, he was consulted by a child ten years old, who had that morning, while running, put a button-mould into his mouth, which during respiration was drawn into the trachea. He complained of uneasiness in respiration, with a slight rattling, and pointed towards the upper part of the sternum, as the situation of the button. On coughing, a rattling was heard, and immediately after, a sudden check to expiration, from the lodgment of the button near the rima glottidis, requiring a sudden and violent effort of inspiration to remove the sense of suffocation. An emetic was given with no advantage. During the night, he had two or three spells of coughing, threatening suffocation.
An operation was urged, to avoid immediate and subsequent dangers from the lodgment of this extraneous body, and was agreed to by the parents, and by Dr. Humes, who was called in consultation. It was performed on the 14th of Aug.; a cathartic, and afterwards an opiate, having been given.
An incision, one inch and a half long, was made through the integuments, extending downwards from above the cricoid cartilage, and exposing the sterno-hyoid and thyroid muscles, which were then separated. After exposing the trachea, a longitudinal incision, about three-quarters of an inch in length, was made through its parietes at the third ring. This was held open, and the patient requested to cough. This was ineffectual. The wound being closed, the button was, by coughing, thrown up against the rima glottidis. A probe passed into the trachea, produced a violent effort to cough, by which, as soon as the instrument was withdrawn, the button was thrown through the wound, to some distance from the patient.
The wound was dressed with two sutures and adhesive strips. Most of it united by the first intention: and in a few days the patient completely recovered.
52. Fistula Lachrymalis—At the session of the Royal Academy, on the 15th of December, M. J. Cloquet related the case of a female, who, three years previously, had submitted to the operation for fistul. lachrym. according to the method of M. Foubut. The canula which had been allowed to remain in the nasal canal, had ulcerated through the floor of the nose, and presented its inferior extremity on the inside of the mouth.
A practical commentary on this mode of operating, which is still recommended by able surgeons!
53. Aneurisma Herniosum.—This form of aneurism is supposed to consist of a dilatation of the internal and muscular coats of the artery; the external cellular having been destroyed. It is termed by Arnaud, and by Dr. William Hunter, aneurisma herniam arteriæ sistens. Its existence in any case has, however, been denied by a large majority of surgeons; and perhaps the only cases reported are those of Dubois, in 1804, found in the thoracic and abdominal aorta of a dead subject.
The reporter of the following case, quotes also Monro, as having cited examples of this kind of aneurism. But what Monro termed a "mixt aneurism," arose from the rupture of the coats of a "true aneurism," by which it was reduced to the state of a "false aneurism;" very different from that here contended for. Sabatier and Boyer, also, deny the existence of this hernia of the artery, and a good summary of facts and arguments is given by Boyer in his Surgery, in support of this opinion, (vide article Aneurism, tome i.) which it would be difficult to invalidate, especially by cases analogous to the following. The reporter, M. Bonnet, of the late French army, considers this case as proving a hernia of the artery in a vessel of medium diameter; those of Dubois having been noticed in the largest arteries.
A Prussian soldier was wounded over the femoral artery by a musket ball. No hæmorrhage ensued, and the wound cicatrized. In this state, M. Bonnet visited him for a mortification of the foot of the same limb, which had been frozen. Amputation of the leg was performed, the stump healed readily, and in 12 days the ligatures came away. On the 13th day, (being six weeks since wounded in the thigh,) the patient perceived a tumour at the original cicatrix on his thigh, which had appeared during the preceding night. On the 14th, it had enlarged to three times its former size: it was painful; fluctuation was evident; but there was no pulsation, not even the thrilling noise, which is evident in the last stage of aneurism. A consultation was called, to determine whether it was an abscess or an aneurism. The question could not be satisfactorily answered, and it was determined to open it, after having made the necessary arrangements to secure the artery, should the tumour prove aneurismal. As soon as the integuments were punctured, the jet of blood evinced the nature of the complaint; and the artery was secured by ligatures above and below the tumour. The coagula were numerous, and the superficial ones, quite hard and cartilaginous. The patient did well, and there was every prospect of his recovery on the 1st day, when M. Bonnet was forced by the movement of the armies to leave him at Meaux.