I here terminate my effort. I have proposed to make yellow fever known, as I have observed it at Havana for some twenty years. The reflections, which I have presented on the nature and the causes of this terrible disease, the details into which I have entered, in order that all that relates to its symptoms, its progress, and its treatment, may be clearly estimated, make this work a monograph, the utility and opportuneness of which, will, I hope, be appreciated by those medical men, who are called to practice in tropical regions.
The Elastic Bandage in the Treatment of Aneurisms.—It seems likely that Esmarch’s bandage will add very greatly to our means of treating aneurism. Dr. Weir has collected twenty-one cases of iliofemoral, femoral, and popliteal aneurisms, mostly the latter, treated in this way. Twelve of these were successful, while the others failed, owing chiefly to the fact that obstruction to the arterial current was not kept up after the removal of the elastic bandage. Upon this point Dr. Weir lays great stress, and states that in it is the gist of the treatment.
In connection with the study of this matter, the question of how long a limb can be kept desanguinated is of importance. In the lower animals the time is six or eight hours. In man the time is longer than has been heretofore supposed. Ischæmia has been enforced for four, five, and in one case fourteen hours without injury. During the compression it is important to remember that the arterial tension elsewhere is increased.
Autopsies have made it probable that coägulation begins in the tumor and extends up several inches into the artery. The arterial clot then becomes organized into fibrous tissue, and for this organization a healthy state of the wall is necessary. Aneurisms with large mouths are perhaps more easily cured by Esmarch’s bandage.
As the result of a study of the cases collected, including his own, Dr. Weir recommends a plan of treatment like the following: the limb should be bandaged up to the tumor and above it, but not over it. The patient should stand erect before the upper bandage is put on. Tubing should be applied in the usual manner. The elastic compression may be kept on for two hours, followed by the application of a tourniquet for two hours. If pulsation is still apparent, the elastic and mechanical compression should be repeated until pulsation has ceased. After consolidation of the tumor is secured it is well to moderate current above the tumor for twelve or twenty-four hours by a bag containing seven or ten pounds of shot.—Amer. Jour. Med. Sciences, Jan., 1879.
EDITORIAL.
NORTH CAROLINA MEDICAL JOURNAL.
A MONTHLY JOURNAL OF MEDICINE AND SURGERY, PUBLISHED
IN WILMINGTON, N. C.