"It appears, then, that in all these varied experiments, the flow of blood was restrained for a time, the shortest period at which secondary hæmorrhage occurred having been twenty or twenty-four hours, and that in three of them the wound in the vessel was adequately closed to have prevented any further hæmorrhage. It appears, also, that out of four experiments performed in the same manner as M. Halmagrand's, but without the use of his styptic, two, viz. Experiments 1 and 2, were permanently successful, in one of them the artery being left pervious, in the other, being obliterated by coagulum; that a third, Experiment 3, failed at the time of the operation for want of sufficient coagulum in the vessel, to defend it after the compresses were loosened; and further, that Dr. Jones's method saved this animal after simple pressure had not succeeded; and that one only, viz. Experiment 4, was altogether unsuccessful, the animal having in this case only died of the operation.

The conclusions which I think may be legitimately drawn from these experiments, and from what I have seen of M. Halmagrand's, (and which are strengthened by the failure of the last two, since the reasons why they failed are plain,) are the following:

Ist. Experiments 1, 2, and 4, demonstrate that pressure continued for ten minutes upon an injured artery, in a nearly open wound of the soft parts, by means of small compresses moistened in various liquids, may check the hemorrhage from an artery in which a longitudinal or transverse wound has been made, or from which a portion has been removed. They thus prove an additional point to the facts ascertained by Dr. Jones, whose experiments upon partially divided arteries were made in wounds closed by a continued suture.

2dly. Experiments 3 and 5, shew that when a portion of an artery has been altogether removed, the hæmorrhage may be restrained, and the vessel permanently closed, by allowing the blood to coagulate in the soft parts, as in a diffused aneurism; Dr. Jones had previously proved this point with regard to several other kinds of wounds of arteries, but had not attempted this peculiar modification of injuries of vessels.

3rdly. Experiments 1, 2, and 4, prove that the means by which hæmorrhage is controlled, when pressure is made for a short time in an open wound, are the same which Dr. Jones's experiments had shewn to be exerted in a closed wound: viz. the formation of coagula, either in the lips of the wound of the vessel, or in the cavity of the artery, or in the cellular membrane around it, or in any two of these situations, or in all of them at once; except in some longitudinal wounds, which may occasionally be closed by the deposition of lymph alone, in which case the vessel may still remain pervious.

4thly. It is shewn further, that if coagulation takes place imperfectly, or if the clot is suddenly or violently disturbed, immediate hæmorrhage will occur.

In two of M. Halmagrand's experiments the compresses were probably thrown off thus by the exertions of the sheep, and the coagulum being consequently disturbed, both of them died. In Experiment 3, also, I could not obtain coagulation at all, the animal being so very restless on the table, and probably it would have died, had I not produced coagulation in a different way.

5thly. Experiments 4 and 5, shew that although the hæmorrhage may be controlled for a time, it may subsequently return at various periods from the causes pointed out in the last section as capable of producing immediate hæmorrhage. In Experiment 4, bleeding commenced about twenty or twenty-four hours after the injury, in Experiment 5 on the third day, and in one of M. Halmagrand's experiments at the London Hospital, described in the Medical Gazette, it did not occur till the fifth day after the wound. Dr. Jones's experiments also lead us to the same conclusion with regard to secondary hæmorrhage from wounded arteries.

6thly. It is probable that styptics applied to a bleeding artery can only be beneficial in two ways,-FIRST, by causing contraction of the coats of the bleeding artery. It is proved

however, by these experiments, as well as by Dr. Jones's and M. Halmagrand's, that whatever may be their effect upon small arteries, styptics scarcely induce any contraction of the coats of a large artery, and often none at all: but, that whatever may be the means employed to control the hemorrhage, the formation of a clot, and the deposition of a lymph, are almost always necessary. Surgical experience, moreover, teaches us the same lesson with regard to partially divided arteries, although, no doubt, in cases where an artery is wholly divided, contraction is powerfully exerted to prevent loss of blood. Or, SECONDLY, Styptics may be of service by accelerating or promoting the coagulation of the blood. If, for instance, the decoction of galls, which was employed in the first experiment, be mixed with recent blood, it instantly produces coagulation, and such I am informed, is also the effect of MM. Talrich and Halmagrand's 'Liquide Hæmostatique ;? but Ruspini's styptic, which was permanently successful in the second experiment, and which is often employed in practice with marked benefit, produces no coagulation, nor any other sensible effect on recent blood; neither, of course, does plain water, which was temporarily successful in Experiment 4, promote coagulation. If, then, pressure for a few minutes upon a wounded artery can permanently prevent hæmorrhage, when that pressure is made with compresses dipped in various fluids, which neither produce contraction of the artery, nor facilitate coagulation, we are justified in concluding, that if styptics are employed, the cessation of the hæmorrhage is to be ascribed principally, if not entirely, to the pressure, or at all events in a minor degree only to the action of the styptic.

7thly. These experiments further demonstrate that the effects of pressure with or with out the use of styptics are precarious and uncertain, even in brutes, and therefore, à fortiori, ought not to be depended on in cases of wounded arteries in man, to the exclusion of the almost uniform success of the ligature, whenever its employment is practicable. And, in fact, every day's experience teaches us, in the most striking manner, the important lesson, which these and all other experiments on the subject corroborate, that wherever there is an external wound communicating directly with a large artery, although 1st, there may be complete cicatrization of the wound, and consequently further hæmorrhage; or 2dly, that a circumscribed false aneurism may be formed, (this may take place at least in man, though I am not aware that an aneurism has been ever formed in any experiments upon brutes,) which is capable of being cured by the common operation of tying the artery at some future time, at a distance from the wound; yet we cannot feel confident that either of these circumstances will ensue, but on the contrary, are obliged to entertain con. stant apprehension lest the barrier afforded by the internal or external coagula should give way, and, in the first place, when the wound in the skin HAS united, a diffused aneurism should be formed requiring a ligature above and below the aperture in the vessel, but accompanied with an extensive suppurating wound, which might have been avoided if the vessel had been tied in the first instance; or, in the second place, if the skin HAS NOT united, then we cannot but feel constant anxiety lest our patient be destroyed by a sudden gush of blood, or, as more frequently happens, be worn out by irritation and by loss of Blood, from the no less fatal influence of frequently repeated smaller hæmorrhage.

8thly. But lastly, while I deprecate most strongly any reliance on the use of styptics in wounds of large arteries, I do not deny that they may sometimes be of service as auxiliaries in the case of hæmorrhage from smaller vessels; and if further experience shall prove that the Liquide Hæmostatique' of MM. Talrich and Halmagrand is really superior in this respect to other styptics, I shall have as much pleasure in acknowledging the fact, as I have in ascribing to their distinguished countryman, Paré, the revival of the still greater security against hæmorrhage afforded by the ligature." 135.

III. ON THE PHENOMENA AND APPEARANCES FROM PARTIAL OBSTRUCTION

IN THE CEREBRAL CIRCULATION. By John Howship, Esq.

Mr. Howship introduces two cases to the Society's notice, with the following remarks.

"The notes from which this present paper is taken, regard two cases that fell under my notice. In the first are seen the symptoms during life, and appearances after death, peculiar to inflammation of the large veins upon the pia mater; in the second may be observed the inconvenience occasioned by the pressure of a large tumour, so situated as to prevent the free return of venous blood from the affected side of the head; and in both are shewn the consequences induced by a partial obstruction to the flow of blood through the brain. In the one I shall demonstrate a particular appearance in the medullary substance of the brain, which although more than once previously met with, I had not before been able satisfactory to explain; and in the other, we shall have occasion to remark (and that to a very curious extent) the extraordinary powers a large artery may sometimes acquire and exert in a very infirm constitution, when labouring to drive forward the blood through the round of an impeded circulation. 424.

Case 1. J. E. a dissolute young woman, miscarried on May 17th, 1830. On the 21st she was brought into the St. George's Infirmary. On the following day and night she was very languid-had no pain-had some thirst with quick pulse-slight stupor. This, with difficulty of articulation, gradually increased, so that for several days before she died she was quite unable to speak. During her illness she frequently moaned aloud-wanted brandy and gin, to which she had been accustomed-had slight tremors and occasional subsultus. For some days before her death the right side was paralytic, and she passed her stools involuntarily. She died on the 29th, and was examined by Mr. Howship on the 30th.

Dissection. On reflecting the dura mater, an appearance of thickening and opacity was seen on the right hemisphere, from inflammation of one of the large veins. Every part of the pia mater from which blood was collected by the branches of this vein was red from inflammation, and had specks of blood effused into its fine celluiar texture. The cortical and medullary substance of that hemisphere were healthy, yet exhibited the peculiar appearance of every capillary within a given space being enlarged to three or four times its natural diameter. On the left hemisphere two or three of the large veins had become inflamed, and there were small effusions of blood in minute masses between the pia mater and brain. On cutting in the cerebral substance, the congested capillaries had apparently ruptured, depositing within the medullary substance small coagula, a few grains each in weight. There was nothing unnatural in the thorax or abdomen.

"OBSERVATIONS.-The above appearances may be regarded, I conceive, as demonstrative of the effects induced by congestion, affecting a part of the brain, from inflammation and obstruction in the trunk of the corresponding vein. The more extensively diffused effects of general congestion upon the surface, or within the substance of the brain, proceeding from various causes, have been frequently enough observed; but the more partial consequences incident to obstruction, of one or two only of the superficial. veins, have been less correctly noticed.

I have presented two portions of the left hemisphere of the cerebrum, which exhibit these appearances very distinctly." 427.

Case 2. In December 1818, Mrs. J. then aged 77, consulted Mr. Howship for a tumor in the neck, which appeared to be an enlargement of the right lobe of the thyroid gland. The swelling had commenced at the age of 25. Mr. Howship tried the burnt sponge, but it so disturbed the pulse and nervous system that it was of necessity abandoned. In June 1825, Mr. H. was again consulted. The lady was then subject to paroxysms of convulsive cough, orthopnoea, and great languor. The tumor was now of the size of a small melon. The right carotid artery pushed outwards by the tumor, pulsated, as did all the arteries on that side of the neck, with considerable activity. In 1828, there was superadded difficulty of swallowing, and more dyspnoea. In 1830, Mr. Howship found the right carotid beating with extraordinary force and activity, the coats apparently thickened, and the diameter of the vessel increased. The trachea and larynx were pressed to the left side. On the 18th April, 1831, she was attacked with giddiness and loss of memory; in the night she lost sensation and motion in her left side and extremities. By leeching and cathartics she was relieved, but early in the morning of the 19th she died.

"Dissection. In the head, between the arachnoid membrane and pia mater, there was a considerable serous effusion, most conspicuous over the right hemisphere. On gently separating the hemispheres, the corpus callosum was apparently tense; and about 3iiss. of serum were found in the ventricles; the septum lucidum being expanded and thin. The substance of the corpus callosum towards its right margin, was somewhat softer than natural; the medullary matter cut into, being found to contain several cavities or small spaces within its substance, filled with serous fluid.

I removed the tumour from the neck; and on subsequent examination found the internal jugular vein, in company with the artery, passing round the tumour; it was now also ascertained by measurement, that although the right carotid artery was very much larger and thicker, it was not materially longer than the left; a circumstance explained by the unusual length of the arteria innominata, in this instance.

It was pretty evident that the tumour itself contained some fluid; but desirous to preserve its figure entire, I preferred immersing it in rectified spirit, without making any division of its substance, in which state it is, therefore, now put up." 432.

There were some other unimportant appearances in the abdomen. Let us hear what Mr. Howship has to say upon the case.

"OBSERVATIONS.-The protracted continuance of the disease in the above case presents only that character with which we are sufficiently familiar. It is not, however, common to see the trunk of the carotid artery so displaced, as to be found directly beneath the integuments of the neck, and apparently extended so as to occupy nearly half the circumference of a large tumour. But the most unusual circumstances, perhaps, are the very peculiar increase in the size and strength of that vessel, and most especially the extreme force with which it laboured to overcome the difficulties with which it had to struggle. In these last particulars, this case affords a very rare example in illustration of a principle laid down by the late Mr. HUNTER, who disposes all muscular parts to acquire increased strength and power, equivalent to any incidental difficulty or embarrassment that may arise in the performance of their functions, from the inroads of disease." 433.

Perhaps it is rare to find
Neither do we see aught
It is rather to be regretted

We do not conceive it an uncommon thing to see arteries, large or small, that supply growing tumors, become enlarged. the carotid so much affected as in this instance. very strange in the serous effusion of the brain. that Mr. Howship did not particularize the condition of the inflamed veins in the first case. On the whole, we confess that we do not derive any great information from the cases, but that may be our own misfortune or fault.

IV. CASE OF OVARIAN DISEASE, COMPLICATED WITH PREGNANCY. By Thomas Hewlett, Esq.

This is a long but extremely interesting case. We will abbreviate it as much as possible.

A lady, æt. 36, who had borne six children without difficulty, being now in her seventh month of pregnancy, sent for Mr. H. on the 25th of August last. She had pains returning at intervals. He discovered on examination

a tumour occupying the hollow of the sacrum, and allowing a little more than a finger to pass between it and the pubes; he could feel no os uteri, and there was no discharge. He drew blood, and ordered an aperient. The pains returned in three days, bore a uterine character, and were only controlled by opiates. Mr. H. was undecided, and, the constitution sympathising, Dr. Locock was called in on the 21st September.

"After a very patient and careful examination per vaginam, he thought he could reach a segment of the os uteri high up above the pubis. With regard to the swelling, we both agreed that it bore more resemblance to an ovarian tumour than what I at first thought it was, viz. a partially retroverted uterus. On passing the hand over the abdomen, the boundary of the womb could be distinctly traced; and in the left hypochondriac region, distinct from uterus, a hard unyielding substance, apparently floating in fluid, could be plainly felt. This Dr. Locock at once pronounced ovarian." 228.

The legs were œdematous. Saline purgatives, quiet, opiates, and puncturing of the legs were resorted to with relief. On the 6th October the pains returned with difficulty of voiding urine. No os uteri could be found. On the 7th, Drs. Locock and Merriman arrived. The latter reached with difficulty what he believed to be a part of the os uteri, and the extremity of the finger brought away with it a small quantity of dirty-looking secretion. He was inclined to think the case one of partial retroversion, and recommended opiates, &c. with the hope of getting the lady to her full time. The sickness was now distressing, the breathing oppressed, the lower limbs distended. The motions of the foetus ceased on the 8th. On this, the 9th, and 10th, she had a slight discharge, such as had appeared on Dr. M.'s finger; on the 12th the discharge was purulent. Examination shewed little difference. On the evening of the 11th the pains were severe; next morning they ceased, and a large discharge of liquor amnii followed, without perceptible alteration of the parts. At 10, p. m., uterine pains returned— in the morning of the 13th she had the regular grinding pains of labour— they increased till the evening-at 7, p. m., there was not the smallest alteration of the parts, no os uteri perceptible, no mobility of the tumor. At halfpast seven there was a different kind of pain-on attempting to introduce