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brief, it appeared to be merely water, containing a little volatile oil or naphtha, and was probably prepared by the distillation of water from petroleum, or some kind of tar.
I next made trial of it as a styptic. I scratched the back of the hand with a lancet till the blood flowed. The water ap. plied to the scratch rather increased the bleeding than stopt it. The following morning, in shaving, the razor inflicted a slight cut: the Acqua Binelli was again applied, and the result was the same.
These few and simple trials were made in January 1831, just after I received the water; and they of course convinced me that the thing was an imposition on the public, and deserv. ing of no farther investigation.
A short time since my attention was recalled to the subject by a medical practitioner of this island, who had studied at Naples, inviting me with others to witness the effects of a preparation made in imitation of the Acqua Binelli, and which he maintained was identical with it in composition and virtues.
The experiment he invited us to witness appeared an unobjectionable one, namely, the partial division of the carotid artery of a goat, the bleeding of which he undertook to stop by means of his Auid. He allowed us to expose the vessel and cut it across ; about one-half of the circumference of the artery was divided, and the bleeding was most profuse. He stood ready with compresses moistened with the fluid, which he instantly ap. plied one over the other, and secured them by rolling a bandage about the neck, making moderate pressure on the wounded vessel. A little oozing of blood followed, which soon ceased. He said that in three hours the bandage and compresses might be removed, without any renewal of the hemorrhage. Accordingly, at the end of three hours they were removed ; but when the last compress was raised, the bleeding broke out as furiously as at first, and, to save the life of the animal, the artery was secured by ligature. On examining the last compress, a small · coagulum of blood was found adhering to it, just the size pro
per to close the wound in the carotid ; thus accounting for the ceasing and renewal of the bleeding.
Reflecting on this result, and considering the chemical nature of the fluid employed to moisten the compresses, which appeared analogous to that of Binelli, the conclusion I arrived at was obvious, namely, that, had the compresses used been moistened merely with common water, the effect would have been the same,—the bleeding would have been stopt; and it also appeared very probable, that, had the compresses been allowed to remain undisturbed, there would have been no renewal of the bleeding
To ascertain the truth of these inferences, the following experiments were made.
On the same day, February 8th, in the presence of several medical officers, I divided partially transversely, the carotid artery of two dogs; one small and feeble, the other of moderate size and strong. In each instance, the bleeding was most profuse till compresses dipt in common water had been applied and secured by a bandage, which, as in the case of the goat already given, completely stopt the hemorrhage.
The small dog, from the proportionally large quantity of blood which it lost, was very feeble immediately, and appeared to be dying ; but it presently rallied, and for several days seemed to be doing well. It unexpectedly died on the 15th, seven days after the infliction of the wound. The bandage during this time had not been touched, and no application had been made. Now, on exposing the neck, the wound was found covered with coagulable lymph discharging pus; and, on dissecting out the artery and eighth nerve contiguous to it, a mass of coagulable lymph appeared lying over the wound in the vessel, extending about half an inch above and below it. This mass of coagulable lymph having been carefully removed, and the artery slit open, the vessel was found quite pervious,—not in the least contracted. The wound in the fibro-cellular tissue, or external coat, was closed by a minute portion of dense coagu. lable lymph. But not so in the middle and inner coat; in these there was a gaping aperture, across which, on minute inspection, two fine threads, apparently of coagulable lymph, (as if the commencement of the healing process), were observable. The cause of the dog's death was not discovered.
The other dog did not appear to suffer from the wound. The bandage and compresses were removed on the 15th February without the occurrence of any bleeding. On the 20th of the same month, the wound in the neck was nearly closed by granulations. The artery was now exposed by incision; and the portion that had been wounded taken out, between two ligatures previously applied. On careful examination of this excised part, it was found free from coagulable lymph, at least there was not the same thickening or tumour from lymph deposited, as in the former case; it was probably absorbed. When the external loose cellular tissue was dissected away, a very minute elevation, about the size of a piu's head, appeared on the site of the wound, the remains of the cicatrix externally. The artery was completely pervious, and not all contracted where it had been wounded. Slit open for internal examination, the wound in the inner coat was marked by a red line interrupted by two white spots ; there was no gaping ; the edges adhered together, excepting at
VOL. XL. No. 116.
one point; elsewhere the union was complete. The white spots resembled the natural lining membrane; and had the whole wound been similarly healed, I believe it would have been impossible to have traced it.
The general results of these experiments, (if I may be allow. ed to speak so of so small a number,) are not without interest in application to surgery. They show how a hemorrhage from the wound of a large artery, which by itself would be speedily fatal, may be easily arrested by moderate compression through the means merely of several folds of linen or cotton moistened with water; and they farther show how, under this moderate compression, the wound in the artery heals, the vessel remains pervious, and without the formation of an aneurism; and how, after a time, only slight traces of the wound are discoverable. Under this moderate pressure the healing of the wounded artery seems to be very analogous to that of a wounded vein, and apparently by means of the same natural process.
Whether similar results could be obtained, were trial made of the same means in the wounds of arteries in the human subject, can only be ascertained positively by judicious experiments. -The probability is that the results would be the same. The analogy is very complete, and some facts well known in surgery accord with it, not to mention the experience of the effects of the Acqua Binelli, as certified by men of high respectability.
It was my intention to have given a selection of the certified cases in favour of the Acqua Binelli, brought forward in the pamphlet which is furnished with the water. But on reconsidering them, it appeared a superfluous labour, as the results (giving them credit for correctness), however excellent in a curative point of view, are no more than the enlightened sur. geon of the present time may readily admit to be owing to water dressings alone, without the aid of pressure,—the majority of instances adduced being examples of gun-shot wounds and contused wounds, from which there was no profuse bleeding, and no necessity, according to the ordinary mode of surgical treatment, for securing wounded vessels.
I have laid stress on the effect of the pressure afforded by the wet compresses applied in the experiments related, believing that the virtue of the means consists in the pressure,—of course not in the water, excepting so far as it renders the compresses better fitted for adaptation to the wound to produce the degree of resistance requisite to counteract the heart's impulse in the vessel ;—and also better fitted to exclude atmospheric air. I would also lay stress on the moderate degree of pressure that is produced in the manner described, -allowing the blood to pass through the canal of the artery, and, as before observed, doing
little more than resisting the momentum of the blood in its passage from the moving source.
The importance of this moderate degree of pressure, which has the effect of reducing as much as possible the wounded artery to the condition of a wounded vein, is, if I do not deceive myself, very considerable. When I have pressed with the fingers forci. bly on the compresses applied to the wouud, expecting at the moment to arrest the bleeding, I have been disappointed. The hemorrhage has continued; and it only ceased when the compresses have been secured, and not tightly, by a roller passed round the neck of the animal. And, farther in illustration, I may remark, that I have been equally disappointed in using graduated compresses, insuring considerable pressure on the wound. This means has failed, when general moderate pressure effected by compresses about two inches long and one wide, succeeded.
On considering the comparative circumstances of these two modes of applying compression, therefore, the difference of result is perhaps what might be expected. The severe pressure can hardly arrest the bleeding except by pressing the sides of the vessel together and closing the canal, the accomplishment of which requires a most nice adaptation, and a furce which cannot easily be applied with steadiness except by mechanical means, and in situations affording firm support beneath.
Should the expectation which I have ventured to form of this method of stopping the bleeding of wounded arteries of a large size in man be realized on trial, I need not point out how very useful it may prove in military surgery,-how very available it will be in the field and in battle, especially in great actions, when, however numerous and well appointed the medical staff of an army, the number of wounds requiring attention must always exceed the means of affording adequate surgical relief, according to the plan of treating them at present in use, of suppressing hemorrhage by ligature.
I have said nothing of the boasted efficacy of the Acqua Binelli given internally. I trust it is as little necessary to make any comments on it now-a-days, as on the Tar-Water of Bishop Berkeley, so very analogous in nature and reputation. Both the one and the other in some cases may be serviceable; but their principal recommendation appears to be, that in doubtful cases they are innocent.
Malta, March 25, 1833.
Art. 11.-Contribution to Statistics of the Army, with some
Observations on Military Medical Returns. By HENRY MARSHALL, Esq. Deputy Inspector General of Army Hospitals.
No. I. THE object of this paper is twofold-Ist, to furnish a few sta tistical facts in regard to the ratio of mortality among troops in different climates or stations; and 2dly, to suggest a simple form for arranging the elements of statistical returns of corps, garrisons, or bodies of troops. The utility of statistical facts in regard to the proportion of sick, and the ratio of mortality among certain classes of people, is becoming every day more generally admitted and more highly appreciated. In civil life the requisite data for compiling exact returns of the ratio of sickness and death can seldom be obtained. Much better opportunities for drawing exact conclusions on these topics are afforded by returns of corps or divisions of troops. Military returns are extremely well calculated for deducing satisfactory conclusions respecting the comparative salubrity of different climates. The men of one corps or division of the army are similar in regard to the period of life; their food, exercise, accommodation, and habits, are also similar; so that when there is much greater mortality in one garrison than in another, the circumstance may be chiefly attributed to the influence of climate. Mr Reide was, so far as I know, the first military medical officer who published returns of the sick and mortality of the corps to which he belonged. See his “ View of the Diseases of the Army in Great Britain, America, the West Indies, and on board of King's Ships and Transports, from the beginning of the late war to the present time, together with Monthly and Annual Returns of the Sick in the 29th Regiment, and the 3d Battalion of the 60th Regiment. London, 1793.”
Mr Reide, in a chapter upon military medical returns, says “ Dr Millar was the inventor of medical returns. Those for the first year at the Westminster General Dispensary, I made up when I was his pupil from the records, which were accurately kept. As the form of these returns accounts for every case admitted on the books, and the event, I have adopted it.” . Are we to infer from the above passage, that when Mr Reide entered the service in 1776, medical officers were not required to forward returns to the head of the medical department ?
Toward the end of the year 1788, the 3d battalion of the 60th Regiment, of which corps Mr Reide was surgeon, reached the