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mysteries; a change attributed to this equivocal and doubtful personage.
But we dare not enlarge farther; our limits are already trespassed upon, and we must take our leave of Mr. Gell, which we do with gratitude and respect, since he has, in a high degree, entertained and instructed us.
ART. IV. Chirurgical Institutes drawn from Practice, on the Knowledge and Treatment of Gun-shot Wounds. By H. St. John Neale, Esq. 8vo. 6s. Boards. Egerton. 1804. AT a moment when a whole nation rises in arms, indignant at the taunts and menaces of a ruffian, every thing that can rouse the spirit of the warrior, or lessen the dangers and inconveniences to which he must be necessarily exposed, will be received with particular attention and complacency. Mr. St. John Neale is not a crude theorist. He has gained knowledge on the tented field; and the dictates of matured experience will be always truly valuable. Though we would not enlist under the banners of theory alone, it is with regret that we find the experience of the practitioner by no means supported even by a due knowledge of physiology and pathology in their present improved state; that the language, after making all due allowance for numerous errors of the press, is confused, inelegant, and often incorrect. To dilate on imperfections is unpleasing, and consequently the faults of the language we shall not stop to enumerate. The following very radical error on physiology we shall select as an instance of confused reasoning and mistaken facts. Every tyro knows, that the cellular substance is a simple solid, without the slightest nervous power or irritability. Our author is speaking of the nervous agitation from the first stroke of a musket-ball: the description is animated and excellent; the theory, only, erroneous.
This agitation is technically named commotion; it happens always in the wounded member, and all those gentlemen of the profession who have seen active service in armies, must have learned from daily experience, that it is communicated to the whole machine. Hence, the whole nervous system is galled and irritated, and often thrown into strictures or tonic convulsions, not unfrequently the source of other consequences. Some of the wounded feel a general numbness, and weight; others are seized with frequent syncopes: one falls into convulsive motions, such as hiccup, vomiting, irregular shiverings, or a tonic stiffness in the whole body; while another becomes yellow, green, or of a plumbane colour, &c. It is well known, that all parts of our bodies are connected by means of a reticular substance.
This is a kind of net-work, that serves as a canvas, if I may be allowed the expression, in which all our vessels are interwoven. Notwithstanding which, in a natural state, all these fine vessels are free
enough, provided the circulation of their fluids be undisturbed. But when strictures come on, that is, when the mashes of this net-work are drawn together by a spasmodic convulsion, the vessels that creep among them are constringed, as if surrounded with a ligature. Besides, the nerves are no more exempted here than the blood vessels; hence the stream of animal spirits becomes partly intercepted, or entirely suspended. The numbness and weight sometimes felt through the whole body is almost a necessary consequence of this doctrine, if the stream of animal spirits is allowed to be the cause of sensibility and motion; hence such accidents will be proportionable to the degree of commotion. As the nervous system is under a greater degree of irritation when the wounded part is tendinous than when fleshy, so the numbness and weight will likewise be more considerable. The universal coldness, which the wounded sometimes complain of, even in a warm season, without any external cause, proceeds in the same manner from the interception of the fluids in their circulation, which cease now to move on with freedom; for natural warmth depends partly on the progressive motion of our fluids,'
Our author describes all the variety of gun-shot wounds, and his instructions for their treatment are, in general, judicious. He differs from some modern reformers, by advising, in almost every instance, a dilatation of the wound; and in the free use of the Peruvian bark. He does not recommend the opiates so freely as many contemporaries, and, in some instances, we suspected that the doses might have been enlarged with advantage. Yet our author is not, on the whole, timid in this respect: he appears to meet the exigencies with becoming energy. In violent wounds, were a warm bath a remedy of easy exhibition, we think it would be highly useful in soothing irritation.
The mystery of managing gun-shot wounds is, by no means, deep. As Mr. Neale is not always clear and discriminate in his explanation, we shall add a short view of the subject.
Our author properly observes that in the gunpowder, or the lead, there is nothing poisonous. In every instance we meet with concussion and nervous agitation, which greatly increase the symptoms of irritation, especially those that arise from the wound of a tendon or a nerve: in flesh wounds, there is a bruise, with the frequent introduction of extraneous substances; in broken bones the splinters increase not only the danger, but the probability of injuring the larger vessels. When a ball is buried among the muscles, or in the cavities, it generally happens that the orifice is smaller than the ball. The parts around are so much bruised, that their organization is destroyed, and they become portions of a dead substance that must be removed. Inflammation and suppuration therefore, after a time, supervene to separate this adhering substance, no longer a living part; and, in this step of the progress, our author feels a difficulty. When a part is thus dead, nature excites an inflammation, or the part itself, becoming putrid, may be a cause of irritation to
the neighbouring living portion. The increased impetus of the fluids must, in the earliest period of the inflammation, break through the smaller vessels, and their fluids form the source of the purulent matter. Pus certainly, as Mr. Neale contends, is not found in the blood, nor poured out from the larger arteries; and, in his process at least, it is not a secreted fluid. It therefore proceeds from the extremities of the smaller arteries, and pus unquestionably dissolves dead animal matter, so as to occasion the separation of the part thus bruised. One great inconvenience arises, in this process, from the inflammation being too violent, so as to occasion hæmorrhage and excessive suppuration. Enlarging the wound is therefore necessary, not only to facilitate the extraction of the ball, but, by a topical bleeding, to lessen undue aching. General bleeding, laxatives, and the cooling regimen, are, for the same reasons, highly proper. We shall select a specimen or two of our author's practical directions.
The wounding body may strike in a perpendicular direction. If it has bulk and velocity enough to take away part of a limb, the wound is never uniform, the bone is never broke smooth, and besides the splinters which may reach much higher than the bone, the bone may be split up a certain length. And farther, the shock may be communicated to the articulation above, and it certainly is so communicated if the wound be near that articulation. Thus its capsula and ligaments are injured. As a proof of this, let it suffice to say, that we have sometimes seen that joint dislocated by the same blow which took away the lower part of the member. When there is no luxation, the capsula and ligaments have resisted, and which they could not do without suffering a violent extension. The amputation should by all means be made above the joint; if it is performed below, we cannot expect a laudable suppuration, where the whole nervous system is in a state of convulsion, and where the ecchymosis, &c. reaches to the joint, and because the stump must soon swell, for the preceding reasons.
If patients have sometimes been observed to die some days after the operation, it is because it was performed immediately above the wound, and below the upper articulation; and because the joint has afterwards swelled, and been seized with inflammation, and the fever has come on in consequence, by which the suppuration has been stopt, the source of many other mischiefs. I have had opportunities of seeing instances where amputation was performed above the wound and below the joint, and as soon as it began to swell, those who have had boldness enough to make a second amputation, which was the sole refuge now, above the superior joint, have commonly seen patients recover, who, without this assistance, to all appearance must have perished.'
'Every contusion of the skull requires the trepan, because it must be attended, sooner or later, with a disorder of the dura mater. I
have, in a great many instances, observed this membrane suppurate, after a blow which was no more than bruising, where I had found the pericranium suppurated, and the bone sensibly discoloured. I have seen the same happen after a blow from a sword, which had only scooped out a small piece of the diploe, the inner table of the skull remaining entire, without any fracture.
In this doctrine I perfectly agree with all the great practitioners (viz.) the late professor Cleghorn, of the university of Dublin, professor Monro, of Edinburgh, Mons. Petit, &c. and affirm, that whenever a bullet grazes upon the head, so as to lay the skull bare, there ought to be no hesitation in applying the trepan; because after such strokes, we almost always have seen the dura mater suppurate at the injured part. A remarkable instance of what the author now lays down happened to the gallant general Harris (whose brilliant achievments in India, and the signal services he has rendered to the British empire, will be long remembered by his country), who, when a captain of the 5th regiment of foot in America, being warmly engaged with the enemy, was struck by a musquet ball on the left parietal bone; which grazed the bone, and made a wound and contusion, so as to lay the pericranium bare, which felt a little rough when touched with the finger. Although he was considerably stunned by the blow, he bravely continued to lead on his company to the charge for some time after, till the enemy were defeated.
Soon after this he fainted, and was carried off the field of action to the first place of accommodation. He was in a little time after plentifully bled, a soft dressing was applied to the wound, and a few drops of laudanum, and antimonial wine were taken by him in the evening.
His rest, that night, was much better than could have been expected; next day, after his bowels were opened, he was much recovered, but felt a shooting pain in the wound. On the second day the dressing was removed; a slight suppuration had commenced, and the part had no unfavourable appearance. As the general was in high health and vigor before the accident, he was again copiously bled, and attention paid to the bowels; his draught repeated at night, and the cooling regimen pursued. Things went on apparently well until the ninth day, when he became feverish, had a restless night, accompanied with other concomitant symptoms, which attend injuries of the dura mater. The trepan was now applied as soon as possible; when the dura mater was found detached and separated from the inner table of the skull, with a considerable degree of suppuration. In a few days after this, his fever, and all his other unfavourable symptoms, abated; and this distinguished officer was soon after restored to his pristine health, to the great joy of the whole British army, being universally beloved and esteemed by all who had the pleasure of his acquaintance.'
On the whole, as a practical work, this seems to be highly valuable our commendation can go no farther, and we regret that knowledge and virtue do not always assume pleasing forms.
ART. V.-History of Pleshy, in the County of Essex, the Seat of the High Constable of England. By Richard Gough, Esq. 4to. l. 11s. 6d. Boards. Nichols and Son.
WORKS in topography, when written with judgement, are justly deemed a valuable class of literary productions: they allow a latitude of investigation which regular history frequently excludes; they afford intelligence respecting particular objects of pursuit, for which it is in vain to search in other compositions; and their effect is more widely diffused than the world is, at all times, willing to allow. What is local is often national. Though, when we bring forward this remark, we do not mean that more should be expected from a local history than is strictly consistent with propriety. We do not wish those objects which should form the foreground of the picture to be seen but in perspective.
It is impossible (says Mr. Gough) to view the site of PLESHY, OF to trace its history, without entering into that of its lords; and the history of Thomas of Woodstock is a history of the first twenty years of the unfortunate reign of his nephew, and a key to the misfortunes which overwhelmed him in the two last.'
The History of Pleshy, indeed, if confined strictly to its venerable site, although the residence of our high constables of England for four centuries from the conquest, will afford but little scope either for history or fancy. It was one of the first spots, we believe, whence Mr. Gough set out on his topographical pursuits, and he has evidently traced its history with particular enthusiasm; but we cannot perceive, upon a close inspection, that it has furnished any new lights for the illustration of our national antiquities.' In the surprize of our author, that, considering how much the Romans were in Essex, their stations should be so uncertain, we readily participate: but that Pleshy, by whatever name originally designed, was no inconsiderable one,' we are not so willing to concede. The discovery of a few tesselæ of pavements or an urn, in the neighbourhood, though supported by a brick or two of Roman fabrication in the church-tower, is not sufficient evidence to warrant the assertion: particularly when the very character of the castrametation which surrounds the castle is inconsistent with the fact. In short, the local history of Pleshy occupies but a scanty portion of the work.
The monks of Ely appear to have been robbed of the manor at an early period: the high constable of England usurped it: and though his property fell a sacrifice to the conqueror's displeasure, the abbey was never reinstated in its rights. Under