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the opening of the artery, became dry and hard; after which the patient continued the use of the bandage for several years but these are very uncommon cases. In the present case, as the blood is stopped, you must contrive to make a sufficient compression on the thrombus, with a bolster, kept on by a steel machine, made so as to give more or less pressure according as it shall be found necessary; for if the bolster was kept on by a roller, it would be a kind of ligature, which by obstructing the course of the blood in its return to the heart, would still increase the swelling of the lower arm. As to other applications, simple dressings are fufficient.
Second Consultation on the Progress of the Disease. « The wound suppurated; but notwithstanding the compresfion I made, and continued on the thrombus, on the fourth day there happened a second hemorrhage, which fortunately I stopped with dry lint. The swelling of the lower arm has since gradually increased, and now extends above the elbow.
· The fever, which was flight, is now become more violent, and the patient feels a great numbness all over the lower arm. The thrombus continues in the same state.' What ought I to do?
Answer. The return of the hemorrhage is a certain proof that there is a considerable artery opened in the bend of the arm; and the thrombus being at the division of the brachial artery, it is there we must look for the opening, without which the hæmorrhage will frequently return, and the patient die. It will be necessary, therefore, without delay, to perform the operation for the aneurism; that is to find out the opening in the artery, and make a ligature above and below it. The external wound where the fword entered, will then be no more than a simple wound, and must be dressed accordingly.
• The swelling of the lower arm, is owing either to the plugging up of the wound to stop the bleeding, or else the compression made on the thrombus, and in all probability will go off after the operation, which I think absolutely neceflary.
• Bleeding, fomentations, or emollient cataplasms frequently repeated, and proper diet, will all contribute to remove it, and to all appearance the fever will abate when the dressings become easier. The discharge from the two wounds will be bloody a long while, on account of the coagulated blood which remains in the interstices of the muscles ; when that ceases, the wound will soon heal.
A crooked Knee. • A child two years old, who has no appearance of the zickets, nor what is called larze
*he left knee bent
inwardly, in fuch manner that when the leg is extended, it makes an angle of seventy degrees with the thigh. This occasions his turning his foot and thigh outwards when he walks. From whence proceeds chis deformity? And is it to be reinedied?
Answer, « There is no wonder that one of the legs of many children should be warped at the knee, or that even the bone itself should be crooked, from the fault of the nurses, almost always carrying them on the same arm, that they may have the freer use of that which they commonly make use of in their business. The bones of these children, being as yet soft, they easily take the turn they are given, and the joints assume it the easier, because the capsulas and ligaments that surround them, are then but feeble. And when the joints begin to bend, the weight of the body increases the bad shape of the joint daily as the child walks.
• As this disorder is contracted by degrees, fo it can only be imperceptibly removed, and it will likewise require more or less time.
. For this purpose, we must take advantage of the child's sleeping in the night, and before he goes to sleep roll his legs and thighs together, (so that he cannot move them) without too much confining them. Children fleep soundly, and this will not disturb them. The rollers fould be of the same breadth and length, as those the nurses use to swathe them with, They are to secure, in the places hereafier mentioned, three small square cushions, about the size of those on ladies toilets, filled with bran, moderately hard, so as not to hurt the epiphyses on the sides of the joints on wbich they are placed.
. The first cushion should be placed between the knees, and the second between the ancles, both secured by three or four turns of the roller. It is plain that the legs being also rolled, the cushion which is between the knees, by degrees will turn out the knee which is bent inwards; but as the cushion will act equally on the other knee, and give that a wrong turn, by pushing it outwards, this inconveniency must be prevented, by placing on the outside of the knee the third cushion, which should be fixed by feveral turns of the same roller. This third cushion supporting the knee, will prevent its being turned outwards by the cushion between the knees. I fuppose the two legs to be extended; and to hinder the child from bending the knee, which would displace the cushions, it will be necessary to place a paste-board over the knees, large enough to reach half way up the thighs and legs, and to secure it, by the last turn of the roller.
· The whole bandage must be merely retentive, to keep the three cushions in their place, and not to make the child uneasy.
• The child must walk but little in the day, for the weight of the body on the legs will make him lose what advantage he kas gained in the night.
. By there means I have known, in about a year's time, many children, who were in the abovementioned situation, recover. It is almost always the left leg, because the nurses generally carry the child in their left arm, that they may have their right at liberty?
Hyftcric convulsive Fits. ' A woman twenty-two years of age, lately become the wi. dow of an old husband, with whom she had not lived above eighteen months, is troubled with hysteric fits, that seize her pretty frequently, according as her spirits are exalted or depresled. In these fits she is deprived of her sense and knowledge, without her pulle seeming to be weaker; on the contrary, it seems ftronger than ordinary, without any intermiffion, and in these convulsions she talks at random, without knowing what the says. This has happened to her several times for this month past, and held her a full quarter of an hour. She has been bled in the foot the three last attacks, and every time it has immediately removed the fit. She has never been irregular, The fits have returned about a week ago, with the same symptoms, and come often. The patient cannot be bled every time. Is there no other method therefore to be made use of instead of the bleeding?
Answer. < The anti-hyfterics prescribed by several authors, and the manner of using them, are so well known, that I fall not mention them. I shall confine myself to making known to you what I have done in these kinds of fits, having always observed! that the imagination has more concern in them than any
fault in the Auids. The following is what I have found always fuc, ceed, and has so immediate an effect, that they have ceased almost instantaneously.
• A lady was in the abovementioned way, and having bled her in the foot, in many of these convulsive attacks, instead of bleeding her again, I applied a cupping-glass to the inside of her thighs. The fkin had hardly rose into the glass when the fie diminished, and in two or three minutes intirely ceased.
I applied the cupping-glasses in the fame manner, more than twenty times in fix months in the like attacks, and the success was every time as expeditious, till at length they entirely left her. I leave to the learned in phyfic to explain how these cures were performed without any evacuation or medicine.
• A young woman of eighteen was troubled with violent convulsive fits, of the fame kind as thofe I have mentioned. I REY, Nov. 1766.
made her put her legs in warm water to bleed her in the foot, and in an instant after, even before the vein was opened, the violence of the fit abated; nevertheless I bled her, and the fit intirely ceased. However this did not prevent her having four attacks of the same kind within a week after. The three first went off by bleeding in the foot, but upon a fourth coming on more violent than the former, I applied a cupping-glafs to the navel; the fit went off in lefs than two minutes, and she has had none since.
• It is not impossible but the constitution, together with a lively imagination, contributes a good deal to these sort of fits, or may even be the cause of them. A sudden fuppression of the caramenia, by any unforeseen accident, or only a diminution, may equally occasion them. In these last cases, bleeding in the foot is of great fervice in supplying the place of them, or promoting their return. But when it is owing to the imagination, the bleedings are not of fo much use, as we have juit before obferved. They relieve, it is true, for that instant, but bleeding so often might prejudice the constitution. The application of cupping-glafles has put a stop to them as well as bleeding, and I have made use of them so often with success, that I do not advile any other thing.'
In this manner Monf. le Dran instructs the young surgeon in the proper method of treating most of the discales which require the assistance of his art. By this method, he is not only taught how to act with regard to the patient committed to his care, but is also furnished with great variety of examples of the proper manner of relating cases to a distant furgeon, whose advice is required. Though some of our capital surgeons may, in a few inttances, have improved upon Monf. le Dran, this book may nevertheless be perused with advantage, not only by young ftudents in the art, but even by a very considerable number of those who believe themselves masters in their profession, and though we might presume, in some instances, to deviate a little from his instructions, yet, upon the whole, his principles are found, and his practice fimple and rational.
The Fool of Quality; or the History of Henry Earl of Moreland;
Vol. II. Concluded.
dom to be met with in books. In the drama we do, indeed, frequently behold very good copies ;- but though our comic writers have been tolerably successful in this way, yet authors, in general, have failed : and it is not difficult to aflign the caule. It is, their want of acquaintance with the criginal:
Some of them are men who bury themselves in their studies, where they remain, secluded from a free, open, extensive commerce with the living world. Others are unhappily deprived of this advantage, by the narrowness of their fortunes, and obscurity of their
situatians : and a third class are those scribbling coxcombs, who are mere pretenders to wit and parts which they postess only in their own fond imaginations. In respect to the forf, their colloquial writings are usually too much stiffened with academical buckram, and totally deftitute of that grace and ease which are rarely to be met with, except in the conversation and literary compositions of those to whom men, modes, manners, and characters, are intimately known, and who are familiarly acquainted with the higher walks of life. As for those of the second class, the poverty of their style and diction is generally of a piece with their indigent circumstances ;-and, in regard to the laft, we have nothing to expect from them but affectation instead of elegance, and flippancy instead of fieedom: while frivolous or frothy conceits take place of that genuinc spirit, manly sense, and liberal manner, which diftinguish the gentleman and the genius from the fop and the witling.--How far Mr. Brooke, the ingenious author of the entertaining work before us, will be distinguished from all or any of the thice classes we have pointed out, our Readers are, in some degree, enabled to judge, from the specimen we gave of his performance, in our last month's Review; where, at p. 297, we were, for want of room, obliged to break off, abruptly, in the middle of the animated conversation that passed at the countess of Maitland's : we shall now give the remainder.
• Mr. Faddle's remark on the conscientiousness of libertines, said Mr. Fenton, reminds me of Jack Wilding, a quondam acquaintance of mine. I had the story from himself; it is an adventure of which he boafted ; and the recital, in his opinion, did by no means detract from his character, as a gentleman.
Mr. Wilding was of a neighbouring country, and was eduCated by pious parents in a scrupulous observance of his duties to God and man. When they thought him confirmed in his civil and religious principles, they tent him here to study our laws in the Middle Temple; where he speedily learned that pleasure was the only good, and that the laws of nature were irreversible by any subsequent appointments. However, he piqued himself extremely on what is called the pun&tilio of honour, and would run any man through the body who should intimate that he had been guilty of an unjust or ungenerous action. • Wilding was a young fellow of parts and pleasantry, and
j a very specious appearance of virtue. A confr - merchant conceived a friendhip for him; and, Аа 2