Dr. Andrew Woods Smyth
BMJ (Clinical Research Edition)
he retired from practice and returned to his native country. He was a man of wide information, and *ook a keen interest not onlv in science, but in literature, mnsic, aud other forms of art. His name was best known to the profession by its association witlh one of the very few successful operations for the treatment of subclavian aneurysm by ligature of the innominate artery. In Treves and Hutcllinson's Manual of Operative Surgery, third edition, 1910, p. 372, it i3 sta-ted tlhat among
... lhat among twentv-four cases collected by Ashurst only two of thje patients survived. One of these was a man on whom Smyth operated in 1864. Tllis case ig-recorded in the Sydenhamt SocietY8 Biennial Retrospect, 1865-6. It is sufficiently remarkable to make the details wortlh recalling. The carotid was tied as well as the inuonominate, so as to stop the regurgitant flow of blood; notwithstanding tlhis precaution, on tlle fourteentlh day lhaeinorTlhage to syncope occurred. Haemorrllage recuirred at intervals for a period of tlhirty-seven days, and was temporarily arrested by filling the wound with shot, till, on the fifty-first day after the operation, a "terrific" haemorrhage took place, stopped by syncope. As this bleeding came from the. d-istal side and from the subclavian artery, the vertebral was tied, with perfect success; bleeding did not recur. "This fact," says Ericlhsen (Scienzce and Art of Surgery, tenth edition, 1895, Vol. II, p. 194), " is of the utmost surgical value; it shows that the secondary haemorrhage, wllich may be looked upon almost as the nece.siry sequence of the ligature of tlle innominiate artery, may be arrested and the patient's life saved by thje ligature of the principal arterial branch that comnmunicates with that and carries regurgitant blood ilnto the distal end of the artery which was originally ligatured." Tlle following is the subsequent hiistory as obtained from Smyth by Ericlhsen: " After ten years of good lhealtlh, in whiclh the patient was able to follow his employment as a ship's steward, the pulsationi returned, and thie aneurysm reaclhed a size larger than before. Thinking it miiglht be fed by the internal mnammary Smyth ligatured that vessel but without result. About six montlhs later an abscess formed over the sac and thle aneuLrysm became diffused into it, and, as a last effort to save the patient's life, the sac was laid open. Thle haemorrhage was profuse, and the openings of the vessels into the sac could not be seen, 0o that the operator had to content himself with plugging tlhe wound. Tlle patient died a few days after. The post-mortem examination slhowed that tlhe circulation had been carried on chliefly by weans of thle aortic itntercostals and branches of the axillary artery." Dr. Smytlh also made some original researches on the kidney. In a letter fromn hiis brotlher, Dr. William Woods :myth, of Maidstone, whicll was published in tlle BRITISH MEDICAL JOURNAL of September 23rd, 1911 (p. 711), it is stated that " A. W. Smyth showed that thlere was no comnmunication between the Malpighian corpuscle and the uriniferous tubules, as taught by Bowman; that there -was no filtratioln; that the water reached the tubules by tlheir own epithelial cells; that tlle glomerule was a vascular bydraulic ram, acting with suclh force as in one instance to puslh a calculus lhalf an inch in diameter. down a ureter." Dr. Snmyth was the author of two books, The Collatercal Circulation of Aneurysm" and The St-nilcture and FPunction of the Kidney. He married a grancldaugliter of tlle late Senator Botuligny of Louisiana, and leaves one daugolter, tlhe wife of tlle Rev. David Hay of Doneimana.