1885 The Lancet  
12 heart was normal ; no albumen in the urine, of which he passed about a pint and a half a day; but feet and ankles were slightly swollen. The bowels acted daily, motions formed, no blood. Tongue furred; mouth not aphthous. The abdomen was slightly prominent, but soft, not tender, and was resonant down the left side. He did not complain of pain or discomfort after food, or any other signs of dyspepsia. Mucous membranes of eyelids and lips were pale. The patient said he took his food well and
more » ... joyed his meals. His habits appeared to be to have a cup of tea and a piece of toast about 6 A.M., a couple of fried eggs or some fish at 11, and to dine at 6 P.M. off a chop or steak. He did not like milk and did not take much of it. Sometimes he would take a glass or two of port. The friends thought there was very little hope for the patient, and, to use their own expression, wanted to know if we could "patch him up for a few weeks." Considering that the patient was so anaemic, but still had a considerable amount of vitality in him that he could take his food so well and was not being exhausted by night, sweats, I suggested transfusion. The patient was willing to try anything, and his wife offered to give the blood. The next day (May 15th), having procured an Aveling, with the assistance of Mr. De Gruyther and a sister of the patient I transfused about two ounces directly from a vein in the wife's arm to a vein in the patient's arm. During the process the patient exclaimed, "I feel so hot ; open the door." The wife rather complicated matters by vomiting during the transfusion, and was rather faint afterwards ; but the patient was in no way worse, and said he should be ready for his dinner at the usual time. On the 16th 11 xlr. De Gruyther reported: "Patient is better to-day; his pulse seems to me to be improved, and is 120; he himself feels better." On the 19th I saw the patient, and found his pulse 128, but much less easily stopped than on the 14th. He had taken his food as usual, and said he felt stronger. He further said that on the 17th he had got out of bed and had walked across the room to an arm-chair without assistance, a thing he had not been able to do for a fortnight. The wounds in both cases looked well, and there were no signs of inflammation or tenderness over the course of the veins. On the 21st Mr. De Gruyther again reported: "Our patient is progressing very favourably; his pulse was about 120 to-day and firm ; he walks without aid." On the 22nd, one week after transfusion, I saw the patient. I found him sitting in an arm-chair, having moved into the next room. He had walked from one room to the other without assistance. He looked much happier; the pulse was stronger and 128. He said he felt stronger, and that he was sure he should be better if he could only get some sleep, that he had hardly had any sleep from 9 P.M. till 5 A.M. the previous night on account of his cough. The patient's wound was almost well, the one in the wife's arm showed a small slough. On the 25th Mr. De Gruyther wrote: " Our patient had a weak pulse of 116 yesterday, and he himself felt weaker. He says he had a better night on Friday (May 23rd) after inhaling five minims of eucalyptus oil in a metal respirator. The slough from the wife's arm has not come away." On the 26th Mr. De Gruyther wrote: " Our patient is not so well to-day." May 28th.—Thirteen days after transfusion I saw the patient. I found him setting on a couch in a room next his bedroom ; he had walked there with difficulty, and with assistance. His expression was much more anxious; his pulse was 130, and very easily stopped; his appetite was very bad, and he could only take liquid nourishment, such as egg and milk or beef-tea. He had lately discovered that he could take milk. His ankles were swollen. I found that on Friday, the 23rd, lie had walked by himself with ease down the passage of his house out into a small garden or yard at the back and had sat in the sun for some hours, and had thoroughly enjoyed it, and that he had slept better that night. On Saturday, the 24th, he had done the same thing again, but had walked with even greater ease, and had felt still stronger. Sunday, the 25th, was a cold day, and he did not go out. On Monday, the 26th, he had not felt so well; on Tuesday, the 27tb, he had felt worse, and on Wednesday, the 28th, he had gone back considerably. The cough was still the great trouble, it prevented his resting; but the amount of sputum was considerably less than when first seen, and there bad been no sign of blood in it since the transfusion. The wife complained of pain in her arm, the slouch had come away, the wound was healthy and healing, but there was tenderness along the course of the median vein, and the vein was thickened and cordlike. On May 30th Mr. De Gruyther wrote : " Yesterday our patient was a good deal weaker ; he took a fair amount of nourishment, and had better rest at night." June 3rd.-I saw the patient, and found him on the couch ; pulse stronger, 120. lie would take no medicine of any kind ; he looked happier again; his appetite was better, and he fully intended to go out into the garden again as soon as practicable. June 12th.-The patient had been out in the garden several'times since June 3rd, but he had gone back. Pulse 120, weak and small. Both legs were much swollen and cedematous. The abdomen measured thirty-one inches and a half; it was tense and full of fluid. Very little albumen in urine, but some dyspnoe at times. A day or two after this date the patient was taken in a cab to the German Hospital, where he remained until July 27th, when he died. I have not been able to hear whether there was a post-mortem or not, but I think it is most probable that it was not allowed. Nulla autem est alia pro certo noscendi via, nisi quamplurimas at morborum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Morb. , lib. iv. Proœmium. ' FOR the following notes we are indebted to Mr. R. Ma.rgerison, surgical registrar. John D--, aged twenty-four, received in May last a blow on the right buttock from the buffer of a locomotive. When admitted soon afterwards into St. George's Hospital, the buttock presented near its most prominent part a contused and lacerated wound large enough to admit a finger. Out of the wound dark blood oozed very freely. The soft parts were very extensively undermined, and beneath them was a large and increasing collection of blood. This blood collection did not pulsate and no bruit was audible. A pad was firmly bandaged over the buttock for three hours. In this interval the collection of blood had greatly increased, and when the pad was removed large quantities escaped. Ether was then administered and the right iliac artery compressed with Davy's lever. When once introduced far enough, this instrument acted perfectly. Mr. Haward enlarged the wound to a length of some six inches. The gluteal muscles were found to be torn across, and beneath them existed a large cavity full of blood. This was quickly turned out, bringing into view the sciatic notch and the open mouth of the gluteal artery. This and a great many other muscular vessels were secured with catgut ligatures. No blood was lost during the operation and the, man's recovery was uninterrupted. The case shows well the value of the lever, and in connexion with this subject of compression of the large vessels of the abdomen it seems well to mention a case of amputation at the hip-joint for sarcomatous disease, which also occurred in Mr. Haward's practice. Here the abdominal aorta was very effectually controlled by a contrivance more or less like that suggested by Sir Joseph Lister. The blunted apex of a py ramidal piece of wood was fixed over the abdominal aorta by an elastic bandage. The apex of the pyramid was about one inch square and covered with felt. The base measured about three inches square and presented instead of a plane surface a broad and shallow groove. The elastic bandage passed round the pelvis and along this groove. When fixed it was placed in the charge of an assistant, who, grasping the wood with both hand.-, could very easily and
doi:10.1016/s0140-6736(02)22155-8 fatcat:r6otf42kbzgbdlkoxegc6v762y