The head was not examined.

There cannot be a doubt that a wound of the femoral artery is always to be regarded as a dangerous, we do not by any means say fatal, accident, not merely in its primary but secondary effects. The ligature of the main arterial trunk of the lower extremity for a wound of it, is, cæteris paribus, much more to be dreaded, quoad the circulation of the limb below, than ligature of the same vessel in the same situation for aneurism. If both artery and vein be wounded, and especially if the wound be gun-shot, the danger is proportionately increased, and there are cases enough on record to prove, that the chances of gangrene of the limb are very considerable indeed. Mr. Guthrie, in his work upon gun shot wounds, a work which every surgeon should possess, has made the following observations on this subject.

"I by no means intend to assert, that the anastomosing branches of arteries are not equal to carry on the circulation in the extremities in every instance, where the main artery has been wounded, for I know the contrary; indeed, in the upper extremity it will almost invariably be effected; but in the lower, where there has been no previous disease, and the femoral or popliteal artery be divided by a musket-ball, the anastomosing branches cannot always carry on the circulation, and sphacelus will affect the toes. I think I have seen it cease at a part of the ball of the great toe, in an unsuccessful case of femoral artery tied after a gun shot wound; and I have seen it in other cases destroy the patient. If the vein accompanying the artery be injured, I believe mortification of the extremity to be inevitable; and in gun-shot wounds there is frequently more or less injury of the vein, as well as of the artery."

Mr. Hodgson remarks, that "it must be acknowledged, however, that the mortification of the limb is a more frequent occurrence after a ligature of a wounded artery than when an artery is tied for the cure of an aneurism." Mr. Samuel Cooper has been at some pains to prove, or to attempt to prove, that the fears of gangrene are unfounded, and the ligature of the principal artery of a limb as safe as in the case of aneurism. Mr. Cooper, however, might have saved himself a vast deal of valuable argumentation, for all who will peruse the cases

recorded in the fasti of surgery, will find, no matter what dicta exist to the contrary, that mortification is a too frequent sequence of such an injury and such an operation.

Of course we do not intend to assert that mortification of the limb must necessarily follow the sudden obstruction by ligature of the main arterial trunk, for we know full well that such is not the case, in the upper extremity especially. What we mean to say is this, that, consideratis considerandis, the chances of such occurrence in such particular circumstances are considerable, and when the artery and vein of the lower extremity are wounded, we do believe that Mr. Guthrie is right in his principle, and that death of the limb will, in all probability, follow. Holding these opinions, we were little surprised at the termination of the present case, which goes as far as one case can go to support and to confirm them. We are disposed, however, to think, that something depends on the kind of injury, as well as on the mere obstruction of the vessels. It appears to us that a wound from gun-shot which lacerates and bruises the neighbouring parts, as well as implicates the artery and vein, is even more certain to produce mortification than a clean, small puncture or stab in the vessels. In the latter case you have only the deficient circulation to deal with, in the former, the inflammation or sloughing in addition, which follow a lacerated wound. In conclusion, then, we would remark on the subject of mortification, that it frequently takes place after wound and ligature of the femoral artery only, and almost always when the vein and artery both have been transfixed. We have said almost always, for a case has been recorded by the Editor of this Journal of wound of these vessels in the sheath of the triceps by a knife, which occurred in one of His Majesty's ships at Spithead, when the artery was tied above the wound, and gangrene did not ensue.* It is possible that other similar cases have occurred, for every one knows the uncertainties of surgery as

*As the case is short, and one of great rarity, we are tempted to extract it entire from the ninth volume of the New Medical and Physical Journal, in which it was detailed.

well as of physic, but whether they have or not, there are instances enough on the other side of the question to prove to every unprejudiced man, that these must be viewed as the exceptions, the supervention of mortification as the rule.

As for the operation performed in the present instance, it is generally, we believe, conceded amongst surgeons, that wounds of large arteries are not to be treated like an

eurismal affections of the same trunks by a ligature at a greater or less distance from the spot, but the vessel is to be tied above and below. We believe that this is the general opinion, but we know that it is not the universal one, and that some whom we highly respect for their station and acquirements are quite of a different way of thinking on the subject. This, however, is a ques

"Wound of the Femoral Artery, Femoral Vein and Crural Nerve.-(Communicated by Dr. Johnson.)-A young man belonging to a transport at Spithead, received a wound in the thigh, a few days ago, by a large knife, which entering the limb crosswise, divided the femoral artery, vein, and, it was supposed, the nerve, at the point where the femoral artery penetrates the triceps in its passage to the ham. There was no medical assistance in the vessel, and a tremendous hæmorrhage reduced the unfortunate sufferer, in a few minutes, to the verge of death. Deliquium animi, however, suppressed for a time the effusion of blood, and a young assistant Surgeon from a gun-brig, the Teazer, (Mr. Lawrence M'Kay, a promising young gentleman,) that lay near the transport, arrived just soon enough to apply a tourniquet, as the reviving spark was giving rise to a second hæmorrhage which would have instantaneously proved fatal!In this state he was conveyed to the Royal Hospital at Haslar, where the steps that were to taken required a discrimination that might be considered necessary or difficult by a great number of Surgeons, though the case involved very nice points of practice, and was calculated to give birth to much bad surgery, among unreflecting operators.

"From the site of the wound, and the dislocation (if the term be allowed) of relative situation in the parts wounded, it was found to be impracticable, or at least extremely difficult, to secure the vessels at the point where they were severed; and the tourniquet was placed on the spot where the artery is usually taken up in the operations for popliteal aneurism. The young man was scarcely alive, from the profuse loss of blood; and the great object was now, to secure the vessels without losing a single drop, if possible, of the vital fluid.

"If another tourniqnet were applied high up, while the present one was slacked off, and the artery secured in the common place, all the blood between the two tourniquets must be lost; and a few ounces might now decide the fate of the patient. If the ar

tery were pressed as it passes over the os pubis, till the operation were performed, it would be still worse, for the posterior iliac would supply blood to the wounded femoral vein, and occasion much hæmorrhage. What then was to be done?-Another tourniquet was applied with a proper pad and compress, on and somewhat above the wound; so as to compress that end of the artery which poured the blood from above, and that end of the vein which poured the blood from below. The original tourniquet was then taken off, the artery laid bare, and tied with a single ligature. The tourniquet on the wound was then removed, leaving just compression enough, by bandage, to prevent effusion from the femoral vein, but not so much as to obstruct the circulation of the venous blood through the other channels of communication with the body, nor the arterial through the branches of the profunda, &c. &c. in its way to nourish the leg. A very slight oozing from the wound took place the first night, since which, every thing went on well, and he is now recovered.

"We thus see that the above Case was an extremely interesting one, and capable of exciting many useful reflections. It may be remarked, that this is the second instance, within these few weeks, where a single ligature was applied to the trunk of the femoral artery with success.

tion which cannot be decided by the experience, however great, or the sentiments, however entitled to our regard, of any single individual, and we do conceive that the operation of aneurism, when applied to wounded arteries, has been found in the practice of the many and in the long run, inappropriate and perilous. All our best writers on surgery condemn it, and facts, established facts, which are worth whole bushels of argument, condemn it also.

On this account we fancy that Mr. Keate's having tied the artery above and below the puncture in its coats, will not be objected to by the majority of surgeons. Probably, however, this may not be the case with the ligature on the vein. It may, perhaps, be said that compression would have stopped the hemorrhage from that, and so in fact it might, for any thing we know, or that any body else can know to the contrary. This, however, we will say, that we saw the operation, we witnessed the bleeding, and sorry indeed we should have been to have trusted that patient, exhausted as he was, without a ligature on his femoral vein, or to have irritated and fretted such a wound by continued compression, Were the accident to occur to ourselves to-morrow, and the vein to bleed as it bled that night, we would certainly entreat the operator to place a ligature upon it. Such a proceeding, if it have an injurious effect at all, must have it by exciting inflammation in the tube-by producing phlebitis. In the present case, no such phlebitis ensued, and the cases we have witnessed lead us to conclude that the deepseated veins are not so liable to inflame as the cutaneous, either after injuries or opera

tions. The application of the ligature, which on the saphena would be fatal, may be used with comparative impunity to the femoral, deep in the thigh. Every one must have noticed how frequently veins are secured on the surface of stumps, and yet how rarely this is followed by any bad effects.

The double ligature on the vein, in this instance, was perhaps not absolutely necessary; but if mischief was to follow the tying of the vein, it would equally result from one thread as from two; and besides, in an operation of this kind, things are often done on the spur of the moment which might not be attempted if the surgeon had leisure to arrange every step with precision beforehand. It is a very different thing to criticise at one's ease, and perform an operation in the midst of blood, and hurry, and confusion.

The symptoms which the patient presented, up to the last day, were those of the most marked irritation which we ever remember to have witnessed. These are the cases which perplex in practice; where we fear to stimulate and dare not deplete. Towards the last, the irritative fever gave way to that of a typhoid stamp, evinced by black tongue, delirium, and hæmorrhage from the nose. These phenomena, we suppose, were symptomatic of the gangrene invading the limb; but certainly any one looking at the man would have thought that he was dying of a putrid fever.

The case altogether is one of such interest, that we trust the length at which we have related it will not be considered by our readers an unpardonable offence.

1. Comments on Corpulency, Lineaments of Leanness, Mems on Diet and Dietetics. By WILLIAM WADD, Esq. F. L. S. Surgeon extraordinary to the King, &c. 8vo. pp. 170. Christmas, 1828.

2. On Aneurism, and its Cure, by a New Operation. Dedicated by permission to the King By JAMES WARDROP, Surgeon to His Majesty. 8vo. pp. 120, with numerous Plates. 1829.

Coroners, and Jurymen. By J. S. FORSYTH, Surgeon, &c. 12mo. pp. 600. London,

1829.

5. Traité Elementaire de l'Art des Accouchemens, ou Principes de Toxiologie, et d'Embryologie. Par ALF. A. M. VELPEAU, D.M.P. &c. &c. &c. Tomes 2. 8vo. pp. 962, à Paris, chez J. B. Bailliere, 1829.

6. The Medical Calendar; or, Student's Guide to the Medical Schools in Edinburgh, London, Dublin, Paris, Oxford, Cambridge, Glasgow, Aberdeen, and St. Andrews; together with the Regulations of the Public Boards, and Conditions of Admission into the Medical Corporations in Great Britain and Ireland. 8vo. pp. 220. 4s. Ed. 1829.

7. A Letter to the Rt. Honourable the Secretary of State for the Home Department, containing Remarks on the Report of the Select Committee of the House of Commons on Anatomy, and pointing out the means by which the Science may be cultivated with advantage and safety to the public. By G. J. GUTHRIE, F R. S. &c. &c. &c. 8vo. stitched, pp. 36. Sams, London, 1829. Price One Shilling.

8. Analytic Physiology, treating of the Cure of Nervous Diseases, by External Applications to the Spine. By SAM. HOOD, M. D., A. B. Second Edition, with an Appendix. 8vo. pp. 207, London, 1829.

9. A New System of Treating the Human Teeth; Explaining the Causes which lead to their Decay, and the most Approved Methods of Preserving them; with Copious and Explanatory Notes, to which is added some account of a Discovery made by the Author for the Cure of Tooth-Ache and Tic Douloureux, &c. By J. PATERSON CLARK, M. A. Dentist. 8vo. pp. 163, London, 1829.

10. The Influence of Physical Education in Producing and Confirming in Females, Deformity of the Spine. By E. W. DUFFIN, Surgeon. 8vo. pp. 135, London, 1829.

11. Traite d'Anatomie Pathologique. Par J. F. LOBSTEIN, Professor de Clinique interne et d'Anatomie Pathologique à la Faculté de Medecine de Strasbourg. Directeur de son Musee Anatomique, &c. &c. a Paris. 8vo. pp. 568. 1829.

Avec, six Planches Colorisees, en folio.

12. A Manual for the Use of Students preparing for Examination at Apothecaries'

15. A Treatise on Diseases of the Chest, and on Mediate Auscultation. By R. T. H. LAENNEC, M. D. &c. &c. &c. Translated from the latest French edition, with Notes, and a Sketch of the Author's Life, by John Forbes, M. D. &c. 8vo. pp. 734. Third Edition revised, with Additional Notes. Underwoods', 1829.

16. A Series of Tables, exhibiting the Results of Disease in the different European Regiments serving under the Madras Presidency, &c. &c. 8vo. pp. 482. Madras. 1828.

17. A Treatise on Obstructed and Inflamed Hernia; and on Mechanical Obstructions of the Bowels Internally, and also an Appendix, containing a brief statement of Cause of Difference in size between the Male and Female Bladder. By HENRY STEPHENS, M.R.C.S. 8vo. pp. 191, London, 1829.

18. An Essay on the Use of Nitrate of Silver, in the Cure of Inflammation, Wounds. and Ulcers. By JOHN HIGGINBOTTOM, &c. Second Edition enlarged and improved. 8vo. pp. 204, 1829.

19. A Manual of the Science and Art of midwifery, &c. &c. By MICHAEL RYAN, M. D. &c &c.

Dr. Ryan's Manual evinces considerable research, acuteness of observation and talent. Fault may be found with the manner rather than with the matter of the work.

20. Elements of Pathology and Practice of Physic. By JOHN MACKINTOSH, M. D. Acting Surgeon to the Ordnance in North Britain &c. &c. &c. Vol. I. 8vo. pp. 484, Edinburgh and London. 1828.

DR. HENNEN, the subject of the following biographical sketch, was born in 1779, at Castlebar, in the County of Mayo, Ireland, where his father followed the profession of a surgeon, and was a man of considerable professional, as well as general attainments. He commenced his chirurgical studies under his father, and completed his medical education at Edinburgh, at which place, very early in life, and before entering into the army, he married a Miss Malcolm. In 1800, he accompanied the memorable expedition destined for Egypt, under the command of General Sir Ralph Abercrombie, being then assistant-surgeon in the 40th Regiment of Foot. This corps, however, having been detained at Malta, on its way to Egypt, Mr. Hennen continued to serve with it until its return to England. Some time after this, he was promoted to be surgeon of the 7th Garrison Battalion, then quartered in Ireland, and was afterwards removed to the 2d battalion of the 30th foot. With this corps he went to Gibraltar, and, subsequently, to Portugal; in which latter country, in consequence of recent and extraordinary political events in Spain, there was about to commence the first scene of a most sanguinary and protracted contest between the mighty powers of France and Britain, for the liberation of Continental Europe. Here an ample field was opened to him, and an opportunity afforded for the display and improvement of those qualities and energies, mental and bodily, for which he was afterwards conspicuous, and which failed not in the course of this arduous campaign to attract the notice of Dr. Macgrigor, then at the head of the medical staff in the Peninsula, and now the Director General, a situation which he fills with no less honour to himself than with advantage to the service. Mr. Hennen continued to serve throughout this long and varied war; never failing to profit by every occasion which presented itself to him, of adding to his practical knowledge, more particularly in that branch which afterwards formed the subject of his principal work, viz. military surgery in the mean time, his appointment to the rank of a staff surgeon, and to the medical charge of a division of the army, gave him more extensive facilities for prosecuting this favourite object. In the short peace of 1814, having been placed upon the half-pay, he settled in practice at Dumfries in Scotland. In the following year, the return of Napoleon from Elba to France, having occasioned the assembling VOL. X. No. 20.

of a British army in Belgium, he was called from his retirement, and ordered to Brussels by his friend and patron Sir James M'Grigor, who had recently been elevated to the office of Director General. It may be perhaps deemed superfluous to say that, in this short, though momentous campaign, Mr. Hennen's indefatigable zeal and exertions were always as manifest as his skill and experience were found beneficial, particularly in his attention to the wounded officers and men after the actions which closed with the far-famed and decisive battle of Waterloo. Soon after these operations, viz. in September following, he was promoted to the rank of a Deputy Inspec tor of Hospitals; and, upon the breaking up of the medical establishments in the Netherlands, he was placed upon the staff at Portsmouth, in February, 1816. The period of comparative repose which now ensued, enabled him to select, and to more seriously prepare the materials for his publication, entituled, "Principles of Military Surgery," a work which he had for some time contemplated, but which he did not complete and publish, until after his removal to Edinburgh, which took place in October, 1818. While stationed at that place, unrivalled as a medical school, he diligently attended the lectures and hospitals, at the same time that he cultivated the friendship of the professors of that university; to several of whom he publicly acknowledges the friendly assistance he received, while preparing the second edition of his work on Military Surgery, published in the year 1825. In August, 1820, he took his degree as Doctor of Medicine at Edinburgh, and, shortly after this, he gave a private course of lectures on military surgery, previously to his quitting the Scottish metropolis for service in the Mediterranean. Here the sphere of his duties was materially extended. He superintended the medical department in that quarter; first, at Malta, till April, 1825; afterwards at Corfu; and, at the close of the same year, he was removed to Gibraltar, where he continued to serve till the 3d of November, 1828, on which day he unfortunately fell a victim to the fatal epidemic, then raging at that place, after a service of twenty-nine years, during the greater part of which time he was employed on active professional duties. It appears that, for two months before his death, his public labours, both night and day, had been prodigious, and greatly beyond his strength : his mind likewise had been exceedingly