OEMEROD'S CLINICAL COLLECTIONS AND OBSERVATIONS IN SURGERY.
NIS volume contains the result of Mr. Ormerod's notes and observations during nine years' attendance at St. Bartholomew's Hospital, (1835- 1844,) first as pupil, and subsequently as a medical officer. The book, as Might be expected from the standing of the author, rarely embraces gene- ral views, but facts and observations on particular points, or accounts ofsingle cases, though the particular case may often contain a larger con- clusion, which the reader can draw for himself. The facts are arranged under particular heads according to the class of injuries or disease they refer to. These heads or chapters are twenty in number ; of which four- teen are on miscellaneous subjects, and aim on syphilis.
The book is of a professional, and in the main of a technical character ; embracing the cream of an attentive observer's notes upon the most striking facts exhibited in a large hospital, during a period very much kmger than students or young practitioners usually can devote to such a course of study. It is therefore in some sort a substitute for an ex- tended "walking the hospital" ; on the one hand presenting the most remarkable cases brought together under their several heads, and so ex- baited as to throw light upon each other and to help to conclusions ; but on the other hand wanting the vivid impression which the actual thing itself produces upon the mind, however it may be encumbered by small circumstances. It is only a great literary artist that can produce by his representations a stronger impression than the reality itself, and Mr. Ormerod very properly does not aim at artistical effects. On the con- trary, he is perhaps somewhat curt and technical ; furnishing practical hints for the practical man rather than general conclusions for the physio- logical surgeon.
These remarks do not apply to the whole of the book; for where man is in any way the subject some points of general interest are sure to spring up. This is especially the case in a great hospital, where the constitu- tions of poor patients as influenced by their means and habits force them- selves upon the medical observer who does not shut his eyes. Mr. Ormerod's chapter "On certain Circumstances influencing the Convales- cence of Patients" is full of interest, for the views it opens up respecting the life of many classes of the poor in a great city : how custom (for the necessity may be doubted) forces men tolerably well off upon habits of drinking, till the constitution is so undermined that the slight- est derangement may prove fatal ; whilst poverty, exposure, and the irre- gular habits they induce, shorten the lives of the poorest. Still, "nature, a mother kind alike to all," interferes to lessen the feeling of misery by deadening sensation. We read of persons, whose case requires a great surgical operation, "so utterly broken down by want and poverty as scarcely to be sensible" of their condition. Sometimes the history of the patient's case contains a sad account of struggle and privation, borne less with patience than with submission as to an inevitable necessity—to a thing of course. In the more strictly surgical cases there are occasional notices of matters where the moral lurks under the medical. We extract a few examples of the kind we are speaking of.
DRUNKEN TRADES OF LONDON.
There are certain occupations and trades in London which are especially drunken trades, and the simple fact of a person belonging to them is a very bad prognostic (hr sickness. These persons do not, however, drink at random, or drink anything, but each particular class drink after a certain rule, follow the same habits, and present nearly the same appearance. They all come to pretty much the same end at last, but they reach it by different roads. The great beer-drixikers—draymen, coal-whippers, and watermen—work much in the open air, exercise their limbs most powerfully, and though seldom of a healthy appearance, often have the size as well as the power of the finest and healthiest countrymen. These men are especially contrasted with the great spirit- drinkers, who work in a hot close atmosphere, only employ some of their limbs, and often work at night or at late hours: such are often newspaper compositors and tailors. These are the two extremes of a class: their habits and occupations are utterlyatferent; their faults take a different turn from the same road; and the
two present a totally different appearance for a certain time.
These men are, so to speak, moderately well off; their wages are good, their oc- cupation pretty regular, and they are not the really poor. There are, however, many trades which are followed by the poor in mind and the weak in body; the wages of which are never high and often uncertain: the employment of these persons hardly (lessee day or night, exposes them to the greatest changes in wea- ther, and they often serve masters little above themselves. Amongst these are waiters at low taverns, stablemen at livery stables, and prostitutes. These drink neither beer nor spirits in the same extreme degree as the two other classes; but they drink a great deal of anything in small quantities, live on bad food, and po-
verty often presses very hard upon them. •
The stout, unhealthy drayman, who takes much of his nourishment in beer, differs often as much in sickness as in health from the pale and weakly ostler or waiter, who drinks what he can get, and works at irregular hours. The drayman is rare as a hospital patient, except for a wound onthe leg, ova fracture; and then, if his ailments are accompanied with erysipelas or delirium tremens, they are often of the most destructive and violent kind; his life sometimes being lest within a few days from the sudden prostration of his powers, by extensive sloughing of the limb, or the continuous violence of the delirium. The ostler and tavern- waiter, with others that come very near them in habits, the knacker and the nightman, are very common hospital patients, for little things, but those very hard to cure. Bad ulcers of the legs, with irregular inflammation round them, ab- ceases from slight causes, and wounds which are tardy of healing, form their chief ailments, whilst low erysipelas occurs very readily in them, and they bear no active treatment. The bad leg of this last class is sometimes very severe, and bores deeply and widely amongst the surrounding tissues. In the sore leg of a nightman the anterior tibial artery burst, and in a similar disease of a stable-man the posterior tibial artery gave way from the extension of ulceration; and in both cases the patients ultimately died. The effects of constant drinking tell by the general change on the habit and power' as well as by the production of disease; but it i extremely hard to say. what degree of drinking short of the production of disease is hurtful. That it does tell, appears to be beyond doubt; but every now and then some habitual drunk- ard resists the powers of disease in a degree equal to that of the healthiest man. These cases are, however, exceptions; and the patient by his own words sometimes announces that he considers his recovery, after such a mode of life, as contrary even to his own expectation.
RATIONALE OF THROAT-CUTTING.
Of the great number of persons who attempt to destroy life by cutting the throat, very few comparatively die immediately, although a larie number never ultimately recover. When a person attempts to destroy himself, he may divide the jugular vein, but he very rarely wounds the carotid artery; when he tries to murder another person, the carotid artery may be readily wounded. Even in the common po- sition of parts, the carotids are backwards, and deep in the neck; but with the chin elevated and the head thrown back, the carotid arteries are very backward. In the summer of 1840, a man cut his wife's throat, and then his own: in the. woman's neck one carotid artery was divided, but in his own the jugular vein alone suffered. The carotid often escapes very narrowly. A man cut his throat very severely: the carotid was not opened, but its coats were just jagged in one spot, so that blood might be seen oozing from the notch when it was accurately Sponged; the blood came only from the coats of the vessel. When a person cuts his throat, bleeding may be immediately fatal by suffocation. A man was brought in dead, with a cut throat: the jugular vein was found divided, and a clot, by falling into the larynx, had choked him. Soon afterwards another man was admitted, with a very severe cut throat: whilst the house-surgeon was clearing the coagula and tying the vessels, the man gasped, coughed, and seemed suffocated; the person assisting stuck his fingers immediately into the glottis, and pulled out a large coagulum which had tumbled into it; this relieved the man, and be lived for a day or two. There is a class of cases of suicide of the most awful description,. where the pa- tient studies beforehand the nature of the parts, and arranges his plan of self- destruction. The following is one of these, and presents some remarkable points. The house-surgeon was called up to see a man with a cut throat: he found a man seated on a bench in the ward, looking moderately easy and comfortable, with a little wound on the side of the neck, about a half an inch long, and apparently through the skin; suddenly the man seemed suffocated, fell, and died. This mart had passed in a pen-knife, which had pierced a large vessel in the neck, and then run on into the trachea. The blood had suddenly flowed into the trachea, and then he died suffocated.
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