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and as the number of representatives from each body is determined by itself, without any suggestion or restriction emanating from any other quarter, many of them have chosen large delegations, especially the popular bodies. These latter, it seems to us, if the delegates vote per capita, will not only swallow up the schools, but, to use a bull, swallow themselves too-that is, the large number appointed by a few of them in the principal cities will oul-vote all the rest. However, if wise counsels prevail so that they vote aright, and benefit accrues to the profession and the people, there will be none to complain.
The number appointed in this city, we believe, is as follows, viz:
three. Pennsylvania College,
three, Franklin College,
three. Northern Medical Association, · five. Philadelphia College of Medicine, two-in all forty-three.
CATALOGUES OF MEDICAL SCHOOLS.
Last year we collected from the Catalogues and Medical Journals published in the different sections of the United States, the number of students and graduates of the season, and published the whole in tabular form, and we are desirous of doing the same the present year. To enable us to perform this task accurately, we respectfully request of the deans or secretaries of the different institutions to forward to us their respective Catalogues as soon as published. Thus far we have received but four, viz: those of the Jefferson Medical College of Philadelphia, the University of Pennsylvania, of the University of Louisville (formerly Medical Institute,) and the Memphis Medical College of Tennessee.
From these it appears that the class of the Jefferson Medical College during the past Session numbered
493 University of Pennsylvania
412 University of Louisville
348 Memphis Medical College
NORTHERN MEDICAL ASSOCIATION OF PHILADELPHIA, In a former number we mentioned that the physicians residing in the northern part of Philadelphia, including Germantown and Frankford, were about to form themselves into a society for the promotion of science and good-fellowship; since then, we understand that an association has been regularly organized under the title of “ The Northern Medical Association of Philadelphia," and that on the 14th of January last the following gentlemen were duly elected officers for the present year:
President-Dr. Benjamin S. Janney.
The association has been judicious in the selection of gentlemen for its officers who are greatly respected in this community, and under such favourable auspices the best results must follow its organization.
RECORD OF MEDICAL SCIENCE.
Observations on the Employment of Compression in Aneurism. By
O'BRYEN BELLINGHAM, M. D., F. R. C. S. I., one of the Medical Officers of St. Vincent's Hospital.
Mode in which Nature effects the cure of Aneurism. When we consider how many writers have devoted their attention almost exclusively to the subject of aneurism, and how much talent has been engaged in illustrating its history, pathology, and treatment, it appears strange that the process which nature herself sets up for its cure should have been so much overlooked hitherto by surgeons; and although this process was daily, I may say, passing under their eyes, that ihe exact mode in which it was accomplished should have attracted but little attention, and no attempts should have been made to imitate or assist it.
In almost every case of aneurism where the disease has subsisted for some time, we find a larger or smaller amount of solid matter deposited in the sac, which is composed of the fibrine of the blood, arranged in regular concentric laminæ.
Examples of the spontaneous cure of aneurism, in which the sac is completely filled with fibrine deposited in regular concentric layers, are not very uncommon.
Again, in cases of valvular or other disease of the heart, when a considerable impediment exists to the circulation through its chambers, we know ihat the fibrine of the blood will separate from its other constituents, and form the bodies improperly iermed polypi, (which are sometimes so closely interwoven with the carnæ columnæ and chordæ tendina as to be with difficulty detached,) which by closing the orifices, or obstructing the action of the valves, not unfrequently proves the immediate cause of death.
These familiar facts all tend to prove
Ist. Thal nature herself sets up a process by which, under favourable circumstances, the cure of aneurism is effected.
2d. That the mode in which she effects this, always in internal aneurism, and frequently in external aneurism, is by ihe deposition of the fibrine from the blood in the sac of the aneurisin, until it becomes billed.
3d. That the fibrine in such cases is deposited in regular concentric laminæ, the oldest or first formed next the sac, those most recently formed nearest the centre.
4th. That a current of blood through the aneurismal sac is a necessary agent in bringing about this result.
5th. That any obstruction to the current by which its velocity and amount are diminished will accelerate the deposition of fibrine in the aneurismal sac.
6th. That once this process has commenced, if the same agents continue in operation, it will go on until the sac becomes filled, and no longer permits of the entrance of blood.
Writers upon aneurism hitherto appear to have been more intent upon solving unimportant points connected with the distinction between true and false aneurism ; or in ingenious speculations as to the comparative frequency of aneurism from dilatation of all the coats of the artery, or from rupture of the internal and middle coats, than in investigating the mode in which a spontaneous cure of the disease takes place. Indeed so little notice is taken of this process in some modern works, that one would suppose the authors were either ignorant of the facts just stated, or looked upon the phenomena as too unimportant to dwell upon.
Before proceeding further, there is a point upon which I wish to make a few remarks. In the details of the cases of aneurism treated by compression which have been published within the last three years, the writers speak of the coagulation of the contents of an aneurismal sac, or of developing a coagulum in it by pressure upon the artery at the cardiac side, as if a coagulum or clot, and the concentric laminæ of fibrine which form in aneurisms, were identical: indeed, from the loose manner of expression adopted, it is sometimes difficult to tell whether the writers are aware of the distinction between them. This is the more remarkable, because the two substances in appearance, colour, and consistence, present a remarkable contrast; the one being soft and loose, of a very dark colour, not deposited in any regular order, and composed of the red globules and fibrine of the blood ; the other being solid and firm, of a paler colour, deposited in regular concentric laminæ, and composed of fibrine alone, or with a very small proportion of the red globules. The former is commonly found in the auricles of the heart, and in the large veins which open into them, and is familiar to every body; the latier constitutes the solid matter, which, in greater or less quantity, fills the sac of old aneurisms.
It is obvious, therefore, that the mode in which these two different deposits are formed cannot be the same. To cause the deposition of fibrine in an aneurismal sac, it is essential that a stream of blood should pass through it for a period that will vary according to different circumstances; but its deposition will be promoted or encouraged by diminishing the strength of the current in the artery leading to it, and by lessening the amount of blood which passes through the sac. This, it is easy to understand, can be readily accomplished by com. pressing the artery at the cardiac side of the aneurism, and the pressure need not be so strong as to occasion very great pain to the patient.
On the other hand, to bring about the coagulation of the contents of an aneurismial sac, the blood must remain at perfect rest for a con. siderable time; if a current continues to pass through the sac, the blood in it will be replaced by another portion before there is time for its coagulation ; for although a coagulum or clot will quickly form when blood is removed from a vein, it is not so easy a matter to bring about its coagulation in an aneurismal sac in a living subject. To effect this, very considerable pressure would be necessary; the com. pression likewise, it appears to me, would require to be made upon both the cardiac and capillary side of the sac, and very near the latter; while the process will necessarily be so painful that few patients would be willing to submit to it.
It would appear then
1st. That it is not by the formation of a coagulum in the aneurismal sac that nature effects the cure of the disease, but by the deposition of the fibrine from the blood which circulates through the sac.
2d. That simply diminishing the current will not cause the coagulation of the contents of an aneurism, but it will occasion the deposition of fibrine in the sac. Proofs that Compression effects the cure of Aneurism in the same way
as nature accomplishes this object. The details of the cases previously given prove that pressure, so as completely to prevent the entrance of blood into an aneurismal sac (supposing that this could effect the coagulation of the blood, or that it could be borne by the patient,) is not necessary for the cure of aneurism; and all the facis connected with this method of treating aneurism go to prove that the consolidation of the tumour is brought about by the deposition of fibrine in the sac, not by the coagulation of the blood contained in it. Thus it has frequently been mentioned that at the commencement of the treatment, the aneurismal tumour was soft and compressible, and collapsed on pressure on the artery leading to it; but after compression had been employed for a tiine, the sac became hard and incompressible, and did not collapse when the circulation through the artery leading to it was interrupted ; proving that a deposition of fibrine had taken place, and that the process by which the sac was to be filled up bad commenced.
In two cases recently published, an abstract of which has already been given, (one of which was treated by Mr. Porter, and the other by Mr. Cusack, and where the patients, curiously enough, were both medical men,) it has been mentioned that after pressure had been employed for a time, it became so irksome that the patients refused to continue it, they resumed their ordinary habits, and commenced taking exercise. At this period the sac in both cases is stated to have become hard and incompressible, yet the aneurisms ceased to pulsate, and a cure was effected, although pressure had not been used for some time; showing that the deposition of fibrine having commenced, went on, notwithstanding that compression was discontinued.
Again, I have given an account of the appearances found in the limb of a patient the subject of popliteal aneurism, who had been under treatment by compression for some time, but who died of er sipelas before the cessation of pulsation in the aneurism, and I have stated that “the aneurismal sac was in a great measure filled with firm layers of fibrine deposited in concentric laminæ," but that "no coagulum or clot was contained in the sac."
Lastly, the very fact of the irregular inanner in which the compres. sion has been maintained in many of the cases, having been often intermitted and resumed according to the sensibility or irritability of the patient, is an additional proof that it was by the deposition of fibrine in the sac, not by the formation of a coagulum, that the cure was ultimately accomplished.*
From what I have now said, it would appear that the mode in which pressure upon the artery at the cardiac side of the aneurism effects ihe consolidation of an aneurism, and that by which nature effects this object, are identical ; in both cases the fibrine of the blood is
*I have often been compelled, much against my will, to digress, in order to correct the misrepresentations and errors contained in a History of the Cure of Popliteal Aneurism by Compression,” put forward in the shape of an "editorial article” by Mr. Wilde, in the Dublin Quarterly Journal of Medicine for August, 18 46 (which has been also reprinted separately, and distributed extensively.) In noticing this curious production for I hope the last time, I shall merely observe, that his remarks upon the mode in which compression effects the cure of aneurism will be read with surprise by every one who has seen this method employed; and cannot fail of leading to the conclusion that the writer must be utterly ignorant respecting both its theory and practice. " It is quite apparent (he says, the italics are also his own,) that its ( pressure) removal at a particular time, even for a few minutes, and allowing the flow of blood through the sac again to take place, will undo all that had been before effected!"-Vide Dub. Quart. Juur: for Aug. 1846, p. 131.