J&. Jis&*&.

"**-

MEMOIRS
OF

MILITARY SURGERY,
AND

CAMPAIGNS
OF THE FRENCH ARMIES,
ON THE RHINE, IN CORSICA, CATALONIA, EGYPT. AND SYRIA;
AT BOULOGNE, ULM, AND AUSTERXITZ; IN SAXONY,
PRUSSIA, POLAND, SPAIN, AND AUSTRIA.

FROM THE FRENCH OF

D.

Jj^ARREY,

M.

Guards, Inspector-general of the Medical Staff of

B iron of the Empire, Commandant of the
Legion of Honour, Kniht of the order of the Iron Crown,
&c. &c. &c.

First Surireon of the Imperial

the Fr.nch Armies, 4tc

BY RICHARD WILLMOTT HALL,

D.,

FROFESSOUR OF MIDWIFERY AND OF THE DISEASES OF WOMEN

AND CHILDREN IN THE UNIVERSITY OF MARYLAND.

With Notes by

the Translator.

FIRST AMERICAN PROM THE SECOND PARIS EDITION.

VOL.

/v

II.

BALTIMORE:
PUBLISHED BY JOSEPH GUSHING,
1814.

6,

N^.GtH V,

NORTH HOWARD STREET

FROM THE UNIVERSITY PRESS

of Sergeant Hall,

134 BALTIMORE STREET.

CONTENTS
OF THE

SECOND VOLUME

CAMPAIGNS

of Vim, Austerlitz, and Jena, con-

tinued,

Further observations on the hospital fever,

Removal of the wounded guards,

Page

#>

Peace of Presburg,
Essay on aneurism,

On

the spontaneous causes of arterial haemorrhage,

Cases in which haemorrhage occurred

Of

27

33

and osse-

the effects of rheumatism on the fibrous

38

ous systems,
Cases of rheumatism, in ivhich

certain means were

43

advantageously used,

Essay on moveable and preternatural

the joints,

Cases and operations,

Essay on cerebral

...

epilepsy f

cartilages of
'
-

65
68

CONTENTS
Memoir on amputation,

Of primitive

Of

....
....

amputation,

cases which require immediate amputation,

Of consecutive amputation,
When consecutive amputation is required,
In ivha* cases attempts should be

to

though amputation appears

the limb,

cated,

made

78

79
-

81

102
110

preserve

<,o

be indi-

and has been advised by authors,

113

CAMPAIGNS IN SAXONY AND PRUSSIA.

Hostile

movements of the Prussians and Saxons,

121

122

Battle of Jena,

Entrance of the grand army

Saxony and

into

124

Prussia,

125
Surrender of ihe Prussian fortresses,
Cases of asphyxia, produced among our troops by

-..-_.

carbonick gas,

127

CAMPAIGN IN POLAND
Entrance of

the

French army

Prussian Po-

into

132

land,

Entrance of

the

French

Affair of Golomin,

into
-

Advan>ug

Arrival a*

Warsaw,

Posen,
-

of the flying ambulances,

ib.

134

135
ib.

Surgical cases,

136

....

endemick diseases of Poland,

French army,

iry into the

March of
tir

the.

at Iloff,

....

139
14,0
il,.

CONTENTS.

,142

Battle of Eylau,

Disadvantages under which the wounded soldiers

143

laboured,

Removal

of the

wounded

to

Inowraclaw,

145

Observations on the advantages resulting from such

a measure,

Surgical cases and operations,

Memoir on

the dry

...
-

146

149

gangrene produced by frost, or

gangrene from congelation,

Head-quart rs removed to Finkenstein,

Battle of Heiisberg,

Operations after ihe

battle,

156

165

168

...

Amputations through the condyles of the

167

170

tibia,

171

Battle of Friedland,

Suspension of arms, and interview of the emperours on ihe Niemen,

1^2

Observations on Koningsburg,

Account of the mode of procuring amber, &c.

diseases which prevailed here,

Memoir on

the Plica,

173

175

-----

179
178

FIRST CAMPAIGN IN SPAIN.

Remarks on

the

Beam,

former provinces of Bigorre and

1"

Observations relative

to the cities Tolosa,

Miranda,
13

and Burgos,

195
Account of a bull fight in the latter city,
Arrival at Madrid, and regulation of the medical
19S
.
.
.
.
stuff,

199
Remarks on the city of Math id,
Memoir on trdumahek gangrene, or gangrene pro-

duced by wounds,

-205

CONTENTS.
Cases of

gangrene,

this

216

Memoir on the colick of Madrid,

Memoir on a particular malignant fever,
Report of the state of the hospitals at Madrid,

Remarks on
Bonaparte

two

the

Castiles,

Summa

Sierra,

250
262

and their inhabitants,

-

arrives at Vittoria,

and return

SECOND CAMPAIGN IN
Battle of

223/

to

SPAIN.

273

Madrid,

Capitulation of Madrid,
The French army passes the Gaudarrama,

274

ib.

276

Battle of Benevcnto,

Surgical cases and operations,

Means

adopted to prevent the spreading

gious disease

among

265
269

the troops,

Cure of paralysis by moxa,

The imperial guard returns

to

Paris,

277

of a conta-

285

286
287

CAMPAIGN IN AUSTRIA

Entrance of

march

to

the

French army

Germany, and

into

289

Vienna,

Capitulation of this city

The army crosses the Danube,

Battle of Esiingen,
Surgical remarks and operations,

Of

290
ib.
ib.

291

the application of the actual cautery, in cases

301

of tetanus,

Wounds of

the

head and face,

309

CONTENTS.
Particular ivcrunds of the head and face, with
cases,

Of

313

contused wounds of the abdomen, caused by

323

balls,

Wounds of the urinary organs,

Preparation for crossing the Danube,

to attack the

enemy,
Battle of

331

Wagram,

Amputation at

Amputation

332

the hip-joint,

at the shoulder -joint,

Observations

at the articulations,

Amputation of the thigh, SfC,

Of amputating the leg through

and

333

335

on the advantages of amputating

Cases of such ampidations,

tibia,

328

340

341

350

the condyles

of the

......

the

rating,

advantages of

Particular cases of injury by

this

mode of

balls,

ope-

356
.363

hostilities, and conclusion of peace,

365
Vienna evacuated by the French troops, and their
return to France,
366
Memoir on hydrocele,
367

Cessation of

Remarks on

the operation for fishda in ano,

372
Case of a watery tumour of the scrotum,
376
Essay on the extirpation of scirrhous and cance-

rous

378

testes,

Particular cases,

Particular cases of hernia,

Of

....

complicated wounds of the abdomen,

Memoir on

the consequences of the operation

empyema, with

cases, operations,

382

383
387

for
and remarks,
888

ERRATUM.
In the case of Mr. Williams, Vol.

2,

page 84,

it was stated that "the abodominal aorta" 'was

wounded and tied. A letter from Dr. Gibson in-

forms us, that

it

was the "

left

aliaca

Communis."

CAMPAIGNS
AT BOULOGNE, ULM, AND AUSTERLITZ
CONTINUED.

p<y*^/^*y<5y<y*a*

PT1HE

symptoms of

among

-*-

the hospital fever that prevailed

our troops in this campaign, varied in their

character and appearance.

In proportion as the adynamick affection predominated, and

to

it,

showed

itself

with the expressions belonging

so also did the ataxick

particular character.

symptoms assume

Wounds

their

own

of the articulations, frac-

tures of the limbs, injuries of the walls of the great cavities,

and haemorrhages most generally produced adyna-

mia, which showed

itself

by nausea, vomiting,

hie

cough, pains of the intestines, disorder of the alvine functions,

quickness and weakness of the pulse

rhal affection of the lungs,

and a greater or

by a
less

catar-

change

of countenance. Internal heat, thirst, fever, and anxiety,

succeeded almost immediately, and at the same time the

moist gangrene, or hospital sphacelus took place in the

Vol.

ii.

MEMOIRS,

wounds. The rapidity of the

&C

latter

depended on the age

or irritability of the patient.

Wounds

of the head, or

were complicated with

any other part of the body,

ataxia,

when

a metastasis of the

putrid or noxious principles of the purulent discharge

affected the brain,

from the inconsiderate use of

spiritu

ous liquors, stypticks,and astringent or cold applications,

such as brandy, decoction of chincona, vinegar or oxy

crat. Yet these articles are recommended by some practitioners.

The

ataxia

ushered in in these cases by cc

is

phalalgia, partial or general paralysis, involuntary evacu

ations, incontinence of urine, loss of perception,

and an

alteration of the senses, except that of hearing,

which

appears to partake of organick

destroyed, the prognosis

is

life:

for

when

this is only

less imfavourable,

and there

more hope, as adynamia alone remains. Finally, deli

riumand drowsiness succeed, and if they be not immediately checked by the proper remedies, the patient soon

is

dies.

Such

may

is

between two

the difference

which

affections

appear at the same time, by the concurrence of the

spontaneous causes of which

those which are external

we have

spoken, with

such as improper temperature,

unwholesome character of the winds, unhealthful

tions ,and baddiet.lt

is

situa-

the union of these causes that pro-

duces the hospital or jail fever, described under different

names by the ancient

nosologists,

and known

in

mo

name of adynamico-atax
epidemick of Brunncamc on with

dern nomenclatures, under the

ick fevers.

When

the

the complicated character that I have described in the

first

part of

its

history,

which was generally the case,

it

often proved fatal in the third or fourth paroxysm.

This epidemick rarely appeared among the wounded

guards who were placed in the hospital la Charite, which

was

distant

from the other

hospitals,

and from the popu

CAMPAIGNS AT BOULOGNE, &C.

lous parts of the city.

and kept perfectly

the sick

was

by the proper

officers,

soldiers of our flying ambulances, so that

lost in that hospital

sick.

was well lighted, well aired,

The personal attendance on

diligently discharged

and the infirm

we

It

clean.

but few of the

Mr. Charamond, the commissary,

wounded

or the

suffered a severe

attack of this disease in our hospital, but he contracted

it

by having frequent communication with the Russian

prisoners and the sick of the line, while discharging the

painful duties of his commission.

Finally, our sick

their security to the benefits of suitable

dical

and

moval

surgical assistance,

and

to another hospital at

prepared for them.

owed

and prompt

me

to their successive re-

Vienna, which had been

This exercise, timely operations,

good dressings, the use of good wine and bark, contribu-

much to their cure.

The causes of this epidemick may be referred

ted

to

the fa

and privations which the troops of both nations had

undergone to the severity and vicissitudes of the sea-

tigue

crowding together the prisoners, the woundto the bad diet, and

son

ed,

and the sick of both armies

to the

confinement after the most fatiguing and rapid

their

marches.

The

was unfavourable when ataxia predowounds were near the internal orarticulations, and when the subject was

prognosis

minated,

when

gans, or large

young and

the

irritable.

remarked

that soldiers

who had

passed the adult age, withstood the effects of this disease

best.

Its progress

was slower and

adynamia predominated
it

less

at intervals,

dangerous,

when

and especially when

was not attended with frequent paroxysms.

The indications of cure were founded on the nature

the affection, on

When

it

came on

its

symptoms, and

in the

its

of

different stages.

form of an ataxick remittent

fever, dry scarifications to the neck,

and hypochondria.

MEMOIRS, &C.

and sinapisms to the

and

soles of the feet, suppurative

antiseptick stimulants to the

wounds, drinks acidulated

with mineral acids, and mixed with theriacal and ethereal potions, arrested its progress, and averted the danVenisection, which by some practitioners was
prescribed and practised in this epidemick, was always
ger.

Doctor Roussel, who, contrary

fatal.

to

my

advice,

used venisection at the first attack of this disease,

he had contracted

a victim to

in the hospitals, fell

died on the seventh day, in spite of

which
and

it

our aid. It

all

is

even improper to use dry cupping, which, when judiciously prescribed, is certainly an important remedy. If
the disease continue to advance, and the ataxia always

predominate, to the remedies above mentioned should be

added camphor and musk the drinks should be strongly

;

The

acidulated with the mineral acids.

surface of the

body should be washed with strong lotions of camphorated vinegar, which should be used cold, and even with
the addition of ice, ivhen the animal heat
ly, rubifacients

and neck

commended by some

authors,

stage of the disease

removed,

final-

is

Opium, which

it

may

when

is

re-

injurious in this affec-

and the cortex should not be given

tion,

great :

cantharides also should be applied to these

parts in the form of vesicatories.

first

is

should be well applied to the feet, legs,

until after the

the erethismus has been

be used according to circumstances. If

symptoms predominate, it may be given in

decoction with other bitters, and in conjunction with

the nervous

Hoffman's mineral liquor:

it

may afterwards

be given in

substance, in larger or smaller doses, with the addition of

sulphurick ether, and acetate of ammonia: the use of

and

coffee should not

be neglected,

if

wine

they can be pro-

cured. I have generally seen the best effects result

from

using the^e remedies in succession, and in different quantities, in

the treatment of typhus.

have also from

fre-

CAMPAIGNS AT BOULOGNE,
quent examinations of those

who have

6cC.

died of this epi

demick, been confirmed in an opinion which I have long

entertained, that the ataxia acts on the nervous system

of sensitive
the

life,

and the adynamia on organick

first affection,

the brain

arterial vessels obstructed

is

life.

always diseased, or has

and

filled

In
its

with black blood. In

the second, the viscera of the thorax and abdomen, and

in general, the

When

stomack and

the disease

intestines,

undergo a change

began with symptoms of adynamia,

arising particlarly from a gastrick or intestinal affection,

an emetick of ipecacuanha or antimoniated

tartrite of pot

ash was given in small and successive doses, and immediately followed

rhubarb

in

by the bark combined with opium and

good wine, or a decoction of serpentaria or

angelica. Also ethereal

and

theriacal potions,

enemata of

camphorated bark, washing the surface of the body with

vinegar, the use of good wine, of vinous lemonade and

stimulating frictions of the abdomen.

wounds which

In

this case, the

are affected with the hospital sphacelus,

should be dressed with vegetable or mineral acids and

camphor and bark,

in

combination with some balsamiek

substances, as the teribinthinate spirits are

by no means

proper, because they dry the ulcerated vessels,

them horny, swell

make

the subjacent sound vessels, and in

crease the disease.

In adynamick fever, I have observed that vesicatorie?

did not produce the advantages

buted to them
plication

The

which have been

excoriations caused

were followed

in a short

by

attri

their ap

time by an appearance

of moist gangrene, or hospital sphacelus.

The

putridi-

ty increased, and the general asthenia remained

tiv

same.

In the cases where ataxia predominated, on the eon

trary, they
its

may

vigour and

produce good
elasticity.

effects:

the cutis retains

Mortification supervenes with

MEMOIRS,

iCC.

greater difficulty; and on account of the successive dis-

charge of serum and pus, the capillary system

is

re-

no longer
oppressed. These vesicatories should be applied on the
neck and legs but care should be taken to keep on the
lieved, the

spasm

epidermis,

which should

removed, and the brain

is

is

be dressed with a

little

Nature sometimes

fall

oft"

of

they should

itself:

cerate.

assists the action

of remedies, and

precedes their effects by salutary crises ; producing

cal abscesses, copious sweats,

the return of

when

criti

abundant evacuations, and

These crises,
occur generally between the

suppuration in wounds.

they do take place,

seventh and thirteenth day.

I have confined myself to this succinct account of this

epidemiek, as I did not intend to enter on the theory of

this species

of disease, which

I doubt not has

been

treated exprofesso by the physicians of the grand army.

epidemiek,

we discovered the fatal termination of this

we hastened the departure of the prisoners

war

France, and then proceeded to remove the

As
of

sick

soon as

for

and wounded, who were transported

where large

hospitals

were prepared

to

Vienna,

for their reception,

with every thing necessary for their cure.

The weather

now

succeeded the

changed, and the most severe cold

rainy and moderate weather

which had continued since

the battle. This kind of atmospherick revolution, with

change of

situation,

sick received at

and the great attention which the

Vienna from

tors general Messrs. Costes

my

colleagues, the inspec-

and Percy, arrested the pro-

gress of the epidemiek, and moderated

From

this

difficulty,

and almost

all

the

sent to this city, recovered.

rage

its

virulence.

time the wounds continued to heal without

among

the Russians

arrived in France.

The

wounded French, who were

The epidemiek

continued to

and the prisoners,

until

they

obstinacy of this disease

was

CAMPAIGNS AT BOULOGNE, &C.

owing

to

want of

withstanding

all

among

cleanliness

the soldiers, (not-

the attention and care of the French

nurses,) to their apathy and carelessness,

and

circumstance of their being crowded

together in the

places

where they

great

These

halted during their removal.

places, although large

ficient,

lastly, to the

and numerous, were always insuf

on account of their unequal distribution, and the

number

of the prisoners.

The mixture

of the indi-

two nations, propagated the disease along

These fatal consequences might have
been prevented, if two routes had been established between France and Vienna, for the removal of the sick;
viduals of the
the

whole

route.

one for the French, and the other

if

Russians

for the

the clothes of the convalescents, and those

and

who had

recovered, had been purified. But circumstances did not

admit of

it.

The removal
mencedthe day

of the

wounded guards, which com

after the battle of Austerlitz,

and

conti-

nued without interruption, was attended with mucli

cess.

They were conveyed

suc-

Domi

to the hospital of the

was amply provided and pre

reception and comfort.

nicans at Vienna, which

pared for their

Peace was soon proclaimed

a near prospect of returning

at

Presburg, and

to France. I

guards in order to inspect the hospitals

tion

on the route, and

we had

preceded the

for their recep-

to prepare particular

wards

for the

wounded and sick of this corps. I halted a few days at

Augsburg to complete the organization of the hospitals.
They were all crowded, and the Russian prisoners were
still

mingled with our

soldiers.

I ordered

them

to

be

se-

parated, and proposed divers improvements, which, as I

afterwards learned, tended

mick. I arrived
I

resumed

my

much

at Paris a short

to

check the

epidie-

time afterwards, whers

usual functions and studies'.

MEMOIRS,

&C

Essay on Aneurism.

During the

short stay that I

made

in

Paris, after the

campaign of Austerlitz, I collected the remarks that I

had made at different periods, after inspecting the bodies
of those
it

who had

died of internal aneurism, and I

which

cases,

As

cal school.
this society,

was only announced

it

have thought proper

I shall only

original form.

in the bulletin of

to give

add some

facts

principles are in unison with those

Scarpa supports
I regret that

in his excellent

my

notice

might be supposed that

perusal of authors,

convinced that

all

its

which the celebrated

in

time, as

it

have taken the opinions which

here support, from his treatise

they were suggested to

here in

which sup

work on " Aneurism."

was not published

I

it

A part of these

port the principles that I then advanced.

made

memoir, accompanied by some

communicated to the society of the medi-

the subject of a short

me by

but I do declare that

observation alone.

By the
am

and especially of Morgani, I

intelligent surgeons, as well as

Scarpa,

have made observations on the progress of aneurism,

and have remarked

lish

its

consequences.

any opinion on a disease

many good

scribed

by

pect to

throw some

so

light

uniting to

well-known

nished by

my own

sist in

facts,

practice,

in the

my own

work

if

I did

not also ex

those which have been

and which

by

fur-

I think will as-

between the principles

which arise

of Scarpa, and those

observations.

pub

been de

this part of our science,

establishing the difference

advanced
out of

that has already

authors,

on

I should not

CAMPAIGNS AT BOULOGNE, &C.

If the opinions of the ancient physicians

who have

written on aneurism be examined with care, it will be

evident that they admitted this organick affection to be

dependent on a particular internal

brated

taint,

which the

cele-

Corvisart has called acre deletere (deleterious

achor, or acrimony,*)

Sabatier and Scarpa are also of

the opinion that the development of this disease

ly attributable to

spontaneous causes. It

of informing myself

is chief-

was with a view

of the true causes of aneurism,

that I instituted the inquiries, the principal results of

which

I shall detail in the sequel.

Indeed,

how

can

we

such as a violent

effort,

compression, can

all at

arteries,

and

suppose that a mechanical cause,

sudden motion, a

fall,

especially of those

which are included

the great cavities of the body, so as to cause

way, and

or sudden

once change the texture of the

in

them to give

the fibres of their proper coats to separate or

break, without producing

fatal

haemorrhages?

No

doubt

nature has well provided against the frequent occurrence

of such accidents, and for the same reason she must have

taken the necessary precautions to prevent their

to this
city.

end she has endowed the

They

a more or

by

soft

arteries

effects

with great elasti.

where surrounded on all sides by

elastick and pliant cellular substance, and

are every

less

parts

which defend them against the

action of

mechanical agents. They are almost every where ar-

ranged

in

a tortuous manner, to follow the extension of

the different parts of the body, or the

tions to

which they may be

they contain, also

assists in

subjected.

uncommon moThe fluid which

rendering them more secure

from the action of mechanical causes. Besides,

if

such

mechanical causes/operated so as to rupture the tissue of

* See his essay on the organick diseases and lesions of

the heart, under the article
Cause of Aneurism of the
Aorta,' second edition.
Voi,. u.
'

MEMOIRS, &C.

10

the artery, as some authors suppose, would that rupture

be confined

to a

few fibres of the muscular or membra-

nous coats ? No, a laceration, or

sels

would then take

place,

sion or pouring out of blood,

body

the

if

caliber, if

it

produced by

violent contusions

were one of the

and the
superfi

I have several times seen cases of this

cial arteries.

kind

its

effu-

in an internal artery of

or the sudden retraction of the vessel,

obliteration of

ter

of the ves

total rupture

and would produce an

balls, just

lat-

as

they have completed their parabola, act only, as I shall

show

in

my memoir

on amputation, by instantly bruising

and disorganizing the arterial trunks, which open or

break entirely ; and

we

find in the

cellular substance,

and

in the interstices of the muscles, an effusion of arte-

rial

blood, while the extremities of the vessels are deeply

concealed, and retracted towards their trunks.

times also in limbs, which are torn off

more or

jected with

less rapidity, the arteries are

at a distance from the part that

was

Some

by bodies pro

stricken

broken

but unless

mechanical causes act very violently, and produce such

effects

with a rapidity proportioned

to their force,

they

cannot be considered as necessary causes of aneurism,

at least in the sense

admit.
ries,

But

we will

which the partisans of

and permanent or

causes of aneurism.

this opinion

allow that direct lesions of the arteirritating

It is also

compression,

may be

very surprizing that they

adduce experiments made on the dead body, as if the

condition of a living part can be compared with that of
a part that

is

deprived of

its

vital properties.

Thus are

errours produced and perpetuated.

Further,

men who

let

them

direct their attention to labouring

lead sober lives, and have no taint of disease

circulating in their fluids. It matters not

sudden their exertions

may

be, or

how

how

violent

unusual

and

may be

CAMPAIGNS AT BOULOGNE, &C.

11

we never find them atAnd why is not this affection seen

among our soldiers, who are exposed to the

the position of their limbs, yet

tacked by aneurism.
frequently

most painful

it

find

which we

causes, of
find

and

fatigue,

Indeed we seldom

to the

it

shall speak,

among

frequently

as Bichat has said,

most irregular marches ?

among them,

unless one of

produces

it

and

if

its

we

the boys of the amphitheatre,

and

have repeated,

his copyists

it

does not here arise from the fatigue of body that they

undergo, but from

their great

intemperance, and from

the absorption of different poisons which

in several

may

take place

modes. For by the confession of authors,

adduce such cases, these

men

who

are often most depraved

in their morals.

If it were possible to investigate the first cause of internal aneurism in persons

be convinced that
seizes

who have

cause

this

died from

we

should

virus

which

it,

was a particular

on some part of the animal economy, according

which the part may have for it. The sy-

to the affinity

philitick virus, if

parts with

which

it

This virus

affinity

meet with obstructions, seizes on the

in contact, and for which it has an

it is

is

also

very susceptible of being nou-

by new absorptions, without showing any external symptom. Nevertheless, it is easy to

rished in

its

progress

conceive that the coats of the arteries, which serve as

conductors for
gins

by

it,

irritating

may

be the

of the part

sensibility

first to

some point of
is

be attacked.

of the

coats of

the

the

immediately changed, and a

kind of latent inflammation takes place in

city

It be-

their internal walls

artery

is

it,

the elasti-

weakened,

their

substance obstructed, and their walls give way, on ac-

count of the change

in their texture,

and the propulsion

which the blood receives from the heart: a gradual dilatation then follows of a part or of the whole caliber of
the artery

and

this dilatation is in

proportion to the size

MEMOIRS, &C.

12

shape, and the age and constitution of the patient. The large arteries, in proportion

of the arterial canal, to

to their size,

can be more dilated than the small, but

enlargement
the

its

is

limited,

different degrees.

and of

this

But

cannot be more than double their ordinary

It generally happens, that aneurism is con-

maximum

diameter.

While

fined to a portion of the circumference.

the debi-

and obstruction of the vessels which go to the coats

of the arteries, produce this irregular dilatation, the vi-

lity

ms

continues to extend

the parts with

which

ravages, and

its

it

by degrees

alters

comes in contact. This erosion

appears to take place more easily in the villous and

brous, than in the

membranous

coat,

fi-

no doubt because

the morbifick principle has less affinity with the former.

So chancres, that

arise

from venereal buboes, corrode the

integuments, and even the aponeuroses of the abdomen,

with surprising celerity, while they do not injure the peritoneum. In like
ries are

the internal coats of the arte-

corroded irregularly by the syphilitick virus, or

one similar to
the

manner

it,

membranous

as the virus of the scrofula,* while

or external coat

is entire.

But when the

erosion has extended to the last layers of the internal

coat, the blood presses against the

distends

it,

and obliges

it

to dilate

effected, as its fibres are flexible,

and extensible, and do

not appear to be so easily acted on

internal coats.
true, or

from simple

membrane
sac,

From

this

membranous coat,
is more easily

this

by the

virus as the

time the aneurism ceases to be

dilatation.

The common

or cellular

contains the fluid, and forms a circumscribed

which characterizes the aneurismal tumour. In pro-

* Ruysch and Morgagni say they have found in animals,

small effusions of a particular appearance in the fibrous
coat of the artery, which had produced aneurismal tumour,
by destroying this membrane, See Medicine Operatoire of
Sabatier, vol. i. The same might take place in man.

CAMPAIGNS AT BOULOGNE, &C.

portion as the texture of the internal coat

be

less considerable,

sudden and extensive. For

this

perforated, and the external

dily formed.

caliber, the

and the erosion more

reason

is this

membranous

sac

coat sooner

more

If this false aneurism be isolated

cumscribed, as

is

sometimes the case,

and

dered as encysted,

wounds

dense and

is

moderate

firm, as in arteries of a small or

dilatation will

13

of the arteries.

it

spee-

and

may be

cir

consi-

as

a consequence of partial

The

dilatation has greater effect

on the arteries which are curved or bending, than on

those which run straight forward.
effect in

young than

It also has greater

in old subjects, in

weak and

phleg-

who are robust, whose fibre is firm

many idiosyncrasies may promote the

matick, than in those

and

rigid.

In

dilatation of

fine,

an artery to a certain degree: yet in

all

cases the extensibility of the external coats, and the ac

tion of the virus,

perhaps

have

less restricted

This dilatation

their limits.

is

than Scarpa supposes for the pre;

paration of an enormous aneurism of the curve of the

aorta proves, that the dilatation
limits

may

which have been allowed

author.This I

shall

extend beyond the

by

this respectable

attempt to demonstrate from

paration, and from several others

It is true that in

it

this

pre

which are similar to

it

a majority of cases the erosion of the

coats precedes their dilatation,

and checks

its

progress,

which otherwise would be more considerable. The internal coats are soon destroyed, and the blood has no
further effect on
lation,

and

its

them by

impetus.

its

presence, and by

They remain

its

accumu-

separated to a great-

er or less degree, sometimes retract, and no longer assist

in

forming the aneurismal sac with which their corroded

edges communicate, but are united to the membranous

walls of the cyst. This union often takes place by means
of small striated, irregular, and divergent bands, which
are identified with the cyst.

MEMOIRS, &C.

14

This

have seen

in

an aneurismal tumour of the popli-

the internal coats

teal artery:

were

perforated, in con-

sequence of being corroded, as I found after the death

of the patient, and were evidently united with the cystick tumour.

The tumour

by pressure

obliges

it

all

then gradually increases, and

the neighbouring soft and

branous parts to assist in forming the sac.

cavities in the

hard parts which

meets with in

it

and

gress and enlargement, such as bones

mem-

even forms

It

pro-

its

cartilage

not

by producing a caries of them, as some authors have

supposed, but by compressing the lymphatick vessels of
the

membranes which cover them. By

the lymphaticks

undergo a kind of

this disturbance,

which chan-

irritation

ge? and increases their functions, so as to cause

them

to

absorb the phosphate of lime or the salino-earthy particles

which
and

originally filled the walls of the osseous vessels,

this action

gradually destroys the thickest and most

compact bones. In the mean time the disease continues

to increase until the

poured

is

tumour

bursts,

The progress of aneurism often

marked by a dull pain near the

sensation of unpleasant heat

more apparent

after eating,

varies

the

first

part affected,

and uneasiness

is

stage

with a

in the func

These symptoms are

lions of the neighbouring organs.

est

and the blood

out.

and while there

the great-

is

tone in the vital powers, as in the night.

The same

takes place in syphilitick affections. In the second stage

symptoms

are

more

which the patient

feels,

the

guish

by the

sight

violent

pulsations

take place,

and the physician can

and touch, if the tumour be

distin

superficial

but they are no longer equivocal in the third or fourth

stage.

of

To

these

aneurism,

as

symptoms
described

here unnecessary for

me

are then added

by

authors,

to repeat.

>t out the most prominent, as

my

It

is

those

all

which

it

is

sufficient that 1

intention

is

to ex-

CAMPAIGNS AT BOULOGNE, &C.

lo

plain the causes of aneurism, and especially of internal

aneurism, and to point out some means suited to arrest its

progress, to cure it, if in an incipient state, or to prevent
it, if

there be a suspicion of

Among

its

approach.

the different kinds of virus which

may

pro-

duce aneurism, I believe that the coats of the heart and

arteries

more

real virus.

which

readily appropriate to themselves the vene

The

quantity of

syphilitick

excrescences,

I found in the ventricles of the heart, about the ori-

gin of the aorta, and on the semilunar valves of this artery, in a soldier

who had

died of an inveterate syphilis

similar excrescences that I have seen in the hearts of

other subjects, particularly at the hospital of the medical school,

and

finally the venereal

symptoms which

have preceded the attack of aneurism,

have died of it under

in persons

who

my observation, support my opinion

we find that aneumen who add to the syphi-

of the action of this cause. Again,

rism generally attacks those

litick virus,

contracted at various periods, the immoderate

use of spirituous liquors, of indigestible and heating

ment, and disorderly or irregular habits of

According

to these principles,

am

ali-

life.

of opinion that,

by authors on the first

aneurismatick symptoms, we

to the general treatment advised

appearance of internal

should lose no time in adding such remedies as are proresist the particular virus, which discovers itself
by the concurrence of its general symptoms with those
which arise from the aneurismal tumour. Thus have I,
by this plan, checked the progress of this disease in many
cases, and have removed it in others. But it is necessary

per to

to persist a long time in the use of these

vary them according

means, and

to

to circumstances.

The sanguineous tumours which appear in the thick part

of the limbs, owe their origin to the gradual and insensible corrosion of the bifurcations of the arterial

branches

MEMOIRS, &C.

16

where

the virus lodges

more

the predisposition of the vessels

of these arteries,

The

obtuse.

which

is

where the

favoured by

when

easily,

and because the angles

disease

commences, ar more

blood being filtered through the aperture,

formed

narrow bifurcations, first fills

membrane, and gradually ex-

in these

the neighbouring cellular

more remote, so as to peneand aponeuroses,

them to form
causing
and to distend their small vessels or
a particular membrane, similar to the corpora cavernosa
penis, or of the spleen, which is capable of a sudden
development or comparative dilatation. These tumours,
which

itself to that

tends

is

trate into the texture of the muscles

which always continue to enlarge, invade all the surrounding parts, and inclose in their interiour the virus

which

produced them, as

first

is

the case in chronick

aneurismal, and scrofulous tumours.

must be

entirely

removed

The

to effect a perfect cure:

pation alone does not generally suffice.

how

deep

it

anew, and

may have been

in a short

These tumours have

part affected
extir

It matters not

carried, they soon return

time acquire the same growth.

little

or no pulsation

have seen

The first, for which my friend

me, was on my route to Lyons, it

three cases of this kind.

Mr.

Petit consulted

was seated behind the internal maleolus of the left leg.

Every part of the tumour had then been extirpated that
could be removed, and the actual cautery had afterwards
been applied

but the disease soon returned, and

came necessary

The second
who,

amputate the

case

was

of a

it

be-

leg.

young lady

at Versailles

having twice submitted to an operation, simi-

after

lar to the

to

above, for a tumour of the same nature, which

she had had for several years on her right fore -arm,
to consult

me. I did not hesitate

arm above the tumour, to which she conand it was attended with complete success. On

tion of the

sented,

to

came
recommend amputa

CAMPAIGNS AT BOULOGNE, &C.

17

dissecting the tumour, I discovered a cavernous or spun-

gy membrane,

which

at the pedicle of

I found the bifur-

cation of an artery, slightly dilated, formed

and anteriour, or

internal inter- osseous, in

by the ulnar
which the dis-

ease had commenced.

Lastly, the third case

was

tice,

that of a

who was

guard,

was

disease

to the

quite favourable

The
resists

when

its

cure

it

in

my

prac-

the imperial

elbow, so that

in the

The

the character of

two former

became necessary
was
the tumour was the
it

result of the operation

cases.

disease of which I have spoken

is very violent: it
every other means but amputation of the limb,

it

rest

met with

received in our hospital. In his case the

amputate the arm.

same as

seated also in the thick part of the fore -arm,

and extended
to

which

soldier belonging to

becomes inveterate; but

antisyphiliticks will ar-

progress, as well as that of aneurism, or even

in

its

forming stage.

some facts which prove the circular and

uniform dilatation of an artery of moderate caliber; for as
I have already observed, the internal cause or virus, by
I shall relate

depriving the proper coats of the vessels of their con-

and

tractile

and by attacking their

same time, almost always corrodes them,

elastick properties,

texture at the

and immediately produces

false

aneurism, or forms a

from the external membranes of the vesthese facts, which might suffice to demonstrate

particular sac,
sels.

the

To

first

ral of

stage of dilatation, I shall add the cases of seve-

my

wounded, which

ferent chapters of

artery

my

will

be found detailed in

was found considerably

dilated in proportion to

the course and size of the vessel.

have also seen the

arteries dilate

plied after amputation,

a dragoon that

Vol.

lit

is

dif-

work. In these, a portion of the

In some cases

above the

and remarkable

,o in the case of

given at the end of the work.

ligature, ap-

This

MEMOIRS, &e.

18

sudden
ical

dilatation is really the

cause

but there

consequence of a inechaii

a great difference in the pro-

is

gress of the tumour and

its

when

development

ceeds the bounds which I have supposed. It

which establishes the morbid

The

ease to advance.

arise

it

ex-

the virus

and causes the

which

cases

first

prove the possibility of

action,

is

dis-

shall give,

whether

arterial dilatation,

it

from an internal cause, or be the consequence of a

a mechanical cause.*

A person

whom

with

was well acquainted, died

Paris from the effects of aneurismal diathesis.

ing his body,

we

pulmonary

aortal arteries enlarged in

The

their caliber, to nearly twice their usual size.

arterial

at

open-

found the four cavities of the heart unu-

sually dilated, the

the branches,

On

trunks,

and the principal ramifications of these two

trunks partook of this dilatation, and

we observed
were affect-

that the trunks and principal arterial branches

ed with chronick phlogosis, and with a corrosion of some

spots

on the internal or

villous coat. Purulent collections

and scirrhous obstructions werealso seen in the lungs,

and

along the course of the membranous and cellular texture,

which surrounds the continuation of the aorta

rax and abdomen.

am

into the tho-

underwent any vioand on the other hand, that he had led a

disorderly and intemperate life, and at different periods
had laboured under different morbid affections.
I

sure that this person never

lent exercise,

Many
the

similar facts are found in authors,

same kind have been reported

and others of

me by

physicians

the cellular

membrane

to

worthy of credit.

Haller has observed that

when

and the membranous coats of the arteries of living animals

are removed, the arteries dilate, and form aneurism. I have
repeated this experiment with the same result

CAMPAIGNS AT BOULOGNE, &C.

Michael Andre, an
hospital of the imperial

infantry chasseur,

19
entered the

guard on account of an aneuris-

mal tumour, which extended from the cavity of the left

axilla, to the fold of the arm. This tumour followed the
course of the humeral artery it was of the shape and
:

size of the largest spindle used in spinning

the vessel

was enlarged

the natural size.

in

its

hemp, and

caliber to about three times

Its pulsations

were isochronous with

those of the heart, and produced excessive pain, especially in the night. Pustules of a venereal character appear-

ed also

in the

same arm, and on othor

parts of the body,

which, according to the information of the patient, came

on with the tumour. Both these symptoms attacked with

out an effort, without an external cause, and in consequence of a chancre, which

this soldier

had suddenly

healed with a desiccative quack ointment. But the cicatrix of the chancre

make

was

mercurial frictions

not yet firm. I directed

on the tumour and

feet;

to take a diaphoretick

Van

Swieten.

During the

tisan,

and the

first fifteen

him

to

soles of the

liquor of

days, there

was

change in the tumour. I persisted six weeks

no
longer in the exhibition of the same remedies, and before the fiftieth day, the pustules had entirely disappearsensible

ed: the tumour

was about

removed, and the patient

half

of the
felt no more pain. I expected to assist the action
along
the
compression
graduated
mercury, by making a

whole course of the aneurism

and 1 believe

this plan

was of great advantage in the resolution of the tumour.

Towards the end of the treatment, I applied a bandage
covered with blistering salve over its whole extent, and
patient left the hospital
it disappeared entirely, and the
in a

It

few days
is

after.

very evident that the

arterial

tube was in

this

case in a state of simple dilatation the uniformity of the

tpmour, its lengthened and almost conical shape, ad
:

MEMOIRS, &C.

20

mitting the point of the cone to be

lost in

the portion of

the artery which runs deep under the aponeurosis of the

biceps muscle, and buries

itself in

the bend of the

elbow

to divide into the radial and ulnar; finally, the gradual

disappearance of this tumour, and its insensible return to

the natural dimensions of the brachial artery, appear to

me

unequivocal proofs of this dilatation.

saw another chasseur of infantry who had a wellmarked dilatation of the two carotids ; more particularly
of the left carotid. Its pulsations were sensible to the eye,
formed a cylindrical and uniform tumour, which occupied the whole course of these arteries, and the membraI

nous cylinder was elastick and distinct from the neighbouring

parts.

This soldier was attacked by epileptick

and by alarming syncope. Venisection

in the

with

in the feet,

arms, with the application of small bladders

ice

and ammonia, gave momentary

relief,

fits

and

filled

and also

reduced the tumour which seemed to disappear entirely

during the syncope.

regretted that I could not

this disease to its termination,

sirous to return to his

own

watch

but the chasseur being dehabitation, I procured his

dismissal, and have never seen him since.* Here again

was an example of true dilatation, which, as in the former case, had advanced to the greatest degree the caliber of the artery

admitted

of:

but the same internal

cause that produced this dilatation by paralyzing the

fibres of the coat of the vessels, no doubt would soon
ulcerate

it,

so as to permit the transudation of the fluid

There is now a soldier of the same army in our hospiwith a very manifest dilatation of the trunk, and principal branches of the right temporal artery, to more than
double their usual caliber, with several syphihtick exostoses
on the same side of the cranium There is reason to expect
that the untisyphilitick treatment will remove these symptoms, which as yet are in an incipient state.
*

tal

CAMPAIGNS AT BOULOGNE, &C.

contained in the arterial cavity to cake place.
gular

coat

and circumscribed

dilatation of the

have said,

The

irre-

membranous

not limited in this case, while in the

is

21

first,

as I

cannot go beyond certain bounds, as is observed in proper inflammation of the testicle. The tumefaction of this organ cannot at most be greater than
double

its

nlcerates,

it

former

size,

but then

its

and a cancer appears, or

which should be evacuated,

if

proper coat bursts or

it

this

forms an abscess

do not take place

spontaneously, to relieve the patient from the severe pain

that he suffers.

While I was at Udino in lg7, I was consulted by

one of the principal surgeons of the military hospitals of
that place, on account of one of his patients, who had an
aneurism of the popliteal artery, on whom it was intend
ed to operate next day. The tumour in the ham waabout the size of a hen's egg; its pulsations were obvious and synchronous, with (he action of the heart.

The

patient experienced acute

and lancinating pains in the

parts during the night, but none during the day. On inquiring into his condition prior to the formation of this

tumour, I learned that after several attacks of the gonorrhoea, he had a herpetick eruption of a syphilitick ap
pearance, that had been removed by means of an un-

guent slightly caustiek and astringent, prescribed by an

Italian physician,
this eruption,

and

he had

that since the disappearance of

stiffness of his

fixed pain in the hollow of the

joints, and a
ham, which was removed

by bending the

this

leg,

felt

and on

limb almost always in a

ing this

stiffness,

account he kept the

stale of flexion.

Notwithstand-

he came not to the hospital until the tu

mour appeared in the ham, and he was unable to walk

He had made use of cooling drinks, and emollients had
been applied on the tumour. This plan had increased its
size, and in a few days it became as large as a turkev's

2Z

MEMOIRS, &C.

was soft, the skin unchanged; pulsating and

At first its character was dubious, and it had
been taken for an abscess. The patient was also emaci
egg.

It

painful.

ated, his countenance pale

and sallow,

and interrupted by distressing dreams

his slet'p painful,

his digestion

was

bad, and towards evening he had a slight febrile pa

roxysm.
After having attentively considered the nature of the
disease,
to

its

and the circumstances preceding and subsequent

appearance, I thought that

it

could arise from no

other cause than the repercussion of the herpetick eruption,

produced by the topical astringents which

dier

had used.

deferred,

and

this sol

I proposed that the operation should

I directed

made on

pression to be

be

an uniform and graduated com-

the tumour. I put the patient on

and

antipsoricks, in the formulas of pills

mild regimen and the most perfect

tisans,

with

rest.

After continuing this treatment several weeks, and re

newing the bandage

curial frictions

mour

frequently, taking care to use

on the part before re-applying

sensibly diminished,

it,

mer

the tu

and the patient experienced

no inconvenience from the compression. The same plan

was

carefully persisted in,

were extended

which he

felt

to the

and the mercurial

whole leg and

thigh.

frictions

The

pains

on entering the hospital had entirely disap

peared, and the diminution of the tumour

more

was more and

were then substituted
and the dose was increased to

perceptible. Belloste's pills

for the antipsoriek pills,

render them purgative.*

Before the

fiftieth

a nut, fluctuation

day, the tumour

was no longer

was no larger than

to be perceived in

it,

This treatment was continued by the chief surgeon of

who afterwards gave me an account of hie

the hospital,
cure.

23

CAMPAIGNS AT BOULOGNE, &C.

and occasional slight pulsations could only be distinguished. The bandage and medicines that I had advised were
continued twenty day^ longer at the expiration of which
;

time there remained

in the popliteal region only a small,

hard, indolent tumour, which the surgeon resolved entirely,

by the

application of a blister,

and the

But an

soon able to leave the hospital

patient

was

elastick boot-top,

with a cushion of a suitable shape, was made for him, to

keep up for a few months a permanent compression on
the course of the popliteal artery

Several years after-

wards, I was informed that this soldier continued well.

I attribute this cure chiefly to the internal and exter
nal medicines that

was of

little

were prescribed: the compression

am

consequence. I

also of opinion that such

success could not be obtained in similar cases, unless

mercurial preparations in suitable forms be used in addition to compression.

Tmight report

a great

number of cases of aneurism, on

the surface and in the interiour of which, ulcerations

with chronick and

to

be convinced of

brated

local

inflammation have been found:

this, it

may

works of Morgagni, and

suffice to

read the cele-

the excellent collection of

by Mr. Pelletan. I shall confine myself to a brief

account of some cases that came directly under my own

cases

notice.

At one

of the sittings of the society of the medical

school, a physician of the Hotel Dieu of Paris, presented

a preparation of a very large aneurism of the curve of the

aorta, with a narrative of the case. I was appointed with

Mr. Dubois

The

to

make

a report on this interesting

aneurysmal tumour was

egg, and

was opened

case-

about as large as a hen's

at the left posteriour

and

lateral

had formed an adhesion with the correspart,

ponding lobe of the lungs, into the substance of which the

where

it

blood had been poured.

The

internal coat of both portions

MEMOIRS, &C.

94

of the aorta (which was obliterated by the aneurism al sac,)

was

and ulcerated

thick, inflamed,

the edges of the ulcerations that

blood,

were

and as

fringed,

it

and

in several places,

had given exit

were, corroded.

to the

The

re-

mainder of the proper membranes of the pectoral and

abdominal aorta were evidently affected with chronicle
inflammation.

We

well

knew

that the subject of this

case had frequently contracted the syphilis.

John Maurice Guenous, aged

forty-one, a serjeant of

the 1st battalion of the guards, entered the hospital April

7th, 1804.

He

had

for

some time complained of a

painful

spot in the thorax, about the middle of the sternum.

pain increased at night, and

was attended with

This

difficulty

of respiration,, and such an oppression, that he often

in

danger of death from

pains to the venereal

Indeed,

rent times.

sternum appeared

to

the junction of its

suffocation.

He

referred

all

symptoms that he had had at diffewhen he entered the hospital, the

have formed a considerable angle

two superiour

that

my

discovered pulsations in the tumour, isochro-

nous with the pulse

tion,

at

portions. This at first

had been considered as a venereal exostosis, but on

first visit I

felt

these

at

the wrist. This, with the fluctua-

and the marble-colour of the tumour, the acute pains

the patient suffered, and the difficulty of respiration

and the

irregularity

and smallness of the pulse,

left

me

no room to doubt the existence of an aneurism, which I

suspected to be in the course of the aorta.

The
was

patient

painful,

was

obliged to

sit

up

and produced dangerous

lying upon his back, he

felt

every other position

suffocation.

When

a most painful drawing that

prevented him from remaining in that posture, even for

a

few seconds.

this

ly

We

afterwards discovered the cause of

drawing, on inspecting the dead body.

He was total

deprived of sleep, and his pain increased during the

night.

CAAIPAIGNS AT BOULOGNE, &C.

All these

symptoms continued

25

to increase for

some

days, and the patient died in dreadful suffering on the

Twenty -four hours

25th of April.

body

afterwards I opened

ok the surgeons of the hospital.

The external tumour was slightly excoriated without

the

in the presence

being opened. I

left

the sternum

and integuments which

covered the aneurismal sac in their places.

this, I cut the ribs

To

effect

on both sides with a saw, and thus

uncovered the two cavities of the thorax, and took every

care to avoid injuring the sac. I

was persuaded

there had been no rupture of

it

it,

and

that

was, as I had pre-

beyond the edges of

which it extended, and adhered on each side to the lungs,
the texture of which was altered, particularly where
they came in contact with the tumour On making incisions into them, I found them ulcerated in many places,
dicted, situated behind the sternum,

and containing a

The

al vessels.

foetid

The tumour,

gray.

as well as

a state of suppuration.
side of the sac,

coat

for

yellow pus that

filled

the bronchi-

lungs were tuberculous, and of a blueish

An

its

ulcer

external coats, were in

had formed

in the left

and had nearly perforated the internal

on making a

slight

part, an extensive rupture

degree of pressure on

was produced, from which

issued a large quantity of black coagulated blood.

portion adhering to the sternum,

similar ulceration that

was

this

That

was destroyed by a

also apparent in several other

parts of the internal and external surface of the sac.

sternum was perforated and carious, as

to the anteriour wall of the sac.

far as

Through

it

this

The

adhered
opening,

the blood had passed into the cellular texture of the peri-

osteum, which covered this bone on the outside, and converted

it

into a

spongy substance. The posteriour part of

the tumour rested immediately on the trachea, the oeso-

phagus, the

The

latter

thoracick duct, and the dorsal vertebrse.

were not

Vol.

ii

injured, but the trachea

was com-

MEMOIRS,

26

fcC.

which the

pressed, and I doubt not that the suffocation

patient experienced,

lying on his back, arose in a

when

measure from the bulk and weight of the tumour

cepting the

tumour by

this position also, the

In

air.

inter
its

weight distended the ulcerated portions of the membrane

adhering to the sternum.
After having examined every part with which the tu
mour was connected, I separated it, leaving it attached

When

alone to the sternum and heart.

it

removed, I found

was about

the largest that I had ever seen. It

fourteen

same in
diameter
fifteen in length, and
its antero-posteriour
near thirty in circumference. It was made up of the arch
of the aorta; the vessels that arose from the arch were
centimetres in

transverse diameter, and the

its

less

The vena cava had also

than natural.

lost its caliber,

and was confounded with the ancurismal

monary

artery adhered to

dilated to double

The

it.

aorta at

short distance, this arterial portion

membranous

fibrous

and

striated

its

The

origin

pul

was

usual diameter; after running a

its

in the

sac.

sae,

seemed

to

terminate

form of a funnel, by

in the

bands: a similar disposition was ob

served in another portion of the arch which formed the

other end of the tumour, and along the pectoral aorta
that

was

itself dilated

low down

as the

at

many

minal aorta was also slightly

fibrous coats of the

mal sac

places of

its

surface as

abdomen. The bifurcation of the abdo

whole

The

dilated.

arterial tube

to the crural arteries

were

internal

and

from the ancuris-

red, inflamed, without

and covered with a purulent exudation in many places; an ancurismal diathesis prevailed throughout
elasticity,

all

the arteries. This diathesis

pending on a syphilitick

From

all

the facts that I

following conclusions

may be

considered as de-

taint.

have adduced, I think

may be drawn

the

CAMPAIGNS AT BOULOGNE, &C.

That the

1st.

2?

essential cause of internal aneurisms,

of those which are gradually formed externally,

is

and

a par-

and that the vims of the venereal and scrodiseases most commonly attacks the white fibrous

ticular virus

fulous

parts of the system in preference to others.

2nd. That mechanical causes produce speedy and sensible effects,

which may be

easily distinguished

from the

preceding.

That when

3d.

we

suspect the existence of an aneu-

rismal tumour, admitting that

at

commencement,

its

sist

the

it

could not be discovered

means which are

the internal cause of this disease

more

suited to re-

may be

used with

or less advantage.

I have thought proper to give in this place

on haemorrhage, as a sequel

my

essay

to the diseases of the ar-

teries.

Essay on the spontaneous Causes of active

morrhasc.

arterial Hce-

among our
commencement of

Arterial haemorrhage often proved fatal

soldiers

who were wounded

in the

1806, and since that period. This species of haemorrhage

some of our men, and in others it pointed out

means which nature adopts to arrest it, whether

carried off
to us the

she act alone, or receive the assistance of

Practitioners,

tomed

who

and especially those

to operations,

art.

are unaccus-

having embraced the general

opi-

nion that the escape of the blood from a divided vessel,

is

prevented by the formation of a fibrous

fice,

clot in its ori-

attempt to produce this clot by making direct or in-

direct pressure

on the open

vessel.

have long since

doubted the formation and the necessity of a

clot in the

MEMOIRS, &C.

28

accidental opening of an artery, or in the extremity of a

truncated vessel. I

in those cases

To this

used.

logical facts

make

on

inquiries

where compression alone was

end, I have attentively collected the patho-

which

my practice

which have been the

mals.

make some

led to

from witnessing the frequent returns of hie

this subject,

morrhage

was

result of

has furnished, and those

experiments on living ani-

have compared them, and have attempted

the best deduction from

an account of them, I

shall

them

to

but before I give

attempt to explain the plan

by which nature closes the orifice of a vessel that has

been opened, or entirely divided by a wounding cause.

The

arteries arc susceptible of three motions, viz. dila-

tation, contraction,

and a vermicular motion. These mo-

tions are the consequences of the elasticity

of the proper coat of the artery that

all

is

and contraction

made up

arterial tube.

This arrangement

is

sufficient to

us, that they possess a proper contractile

is

of fibres,

of which appear to run in a spiral direction round the

dependent on the

arterial vessels (vasa

convince

power, which

vasorum) that

run in the same direction around these elementary

and

that

whatever

may be

fibres,

the nature of these fibres,

they must constantly undergo a relative degree of abbreviation.

ture of

The muscular and elementary

fibres, of the na-

which we are equally ignorant, bear the same

lation to the little arteries that

phenomenon

of their abbreviation also depends

stantaneous obstruction of their vessels.

cut transversely, the part
terial

branches

is

which

re-

surround them, and the

is

on the

in-

If a muscle be

separated from the ar-

of necessity paralyzed.

The

contraction

of a tight cord or cable, after being soaked with water,

very great. This ingenious means

is

is

used to raise vessels

of war from their ways, and to launch them

and thus
by the contraction of cables can they raise such enormous masses. From this principle, it would be natural
;

&C

CAMPAIGNS AT BOULOGNE,

29.

to conclude that wherever the arteries are spirally ar-

ranged, their length must be necessarily reduced,

the fluid

when

which circulates through their caliber is suddenand accumulated in them by any cause. The

ly arrested,

primary causes of
ed

but

this obstruction are not easily explain-

probable that they arc the

it is

effects

of a vital

fluid, transmitted by the nerves into these

Thus the contraction of the muscles of a living
animal, caused by the transmission of this latter fluid, is

or galvanick
vessels.

in

consequence of the instantaneous ob fraction of the

small arteries in the muscular fibres ; and these vessels

are so numerous, according to the injections of Prokaska,
that the elementary fibre disappears entirely.

croscope shows

nothing but vessels

round each other. The

on opening

itself

phenomenon

first

rity of these

the age,

or entirely dividing an

often

two motions

and

pelled

by the

spirally

artery,

two

is

arterial

its

tube lengthwise; the cele

is

according to the strength,

irritability of the subject.

overcome by the

mi-

that presents

the sudden approximation of the walls of the

ends, and the retraction of

The

which wind

This power

is

column of blood procase, effusion takes place and

force of the

heart. In this

the haemorrhage will continue without ceasing until death

ensues. If' the vessel
cases, the patient's
is

be

large,

and near the heart,

endangered.

life is

of small caliber, the haemorrhage

When

in all

the vessel

may be suspended

spontaneously, or by slight compression. But sometimes

the opening of a very small artery produces a haemor-

rhage which

is

difficult to

This depends on

its

situation,

neighbouring parts, and

trunk.

When

an artery

ment, the bleeding

is

manage, and may prove

its

is

on

its

relation

and

its

the

proximity to a large arterial

simply opened by some iustru

very dangerous, because the walls

of the open vessel approach' each other with

culty,

fatal

to

tube cannot retract

To

more dim

the ^ainc cause

&C

MEMOIRS,

30

be attributed the frequent return of hemorrhages,

may

the danger of which

On

artery.

the other

is

in proportion to the size of the

hand we frequently

arteries, that are quite divided, retract

see very large

with such force as

wounds

to stop the discharge of blood; in large lacerated

for example. Neither does hajmorrhage take place in

gun-shot wounds, when the vessels are entirely broken.

After these general data,

it is

easy to perceive that the

current of blood from the extremity of a wounded artery, is not arrested by the formation of a clot ; for if
it

were, the haemorrhage might be arrested by holding

few minutes, and the clot

the aperture of the vessel a

would be immediately formed: but

the vessel be

this is not the fact. If

not sufficiently irritated

when

the

immedi

ate compression ceases, the bleeding returns;

and

al-

though on the outside of the open vessel a quantity of

coagulated blood

These external

is

found,

it

does not remain there.

cannot stop the haemorrhage, and

clots

they lessen the resistance opposed to

sensibility of the parts

it,

by destroying the

with which they come

in contact:

crethismus then takes place in the part, and a gangrene,

makes its. appearance, and all

symptoms which accompany that affection soon fol

or hospital sphacelus soon

the

low.
If coagulated blood be found in a vessel

been

of that
tity

which has
some time before, this clot is the consequence
coagulation which takes place in the small quan-

tied

of blood remaining above the ligature, in the space

between the ligature of the artery and the nearest branch

that

it

motion

and

gives off;

this takes

place from the

in this part of the arterial tube

want of

but the orifice of

the vessel cannot be closed, unless by the contraction

and adhesion of

its

walls.

This adhesion

above

it,

so that

if

the ligature

is

not confined

some millimetres
should come away, the

to parts under the ligature, but extends

CAMPAIGNS AT BOULOGNE, &C.

adhesion

still

31

continues, and can prevent the escape of

the blood.

Adhesive inflammation of the walls of an open artery

takes place, as I before said, sooner

more

irritable,

when

and when the subject

greater vital energy.

Thus

we

the

vessel

is

young, and has

is

seldom see haemorrhages

succeed to operations for acute diseases, or after wounds

received in battle. Yet

it

often happens that the ligatures

ope

are displaced, or even torn off a short time after the

by

Tation

the shocks and jerks to

which

wounded

the

are subjected during their removal from the ambulances

to the hospitals of the first line.
is

This short space of time*

sufheient for the production of adhesive inflammation

am

so well convinced of this fact, that I never

but one knot in the thread that

on the largest

The second

vessels.

make

use for a ligature, even

knot

is

useless,

and

often prevents the ligature from coming away, by causing

it

to stick in the cicatrix as

then

difficult to extract.

have often seen, and

it

is

In some instances I have been

obliged to cut the thread deeply under the artery with

scissors.

A difference

The

chronick diseases.
forces are

made

should be

in operations for

patients are exhausted, the vital

weakened, and the haemorrhage

easily returns,

because adhesive inflammation in these cases comes on

more slowly:
the ligature,

The

it is

and

necessary then to

to tie

even the smallest

application of a styptick

arteries of animals

morrhage, and

to

is

make two

knots in

vessels!

on the recently divided

generally sufficient to arrest the hae-

produce adhesive inflammation. I have

repeated this experiment very often. In

man

it

often hap-

pens that washing the part with cold water, or admitting

cold air to the part

divided arteries,

* I

is

also sufficient to contract the small

and to produce

this

inflammation, so that

suppose from twelve to twenty-four hours at most.

MEMOIRS, &C.

32
in

many

cases the ligature might be omitted.

be prudent to

the vessels that

tie all

we

operations that

performed

at

can be

But

seen.

it

will

In the

the battle of Eylau,

we had

while the cold

was 14 and 15 degrees below

nothing to

but the great trunks of the arteries, and

tie

the most simple

and

zero,

was sufficient.
by haemorrhage, du-

superficial ligature

Not one of our wounded was

lost

ring a long journey to their place of destination,

beyond

the Vistula.

Adynamick

fevers, ataxick

and scorbutick

diseases,

prevent this adhesive inflammation from taking place

these cases

in

we may expect consecutive haemorrhage, as

when the vessels from which it takes

frequently happens

place have been cut in an operation for a disease that has

already exhausted the stre,.th of the patient

In such cases attention should be paid

to the re-esta

blishment of the strength, and to the restoration of the

natural irritability of the injured vessels.
first

fulfil

the

bark should be given, united with

indication, the

opium or camphor

To

and to the drinks, should be added

some mineral acid, as the nitrick, or nitrick alcohol may
be used. Tonick and astringent substances should be ap
plied

The

on the

vessel, or as

near as possible to the ligature.

strictest rest should

be observed by the patient, and

he should have good jelly-broths, generous wines, &c. &c.

Some

cases of sabre wounds, with haemorrhage,

I shall report concisely, confirm the principles

have just advanced.

which
which wp

CAMPAIGNS AT BOULOGNE, &C

33

CASE FIRST

Morin, of the guards, was carried

pital

hos

to the

with a sabre-wound that he had received in a

duel.

I did not see him until the following morning. The

wound, which was small externally, had been made by
the point of the weapon, and had penetrated deeply and

obliquely into the middle and posteriour part of the right

fore-arm, at the fold of the elbow, so that the ulnar artery had been cut under the pronator teres,

scratched

wound

and the ulna

a large quantity of blood poured into the deep

in the thick

muscles of the forearm. Notwith-

standing the diffusion of this coagulated blood, and the

it produced on the whole extremity, and
on the course of the humeral artery, the haemorrhage
was incessant, and reduced the patient to the greatest

pressure which

danger.
I

reluctant to lay bare the humeral artery to tie

felt

although the operation

was

indicated,

it

to dilate the

wound. The escape of a large quantity of

coagulated blood facilitated

my

not able to discover the artery

some

researches ; yet I

made

cle

was

I could scarcely per-

slight pulsations at the

bottom of the wound,

very near the brachial trunk, under the pronator

I

it,

being un-

whether the limb could be preserved, I resolved

certain

ceive

and

teres.

a counter opening along the course of this mus-

on the

internal side of the

bend of the arm, where

the aponeurosis had been cut by the point of the instrument, and distended by effused blood. I cut the aponeu
rotick portion deeply

made a

transverse section of the

pronator teres, to lay bare the injured vessel that I might

tie it

but just as I expected to find

Vol.

ii.

Er

it,

the

hemorrhage

memoirs, &c.

34

stopped, and never re-appeared, although I injected

water into the wound to wash away the

structed

my

wounds

as simple,

view. I

clots

warm

which ob-

was then obliged to consider the two

and dressed them accordingly. I only

introduced into the bottom of the counter opening, to-

wards the wounded artery, a dossil of lint, dipped in a di

gestive made with turpentine, oil of camomile, camphor,
pulv. chinchona,

and a few drops of sulphurick acid.

pledgets of lint, and with

The wound was covered with

compresses dipped in camphorated wine, and retained

by

suitable bandages.

The arm was kept

suitable position. I prescribed a rigid

and

lated cooling drinks,

From this

pills

of

in the

camphor and opium.

period the patient continued to improve

strength returned, his

most

regimen, acidula

wound became

clean,

was complete on the thirty -third day

ration, when he left the hospital.

trix

and

its

his

cica-

after the ope-

CASE SECOND.

Moudre, a dragoon, entered the

a sword
its

wound

hospital with

in the cavity of the right axilla, small in

external dimensions, but very deep.

He had an

instan-

taneous and profuse haemorrhage, which they attempted

check by strong compression on the wound, that was

not more than two centimetres in length. The patient
to

was

feeble

when

saw him,

countenance discoloured

his pulse small,

and

his

a stream of blood of aver-

was constantly discharged from the wound

The pectoral region was considerably distended, and an
ecchymosis had formed. By introducing a probe, I dismillion colour

covered the depth of the wound, and the immense effusion under the pectoralis major. I dilated the two an-

CAMPAIGNS AT BOULOGNE, &Cgles of the

wound

35

extensively, in a line parallel with the

tendinous edge of this muscle, and turned out with

my

kilogramme of coagulated blood

I sought for the source of the effusion, and I cut up all
the cellular and tendinous ligaments. I expected to apply
fingers about half a

the ligature on one of the thoracick arteries,

which I sup-

posed was wounded by the point of the sword ; but

af-

were removed, and the wound washed,

no more blood was poured out. Being well convinced

ter all the clots

that the orifice of the vessel

wound

had retracted, I gave the

a simple dressing, and prescribed the internal re-

medies, mentioned in the

case.

first

Suppuration was

soon established, was interrupted by no accident, and the

patient

was cured

in less than six

weeks.

These two cases, and a great many others of a similar

kind that have occurred in my practice, prove that the
clots of blood, so far

from arresting haemorrhage, on the

contrary increase

by

escaped from

its

it

and

is

and

its

homogenous

blood has

effused into the cavities

of the body, or into the cellular

vitality,

When

their presence.

vessels,

membrane,

properties.

it

loses

its

It appears that

oxygen and calorick are absorbed by the surrounding

remain uninjured. This fluid loses its vitality
ia some degree, and is carbonized as soon as it comes in

the

vessels that

contact with the external

air.

The

arteries

which open

in the midst of these clots, are rendered torpid, lose their

action, permit the blood that they contain to escape,

and

to

be expelled by the contraction of the heart, and

of the distant arteries: the haemorrhage continues be-

cause the vessel has lost

its

sensibility,

and cannot retract

or inflame so as to produce the adhesion of

the

moving fibres being

tract

and

also

its

walls

rendered torpid, cannot con-

assist in the obliteration of the arterial tube.

External compression increases the symptoms by

dis-

abling the circulation of the cutaneous system, increases

36

MEMOIRS,

local turgescence,

SCO.

These

and promotes haemorrhage.

phenomena account

symptoms

for the cessation of the

on removing the dressings, as

we have

often seen.

Being then well convinced that haemorrhage will not

cease, until there is a contraction of the vessel, and an
obliteration of

walls,

we

its

be made immediately on the open

vessel runs over a part

we

by adhesion of

caliber produced

its

when it can
and when this

should never use compression but

which will

vessel,

afford a firm resistance

wounds and to re
remove
or with a view to caute-

should not hesitate to enlarge the

move

the clots, either to tie the vessels, or to

these injurious foreign bodies

rize or irritate them, taking the necessary precautions to

avoid an injury of the neighbouring parts. This practice

has been in

add
of

to this

two

my hands always perfectly successful. I shall

view of the wounds of arteries, a summary

interesting cases.

Houze, a grenadier of the guards, came to the hospi

tal with a wound, made by a cutting instrument, in the
middle and anteriour part of the right

leg.

It

was

paral

from the internal edge of which it was

but two centimetres distant, and passed deep, backwards
lei

with the

tibia,

and outwards,

was

to the posteriour surface of this bone.

suspected that the tibial artery

of the sword

indeed there

was

It

by the point

cut

was an alarming haemor-

rhage, which continued until the patient fainted, and

strong compression

was made on the wound

charged vermilion coloured blood

when he

it still

dis-

entered the

The division of the integuments, not being ex

over the wound of the subjacent parts, which was

hospital.

actly

deep, a large quantity of coagulated blood

filled this in

ternal excavation, without stopping the haemorrhage.

I hastened to dilate the small external

cut

wound

I freely

up the aponeurotick ligaments, and turned out

all

the

CAMPAIGN AT BOULOGNE, &C.

clots of blood.

37

washed the wound with water and

vi-

negar, and waited for the return of haemorrhage to dis-

cover the vessel, and to apply a ligature upon

soon as the

wound was

but as

it:

cleansed, and the ligaments cut

up, the bleeding ceased, and returned no more. I applied

a suitable bandage, prescribed rest, regimen, and medi.
cines suited to his case.

Suppuration took place in the wound, which I had

was healed over entirely on

accident. Just as he was about to

dressed with emollients ;

the 21st

day

after the

be discharged,

in

it

consequence of a violent

which

effort

the patient accidentally made, a circumscribed pulsating

and

fluctuating

cicatrix,

down by

tumour was formed suddenly under the

and gradually increased

but being kept

in size;

a compressing bandage,

it

then extended

itself

along the course of the vena saphena, to the posleriour

I thought that this

part of the internal maleolus.

encysted aneurism, such as

The

is

was an

described by Foubert.

patient was, at the time, unwilling to submit to the

operation which I proposed

some

future time, propose

it

but he will probably, at

and then

himself,

we may

be able to discover the true character of this tumour.

Tabellion, another soldier, had been

wounded by

a sa

bre in the right hand, so that the point had pierced deep

from the edge of the radius

tween the

first

carpal bone.
dial artery

into the

palmar region, be

phalanx of the thumb, and the

The abductor

of the index

had been lacerated, where

articulation of the first

it

was

first

meta

cut; the ra

passes over the

phalanx, and the deep arch of

the

palmar artery was cut by the point of the instrument uu

der the flexor tendon of the index finger. The portion ol
the radial artery

which goes

to

form

this

arch was aneu

wound filled with clots of .blood. At firsf

haemorrhage was very profuse, and it continued un

rismal, and the

the
til

saw

(he patient at

my

first

visit.

enlarged the

38

MEMOIRS,

<!^

wound above and below, and removed

the clots

all

discovered the aneurismal tumour at the bottom; but

had ceased. As

the flow of blood

that

it

tery.

would return,

was apprehensive

I applied a ligature

on the

rhage, which I immediately checked, by

dical
dius.

radial ar-

The sac burst, and I again had a sudden haemor

making metho

and continued pressure along the course of the ra

This pressure had all the desired effects, and I sim-

ply dressed the wound.

slight

inflammation of

all

the

hand succeeded, with a paroxysm of fever: the palmar

It was then necessary to perform

arch soon bled again.

I first laid bare the radial artery,

a delicate operation.

which

I tied; but

it

was very

ty of the palmar arch.

difficult to tie

the extremi-

Yet the operation was completely

and the patient was discharged, cured, from

successful,

the hospital in a short time.

Of

Rheumatism on

the effects of the

the fibrous

and

osseous systems.

If

it

be

difficult to

explain the

modus operandi of

the

auses of internal aneurism, and of the cessation of hie-

morrhage,

happy

it

is still

more

osseous systems,

more

ossifying process

is

obscurity

difficult to

account for the un-

rheumatick taint on the fibrous and

effects of the

especially in those persons

which covers the progress of

its symptoms, I believe

the variety of

tick principle,

by

its

organick sensibility

by

and

rheuma-

and the vessels of the bones

of their vitality. This substance loses

arc not acred on

this disease,

that the

deleterious properties, deprives the

fibrocartilaginous substance

its

whose

not completed. Notwithstanding the

its

elasticity

the lymphatick vessels,

and

which

the morbid cause, but appear to un-

CAMPAIGNS AT BOULOGNE, &C.

dergo a sympathetick

irritation

energy on the particles of

become

They

as

it

were

inert,

from

it,

39

act with increased

which have
and gradually absorb them.
this substance,

thus cause a destruction of substance in the solid

bodies, and in the parts

which are contiguous

to the seat

of disease: a latent inflammation, accompanied by a species of serous

and purulent secretion

which, by congestion, gives

ra of

this

is

the consequence,

rise to abscesses.

The rcmo-

heterogeneous fluid in the bones or ligamen-

tous cartilages,

which are changed, hastens the progress

of caries, and spreads the disease

more

extensively.

This process of internal caries and decomposition,

is

ra-

pid in proportion to the imperfection of ossification. In

such subjects the absorbent system possesses great

vity,

and the phosphate of lime easily separates from the

bones, because they have not

which

is

acquired the

hardness

necessary to resist the action of the virus, or

the secondary action of the lymphatick vessels.

who

acti-

They

laboured under this disease in our hospitals and am-

bulances,

were

all

young

soldiers,

between eighteen and

twenty years of age. In some the rheumatism unfortunately caused a caries of the bony pieces of the orbicular or

ginglymoid articulations, seldom with spontaneous

In others a caries of one or two vertebrae, and

some a separation of the bones of the pelvis we shall

luxation.

in

give some cases of

it.*

This rheumatick virus acts on various parts of the

body, according to their predisposing debility, or certain
concomitant causes which determine the morbid principle to these parts.
*

While

In every case, the disease, during

who were

its

to be placed on
os coxigis separated from the sacrum. It followed all the motions of the
corresponding thigh. This case was precisely similar to one
which professour Lerithier showed us at the practical school
some time before his death.

half pay,

visiting the soldiers

of

we found that one

them had the

MEMOIRS, &C.

40

it

differ in

works

of Pott,

progress, presents uniform phenomena, unless

its seat

I shall not point

them

out, as the

and the memoirs of the royal academy of surgery have

given us their etiology in detail. In general this disease is
fatal,

The

when proper means

success

are not early used to arrest

which has attended some

applied with perseverance,
that if they be exhibited on

my hands, when
induced me to believe,

means
lias

in

the approach of the disease, or the

symptoms,

its

it.

of these unusual

it

may

first

be conquered, and

appearance of
its fatal

conse

quenees often prevented.

These means are such

as will give a brisk stimulus to

and the

the diseased parts, so as to restore the elasticity,

proper and natural sensibility of the

weakened

vessels.

be the least sign of local swelcautery, as a topical reme

actual
the
and
ling, moxa,
dy have produced the most happy effects in cases that have
Scarifications, if there

been considered desperate. Mercurial

frictions, as

near as

possible to the seat of the disease, at intervals of four or

five

days, have appeared to

Even admitting

cure.

me

to contribute

that there

have generally observed that

best effects in all diseases

is

this

no

much

to the

syphilitick virus, I

remedy produces

the

which arc improperly called

lymphatic!:, provided the patients

be not too much ex

hansted.

When the
ficial

part

abscess

makes

its

appearance on some super-

which corresponds with the

munrcate with the focus of disease,

with some success.

symptom which shows

is

is

checked:

it

may

When this abscess remains

after the use of internal

state,

Under

this

that

fistulas

in the

it,

same

and external remedies,

it

that the progress of the caries

impression I pass a pointed cut

ling sieel blade, heated to a white heat, through the

of

com

be treated

middle

and discharge as much of the matter as possible by

means

of a cupping-glass, that will include the

whole

tu-

CAMPAIGNS AT BOULOGNE, &C.

mour and

its

two

41

openings. I then pass a seton of soft

nen through these two openings, and over

compress, dipped in camphorated

all

li-

I apply a

of camomile, and a

oil

compressing bandage.
Contrary to the opinion of practitioners, I evacuate

all

the fluid at the time of the operation, without fearing the

consequences of the admission of

would be more

injurious if

of pus, because

this

would

which

acted on a large quantity

would soon be decomposed, and

infect the individual

be taken to evacuate

it

air into the sac,

it

at

whereas,

the precaution

if

once, this inconvenience will

be prevented. The application of the moxa should be continued on the parts over the caries, as also local mercurial frictions.

ters,

Internally, sudorificks,

combined with

bit-

sometimes With bark, and some of the mercurial

which are given with more advantage separately,

in some convenient vehicle, have succeeded well in my
hands. I shall not enter into minute details on the prosalts,

some very

perties of these medicines, as

satisfactory opi-

nions on this part of the therapeutick plan

Salmade's work,* but I consider topical appli-

in Dr.

cations, or the

means which belong

efficacious in this disease, if

I think

we may

cumstances
1st.

may be found

it

to surgery, as

more

be curable.

expect a cure under the following

cir-

When the

disease

within the reach of

is

not very far advanced, and

is

art.

When the patient is young, and exempt from any

2dly.

other virus, such as the venereal or scrofulous.

3dly.

When the

caries is not deep,

and

is

distant

from

the internal organs.

* See his practical observations on Scrofulous

and diseases of the lymph

VOL.

II.

affections,

MEMOIRS, &C.

42

We can easily conceive that when the

in

an incipient

effects

we may

state,

disease

check or prevent

sensibility of

by promptly changing the organick

the part affected,

by restoring

culation of the fluids,

its

only

is

its first

elasticity,

and the

cir-

by preventing the lymphatick sys-

tem from taking on the unnatural functions which it assumes, and confirming those which are natural to it: I
can adduce many facts to attest these truths. But how
shall

we

explain the success that has been obtained afteF

com-

the abscess has been formed, and the caries has

menced?

It is, doubtless,

perhaps that

of the

guards,

is

problem, and one

impossible to solve. I shall confine

first

my-

examples was a young soldier of the

who came

Austerlitz, with

all

into the hospital

the

articulation.

on our return from

symptoms of an

taneous luxation of the

bility

difficult

faithful report of the cases that I have collected,

self to a

One

it

left

incipient spon-

thigh, at the coxo-femoral

There were acute pains of the

part,

of the limb, a preternatural elongation of

immo-

it,

to the

extent of several millimetres, a projection of the trochanter, emaciation of the extremity, and a febrile affec

some preparation, I put this soldier on the use

of the tonick and depurative plan above mentioned, in

tion After

the form of

pills,

ptisans or potions,

directed that scarifications should be

the joint
ficient

I then applied

some

and I immediately

made

round
and a suf-

entirelv

blistering flies,

number of moxas.*

The symptoms
application of

subsided by degrees, and on the ninth

moxa, they had disappeared entirely. Yet

I directed several others to be applied to confirm the

* I always took care to prevent ulceration in

the parts
burned by the moxa, by the immediate application of

snonia

am

CAMPAIGNS AT BOULOGNE, &C.

care. I

had also directed some mercurial

43

frictions

about

the thigh and pelvis.

Eleven cases of persons of the same age have since

been received in the same

They

hospital.

laboured un-

der the same disease, which had attacked the articulation

of one knee or of one thigh: in five of these the cure

was

nearly complete; a slight lameness alone remained, with

a shortening of the limb about one or two centimetres:

yet we were obliged to disband them. In three cases
spontaneous luxation appeared to have taken place
is

to say, the

symptoms, which authors

tell

that

us indicate

such as a decided shortening of

the limb, deviation of the foot and knee from the natural line, (generally outwards,) elevation of the great trothis luxation, existed

chanter, stiffness and difficulty in

moving

especially the impossibility of bending

head of the femur

left

it.

the thigh,

Has

and

the sound

the cotyloid cavity in these cases,

and become fixed on some part of the circumference of

rathis cavity, and does this cavity remain sound ? Or,
head
the
of
reduction
or
substance
loss
of
there
a
tfier, is
of the bone, or finally,

is it

a greater or less excavation

irof the articular cavity that causes the shortening and

induced
observations have
regularity of the limb?

My

me to adopt the latter opinion, as agreeing best with the

principles of sound physiology. Besides, I have never
been able

to discover this

supposed luxation of the head

who had
of the femur on disseeting the bodies of those
displacement,
laboured under spontaneous luxation. This
and
obstruction
gradual
a
authors tell us, takes place by
cavity, which
thickening of the cartilage of the cotyloid
and complete
by degrees expels the head of the femur,
consequence. If a case attended with such

luxation

is

the

circumstances has been met with,

the luxation

was

accidental, that

we

is,

dare affirm that

produced by an ex-

MEMOIRS, &C

44
ternal cause, of

which the patient may even remain

ig-

norant.

The
tible

moveable

cartilages of the

joints are not suscep

of the changes which are proper to organized parts,

as I hope to prove

essay

subsequent

in

on

the

formation of preternatural and moveable cartilages of

the joints. Far from acquiring an increase of thickness,
and a larger size, they easily dissolve, and are reduced
to a

powder, or small

friable grains,

and are

easily

ab-

sorbed by the lymphaticks, so as to disappear entirely.

This has been uniformly the case in the bodies of those

who

have sunk under

articular

this

have

disease, as I

This cartilaginous substance

found in dissecting them.

being no longer secreted by the osseous vessels of the extremities of the bones to
cles disunite, are

which

it

attached,

is

its

parti-

decomposed, and are absorbed, and

even the osseous vessels

is the femur shortened
down, become hard, and contract, which also assists
shortening the limb and all this is done, and can be

thus

sink
in

without inflammation, suppuration, abscess, or

done

hectick fever. Indeed,

joints affected

with

we

tirely stripped of cartilage,

sons retained the

in

my possession

great

often find the

this disease for

and

bony pieces of

a long time, and en-

yet,

whde living, the

power of moving

several preparations of this kind,

number may be seen

in

very interesting case that I

cartilaginous substance

per-

these joints. I have

and a

anatomical cabinets. But a

shall give,

proves that the

and the osseous principle

disappear, and again be restored without producing

may
any

of these serious symptoms which often attend diseases

of the joints, especially

doned

when they

are entirely aban

to the resources of nature.

Among the
seum of
showed

curious anatomical preparations in the

the university of Vienna, professour

me

mu-

Prokaska

a dried thorax, in which the head of the

CAMPAIGNS AT BOULOGNE, &C.

right

45

humerus was fastened between the second and

forming a tumour with its convex side

third true ribs,

looking into the cavity of the thorax.

The

singular error

bone was the consequence of an accidental

luxation caused by falling on the elbow, while the humerus was extended, and projecting from the body. The

loci of this

head of the humerus,

after

having ruptured the capsular

ligament, had been violently forced into the axilla under

the pectoral mumbles, so as to separate these two ribs,

and

to pass through the space

between them. The head

of the humerus, or the bony sphere, overcame

all

ob-

and penetrated entirely into the cavity of the thorax, pushing before it that portion of the pleura that opstacles,

posed

In vain was every

it.

effort

and expedient made

use of to reduce this singular luxation

alarming symp

toms ensued, which were removed by venaesection,

bathing, and cooling medicines ; but the arm remained
at a distance

from the body, and the patient became by

degrees accustomed to this position of the limb, and

af-

some years of uneasiness and pain, it gave him no

further trouble. Thus he lived to be thirty -one years of
age,* and died of a disease which had no connection with
this injury
The physicians were desirous of being ac
ter

with the nature of

quaintecl

which they had

They were
find the

as yet

this singular infirmity, of

formed an imperfect opinion

astonished on opening the dead body, to

head of the humerus within the thorax, sur

rounded by the pleura, and firmly embraced around

neck by the two
still

more

He

above mentioned

its-

but they were

when

in lieu of a small sphere

cartilage, they

found nothing but a very

astonished,

covered with

ribs

died sixteen or seventeen years after

had befallen him.

tjiis

accident

46

MEMOIRS, &C.

membranous

soft

ball,

sure of the finger.

of

The

that part of the

all

which yielded to the

and

cartilage,

slightest pres-

the

humerus contained

bony texture
in the

proper

cavity of the thorax, had entirely disappeared: the ab-

sorbents had taken

it

up, and like faithful guardians, had

endeavoured to destroy

gradually

it

not being able to

enemy en masse, that had feloniously entered a

where it was unwelcome and injurious. Nothing more of this part of the tumour remained, than the
membranous rudiments of its bony head yet these rudi
expel an

habitation

ments, in
talis.

my

opinion, belonged chiefly to the pleura cos-

This case, while

it

supports

ture of that morbid process

my

opinion of the na-

which takes place

in

rheu

matick diseases of the articulations, explains the decorn

posing powers of Nature,

who

I believe

is

endowed

in

an equal degree with the powers of re-composing.

CASE FIRST

The

cure of tabes dorsalis, with an abscess from

first

conjestion, that I saw,

the second class,

east.

was on Mr. Bernard, a surgeon of

the army of the

who had been with

He was twenty- seven

years of age, and of a delicate

This young man, during the blockade of

Alexandria in 1801, after having for a long time felt

constitution.

pains in the posteriour part of the body and thorax, sud-

denly experienced a debility of the lumbar region, which

obliged

him

The

to discontinue his attendance at the hospi-

became general. On
the fifteenth day, having carried his hand mechanically
to the lumbar region, he there felt a tumour as large as a
tal.

prostration of his strength

hen's egg.

He was

then so

weak

as to be obliged to

keep

47

CAMPAIGNS AT BOULOGNE, &C.

was

his bed. I

the

called to prescribe for him,

and found

symptoms of an abscess from congestion.

all

I directed

that he should be immediately carried to the hospital in

the

mosque which was appropriated

I directed several applications of

The

application of

fifth

dent improvement, that

mediately after

it,

to the tumour.

was followed by such an evithe patient was able to rise im-

it

and take a turn

in his

rected such a regimen as circumstances

mit,

and

to the officers:

moxa

chamber. I

di-

would then per-

and the use of tonicks and opium. The application

of the

moxa

continued for eight clays,

when

was

obliged to put him under the care of the chief surgeon of

The great number of general officers who

were then wounded occupied my attention so completely, that I could not see him for two months afterwards.
The tumour had enlarged, and changed its form the
the hospital.

patient

w as tormented
r

by an obstinate costiveness, and

sometimes could pass no urine.

Having decided on attempting

to

open the abscess, I

applied a piece of concrete potash on the most projecting

part of

it,

but the motions of the patient removed the

dressings during the night, so that

Next day

it

produced no

effect.

I plunged the point of a red hot iron with cut-

ting sides, into the tumour. It discharged a serous pus

of a dull gray colour, which towards the

last

was mixed

with whitish lumps. I directed the bark and

bitters to

be continued. These

removed

in

addition to good diet,

the fever, and he soon regained his strength. After

two

months, the wound discharged nothing but a very small

quantity of yellow serum, which ceased five days after
in the latitude of the isle of Candia, as he

to

France.

years, and

by

strict

The
was

cicatrix

painful

was returning

remained blueish for three

when

the weather changed

regimen and great care, Mr. Bernard

now

but
en-

48

MEMOIRS, &C.

joys perfect health in the

troubled

by go symptom

of his family, and

bosom

is

of this disease.*

CASE SECOND.

came to the hospital

of the guard with all the symptoms of a caries of the
fourth or fifth vertebra. There was a tumour at the part,
Anglaret, an infantry chasseur,

and he remained always bent. Local pain, and an ab

scess as large as a turkey's egg, situated near the inferi-

our angle of the right scapula,

left

no doubt of the

caries.

him on the general plan of treatment

above mentioned: moxa was applied nine times in succession on the muscles of the back. The tumour remained stationary for some time, and then appeared to dimiI immediately put

nish a

little.

I resolved to pierce

downwards, with a

steel point

I applied cups immediately, to

rected

him

to use bark,

it

obliquely,

brought

draw

to

from below

a white heat

out the pus, and di-

opium, and antiscorbuticks. Not-

withstanding the very advanced state of this disease, the

symptoms abated by degrees, and disappeared entirely

The abscess became clean, and a cicatrix formed on the
two wounds some months after. This chasseur was finally restosed to health, yet without

in the service.

He

being able to continue

remained crooked and weak.

This case was arranged by Mr. Caumette, surgeon maBernard in Egvpt,

jor of the guards, a companion of Mr.

who also continued to attend him until
milv.

he

retired to his fa

CAMPAIGNS AT BOULOGNE. &C.

49

CASE THIRD.

Zwart Villhem, a

light

horse lancer of

the.

2d

regi-

ment, twenty-two years of age, of a weak appearance,

and subject
infancy,

to flying pains in both his shoulders

was removed

ward among

into the

the

from

his

wound-

from the fever ward. At my morning visit, I examined this young man, and then discovered that he la-

ed,

boured under tabes dorsalis, or the gibbosity of Pott, so

well described

by him.

It

was marked by the relaxation

by great weakness of all

of the ligaments of the spine,

the spinal column,

by

a considerable projection of the

sixth dorsal vertebra, lying on the right side, constant

bending of the thighs on the

sleep

and

difficulty,

by the

to relieve pain

with

the

pelvis, in order to procure

finally, the patient

walked with

back curved, and scarcely supported

seton had been inserted
extremities.

his

inferiour

in the skin,

over the diseased vertebra.

ordered the seton to be removed, and I began with

moxa

along the course of the spine: this plan

continued for some time, and every second day

roll

of cotton

was burned on

was

anew

the muscles of the back,

and about the tumour. I gave him, internally, tonicks,

such as bark, opium, and good wine. These means pro-

duced an evident amelioration

tient,

and

after thirty

in the condition of the pa-

days he was able

to

walk abroad,

during a part of the day, without being obliged as formerly to sit or lie down. He gradually regained his
strength: the projection of the spinous apophysis insensibly disappeared.

Vol.

ii.

Several other applications of

Cr

moxa

MEMOIRS, &C.

50

along the vertebral column, removed the debility that

still

was

remained there, and expedited the

cure,

which

complete the third month after he entered the

hospital.

CASE FOURTH

Miss A***, a young lady to

the city,

was

attacked by the

whom
same

was

called in

disease, attended

with the same symptoms as the lancer. She was cured

by applying moxa five times on the dorsal column, and
by the use of depurative syrup, with the addition of
opium she was also threatened with phthisis pulmonalis.
:

Several physicians

who had been

pronounced that

it

would prove

cus) asses' milk,

and good

consulted on this case,

an issue in the left

arm, antiscorbuticks, the Iceland moss, (lichen islandidiet,

fatal:

completely restored

thi>

lady to health

CASE FIFTH.

I shall here insert the case of Jacques

laud, as

Antoine Boybel

an example of a cure of abscess from congestion,

with caries of the vertebrae

He was a young grenadier,

immediate observation in the
hospital of the guards, where he entered July 12th,
1811,
with a tumour on the lumbar region, as large as the
and came under

my own

first

attended with

all

the

symptoms of an abscess from con

gestion, and with a caries of one of the

dorsal, or neighbouring lumbar vertebras, caused by excessive
onanism,
and by the moisture to which he was
exposed in bl

CAMPAIGNS AT BOULOGNE, &C.

vouac, during the two last campaigns.
disease
little

had arrived

at its last stage,

hope of a cure, I

no time

lost

same plan of treatment

51

Although the

and there was but

him on

in putting

the

as directed in the foregoing

The fluctuation of the abscess was sensible in every part. The skin of the most dependent parts, considerably worn away, and ready to burst. The patient was

cases.

all motion, and lay in bed with the body

and inferiour extremities continually bent. His debility

deprived of

was extreme:

the chronick suppurative fever

which ac-

companies tabes dorsalis

in the evening,

is marked by slight paroxysms

by clammy sweats of an unpleasant

odour, by insomnia, and by the irrregular state of the

pulse.

I put^this patient on bark

and opium

in different for-

mulas, according to circumstances; and I applied the

moxa

ten times along the spine,

the tumour, at intervals of one

and about the base of

and two days. The

sta-

tionary condition of the patient, the strength which he

had acquired, and the wish which he expressed, that I

should open this abscess that was about to break spontaneously, induced

me

to

perform the following operation

After having brought a

dually broader towards

its

steel point

base, and had cutting edges,)

to a white heat, I pierced the abscess with

side to the other, obliquely

part,

where

it

was attended

from the highest

was nearly ready

with but

little

to burst.

pain.

mixed with white albuminous and

charged in great quantity
tally,

(which grew gra-

it

from one

to the lowest

This operation

A whitish

serous pus,

thick flocculi, was dis-

but in order to remove

it

to-

I applied cups on the tumour at different times.

was thus completely emptied. The whole

more than half a litre.
deep cavity remained when the abscess was evacua-

The

abscess

quantity of pus might be rated at

ted.

Without introducing any probe into the wound,

MEMOIRS, &C.

52

discovered by the touch that the caries

first
oil

lumbar vertebra.

An

was

seated in the

open compress, dipped

of camomile strongly camphorated,

was

mediately over the wounds, with pledgets of

bandage

slightly

broth, with claret,

ing to be taken in

The
ration

lint,

draught of ether and

I prescribed for

and a

him good

and two grains of opium in the eventwo ounces of hot sweet wine.

nature of this case

was such that

I feared the ope-

would hasten the death of the patient; but to

agreeable surprize, I found

had

compressive.

laudanum was administered

in hot

applied im-

slept several hours,

him

better next

and the fever was

my

morning; he

less.

For several days the discharge of pus was very abunit diminished by degrees with the other symp-

dant, but

toms of the
the

moxa

The

disease.

sloughed

off,

eschars of the cauterifs and of

considerable quantities of albu

were discharged from the abscess, the

Walls of which sunk down, retracted, and began to reminous

unite.

flocculi

At

different periods

we

had given him two mild

emeticks, and had continued the bark with opium, good

jelly -broths,

and good wine. I

am

reporting his case on

the thirty-first day since the operation: his ulcer appears

to

be in a good

state,

and secretes a small quantity of

white thick pus. Most of the sores caused by the moxa

have healed; his strength is in a great measure re-established,

and

his appetite

and sleep have returned: he

stretches himself on his bed, and can rise at pleasure.

Unless some unforeseen accident should occur, I do not

doubt but he will finally recover.

CAMPAIGNS AT BOULOGNE, &C.

CASE SIXTH.

Although the disease in the two following cases has

some

similarity to the foregoing, yet as their causes

different, I shall report

Honore Desplan, a
of

Wagram,

nearly spent.

them

were

here.

fusileer of the guard, at the battle

received a contusion from a ball that

As

it

turned on

its

axis, it

was

grazed his back,

destroyed a part of his apparel, and produced an incomplete luxation of the 10th dorsal vertebra, so that the

spinous process of this vertebra protruded about

timetres.

The two

two cen-

contiguous vertebrae were evidently

more depressed than the rest. This soldier was several

months in the hospital of the guards, after returning from
the campaign of Austerlitz.

with

difficulty

sensibly

He

suffered greatly,

could find an easy position.

became accustomed

The

and

parts in-

to this state, the ligaments

grew strong, and he walked with ease, though his back

Was curved; he felt slight pains from changes of tern
perature

CASE SEVENTH

Moilleseaux, a voltigeur of the

first

regiment

of the guards, twenty -three years of age, presented a

case similar to the preceding.

By falling,

while in Spain,

from a steep place, he produced an incomplete luxation

of the 11th dorsal vertebra.

He

walked with

his

back

bent, but the contiuual pain that he suffered, produced

MEMOIRS, &t

>1

He experienced

gradual emaciation.
ritus,

an

uncommon

pru

attended with an agreeable sensation in the parts

of generation,
the bed.

He

he attempted to stretch himself on

when

is still at

the depot of his regiment, and will

soon be placed in the corps of invalids.

CASE EIGHTH.

Charles Stoll, of the artillery of the guards, twenty

six years of age,

came

into the hospital for a

rheumatick

affection contracted in Spain, by fatigue and exposure.

This disease was seated

in the left thigh,

while the pain

was principally in the knee. It was treated by cupping,

by vesicatories, and by moxa. All these means could not
prevent apparent spontaneous luxation of the head of the

femur from the acetabulum, as was soon known by the

shortening of the limb, its loss of motion, local pain, and
the turning of the foot outwards.

The

patient soon felt very acute pain in consequence

of this affection, which acting on the general system,

produced a sympathetick quotidian fever. Tonicks,bark,

and

bitters

mus.

were administered, but he

fell

into a

maras

A purulent discharge took

place from his ears, a

came on with mucous expectoration and
fever, with all its symptoms ensued. The ap

frequent cough

a heetick

plication of a blister to the leg of the

diseased side,

appeared to suspend the symptoms in some measure for

a

week, but they soon returned with greater violence,

ami

after

having suffered the most acute pain, he was sud

deniy attacked by a most dreadful suffocation

became

discoloured, the pulse small

respiration difficult

mained unimpaired

and

stertorous.

his face

and vermicular, and

The animal

until the last sigh.

life

re

CAMPAIGNS AT BOULOGNE, &C.

On

examining the body,

the hip-joint, filled

we

55

discovered an abscess at

with serous matter, mixed with white

lumps, and the remnants of cartilage: the head of the

femur was affected by a species of

centre of the

opening that

caries, and on the

bony edge of the cotyloid cavity was an
communicated with the pelvis

CASE NINTH

Nicholas Martin, an

artillerist in the

brought to the hospital with a deep

superiour and internal part of the

mining him next morning,

quantity of pus

horse guards,

was

fistulous ulcer in the

left thigh.

After exa

I found that a considerable

was discharged from

depth of which I could not ascertain.

the

wound,

the

The

patient

felt

great pain about the hip-joint, and especially in the knee.

The

leg

was generally bent on the thigh, and the thigh

By these symptoms I discovered a sponta

on the pelvis.

neous luxation of the head of the femur, and the forma

tion of
tient

an abscess around the articulation: but the pa

had already

fallen into

a marasmus, and I was ob

some internal remedies to sup

was soon entirely exhausted.

liged to confine myself to

port his strength, which

He

died at the expiration of a month.

body we found

The

the

same disorder

cotyloid cavity

was

into a part of the pelvis.

On

as in the

opening the

preceding.

perforated, and the pus poured

56

MEMOIRS, &C.

CASE TENTH

Frank, a

fusilcer of the guards,

came

to the hospital

on account of a rheumatick pain that he had

months
for

in the left thigh.

felt for

some days, I discovered symptoms of a disease

hip-joint,

in the

and 60on after such as attend a luxation of the

femur, or rather the destruction of the

head of

three

After having attended to him

this

cartilage of the

bone, and of the acetabulum.

most energetick means, such as cupping,

moxa, which

I often repeated,

formation of an abscess.

been very acute,

now

The

and

and thus prevented the

pains

which

at

first

had

abated by degrees, the parts ac-

commodated themselves

to the change,

and the patient

regained his strength and good appearance.

of six months he

I used the
blisters,

left

At

the end

the hospital, but continued lame

and deformed, the necessary consequences of such a

dis

ease.

CASE ELEVENTH

Mongin entered

the hospital with a disease similar to

the last; but his pain

in

was

less acute.

He was

younger,

marasmus. The disease went on

the same manner, and the same means were employed

and

fell

into a kind of

The whole limb remained

quent deformity

Before

of

emaciated, and the subse-

great.

I pass to the last subject relating

the joints, I
sults

was very

my

may

observe that

inquiries

my

to diseases of

experience, and the re-

on the causes and

effects of

sponta-

CAMPAIGNS AT BOULOGNE, &C.

57

ncous luxation of the femur, agree with the principles of

Sabatier.

(Seethe

Royal Academy of

fifth

volume of the Memoirs of the

Surgery,

p.

791.)

Essay on moveable and preternatural cartilages of

the

joints.

The

formation of cartilaginous bodies, which remain

loose and

floating in certain

ginglymoid articulations,

is

a disease that has not been noticed by the ancients, perhaps, because

when

its

diagnosticks

not courage to

make an

incision into a joint to extract

them, from an opinion that

the cavities of the joints,
well-attested case

first

were obscure, or because,

they had discovered these concretions, they had

all

wounds, penetrating into

were highly dangerous. The

we have reported, where

that

were present in the articulations of the knee,

is reported by Ambroise Pare. In 1558, this celebrated
surgeon, while opening an imposthume of the knee, saw
these bodies

a white hard polished concretion, of the size of an almond, pass through the orifice. In 1685, Dr. Vagne-

same appearance in the knee of

an ox. In the next century Alexander Monro, Simson,
Bromfield, Cruikshank, Theden, Morgagni, and Bell

rus found several of the

extracted similar foreign bodies from the knee-joint.

operation, although performed differently by

The

each of

them, had the same effect. Lately Sabatier and Desault,

have performed it with equal success.
It

was

generally believed that these cartilaginous con-

were never formed except in the knee-joint but

Haller mentions a woman, in the articulation of whose

cretions

jaw,

after death,

condyle,

Vol.

and
ir

he found several: the cartilages of the

oi the glenoid cavity of this articulation

MEMOIRS, &C

58

were destroyed.

Bell has also found

the foot, and proposes to extract

them

them

in the joint of

in such a

case by

incision.

The development

of these foreign bodies, and the uni

formity of the symptoms which follow and attend them unextracted, prove that their production always depends

til

on one and the same cause. Nevertheless, physicians

who have written on concretions of the joints, are divided in opinion: some suppose that they are formed in

some part of the synovial membrane that lines the capsule of the joint: others that they are formed of the adipose and vascular

membrane

that lies in the posteriour

depression, between the condyles of the femur,

and are

loosened from their attachments by shocks or concussions.

Again

there are others

who

adopt the opinion which

is

most generally received, viz. that a part of the synovia

grows thick in the most dependent parts of the joint, so
as to form these concretions, which afterwards gradually
enlarge. All authors agree as to the diagnostick of this

disease and the operation

limited

number, they

making the

avoid

all

and

if

give the

we may

except a very

same good advice,

to

incision of the skin, to correspond with

that in the capsular ligament, in order to prevent the en

trance of the surrounding

air.

Without examining the

different theories that have

advanced
the
been
on
formation of these concretions, I
shall

me

attempt to refer their production to causes, that to

appear most reasonable.

It is

necessary,

first,

to

be

well acquainted -with the nature of the cartilages that

surround the extremities of the bones, forming the

move

able articulations, for they differ in organization from

others. I

would designate

fibro-cartilaginous:

which
pelvis

unite the

and the

this

of this

different

ribs, to the

all

substance by the term of

species
vertebra?,

are

the cartilages

the bones

sternum, &c.

These

of the
carti-

CAMPAIGNS AT BOULOGNE, &C.

lages are also supplied with vessels

changed: they become

ossified in

and seem

bony substance.
there

is

to

which are
ossification.

make up a

The changes

easily

advanced age, or pre-

maturely by such causes as produce

unite the bones,

58

They

continuation of

of the cartilages,

where

a union by diarthrosis, bears no analogy to

where there is a sunarthrosis.

none of the affections that are
ligaments, to the synovial capsules, and

those of the cartilages,

The
common

former are liable to

to the

fibro- cartilaginous substances,

such as tumefaction, in-

flammation, suppuration, and gangrene: the authors

who

have supported an opposite opinion have been led into an

errour by the colour which these cartilages receive from
the fluids accumulated in the articulation.

As

in acute nephritis, the urine is coloured red, so

by

inflammation of the articular ligaments, the synovia

and
an articular extremity be sawed

also coloured red

but

if after

is

stains the cartilage of a red colour:

ligaments removed, you macerate

this tinge will disappear.

it

in

off,

common

and

its

water,

This I have remarked, and

have repeated the experiment when particular circumstances occurred to corroborate this opinion.

Soemme

fine inring and Prokaska have demonstrated by veiy

memsynovial
the
ligaments,
the
although
jections, that

branes, the periosteum, and the bones be injected, the

cartilages that cover the surfaces of their bony extremities,

and form moveable

articulations, or diarthrosis,

receive no portion of the injection.

prepared pieces with a glass,

little

we

On

examining these

see,

on the contrary,

branches arising from the extremities of the injected

vessels,

and uniting

to

form the

artieluar ligament,

and

the bony and synovial membranes, winding round each

other, and describing so many small curves, from the

convex part of which a villous system of vessels, exceed

appears to be
Uigly fine and delicate, seems to arise, and

MEMOIRS, &C.

60
lost in the cartilages.

tion, that

Yet

am

convinced from dissec-

a very fine and delicate prolongation of the in-

ternal layer of the synovial capsule, covers the articular

surface of these cartilages to

pellicle

which

so intimately united that

is

can be separa-

when
ges

dissection.*
it

its

tended

It

would seem

the most de-

by

ted only with the greatest difficulty, and

licate

membranous

this
it

that this

membrane,

reaches the edges of the articular surfaces, chan-

texture and qualities. Nature appears to have init

to confine the

expansion of the cartilage, and to

smooth and polished surface, by

small inequalities that remain between the
produce

its

filling

up the

particles se-

by the vessels of the bones for having raised

membrane, the naked cartilage appears rough. I
creted

also of the opinion that this

bably insensible

membrane

assists in

This portion of membrane

ling the synovia.

:

it

seldom gives proof of

is

this

am

exha-

most pro-

its sensibility

even when acted on by a morbid cause; under

this sup-

position , it never assumes the inflammatory character com-

mon

membranes:

to other

membrane, or
cartilages or

finally, I

pellicle,f bears the

moveable

might say that

same

this

relation to the

joints, that the elongation of the

conjunctiva bears to the transparent cornea. If these cartilages

be subjected

to the action of boiling

water, they

will soon be reduced to a substance that resembles albu

men

in appearance,

with the external

and soon

air,

they are never affected

and

putrifies,

when

in contact

after chronicle diseases.

by inflammation or

Yet

obstruction

but in certain states of disease, they are dissolved and

destroyed most generally they become detached in lav.
:

* Nesbit, Hunter, Bichat, Portal,

this

membranous expansion.

and Boyer, speak of

| I shall speak of it again at the end of the worl*,

treating of amputation of the thigh.

when

CAMPAIGNS AT BOULOGNE, &C.

61

and separate from the

ers, or scales of various sizes,

bones, as I have seen after amputation at the joints, more

especially at the shoulder-joint.

This exfoliation was very evident

ral Daboville,

the battle of

in the case of

head of the scapula was struck by a

away

two-thirds of the

the shoulder

gene

who had the operation performed after

Wagram. The articular cartilage of the
arm and

ball that carried

of the prominence of

exfoliated in very thick lamiliae.

it

After the numerous extirpations of limbs, that I have

in consequence of gun-shot, or incised wounds

performed

of the joints, I have never found the diarthrodial

carti-

lages swell or inflame as has been generally supposed

same reason tumefaction cannot produce the

spontaneous luxations at the coxo-femoral articulation
that is often caused by rheumatick affections. On the

for the

contrary, this luxation

tion

and internal

is

the consequence of a destruc

caries, as I

preceding essay, and

in the

have attempted

in this opinion I

to shov.

have been

confirmed by examining a number of dead bodies.

gradual inflammation of the fibrous parts of the articula

tion takes place.

The

concretion of the cartilages

pended when the exhalation

grinds them

down and

The

ceases.

dissolves

is

them: the articular ca-

diminished in diameter, and the head of the

vity

is

mur

in thickness.

The round

the cotyloid cavity, and

partially,

rest

become

displaced, cither totally 01

and a luxation takes

rare circumstance.

The

on the depressed edge of

by distending the ligaments

lost their tone,

fe

ligament becomes detach

ed, in consequence of the internal inflammation.

head of the femur can then

bony

sus

least friction

that

place.

Most commonly,

have already
This

is

a very

the caries of the

pieces of the joint takes place as soon as the carti

lagesare destroyed, and the ligaments suppurate. Thei

follow abscesses and

fistulas,

which

after

having attack-

62

MEM0IR3,

&a*

ed the articulation, make their

rections.

way

out in different di

Instead of producing these

symptoms, the

rheumatick affection sometimes causes two bones to unite,

or to anchylose, by the production and reciprocal adhe
sion of the osseous vessels of the

by the

ligaments

ossification of the

cartilages take

no part

two

in

it.

articular pieces,

and

but the diarthrodial

This process I saw well

explained on a very curious skeleton which

my uncle,

Mr. Larrey, chief surgeon of the general hospital of Toulouse, sent to the royal academy of surgery in 1787, and
is

now deposited in the museum of the school you

will find

that the articular surfaces, far

which

on inspecting

it,

frpm being united, as would be the case if the cartilages

which cover them had been ossified, were on the contrary separated, except where the condyles were in con^
tact,

and there no intermediate substance remained.*

The

formation of these cartilaginous concretions

is

no

doubt owing to some particles of the cartilaginous substance that are crystalized on the surface of the condyles,

become detached and conglomerated

in the cavi-

ty of the joint, or perhaps these crystalized particles are

strained through the

little

vessels that arise

from the sy-

novial capsule, and the concretions thus formed, remain

suspended by a pedicle that breaks

quired a certain volume

new

when they have

particles of

ac-

albumen and

phosphate of lime collect on these cartilaginous nuclei, and

increase their size, as in urinary calculi.

which

Every cause

injures the cxhalant vessels of this fibro -cartilagi-

nous substance, makes

effusion.

This

is

it

liable to irregular action

and

the opinion of Alexander Monro.

times this substance

is

entirely dissolved

Someand mixed

* See the work of Choppart on diseases of the urinary

passages, where may be found a circumstantial account o!
the preparation of this skeleton.

CAMPAIGNS AT BOULOGNE, &C.

with the synovia, so that
absorbents then take

ry

it

it

The

disappears entirely.

up with that

it

63

fluid,

and car-

into the circulation. In such cases, the cartilaginous

concretions are not formed, but the articular extremities

of the bones being stripped of their proper covering, acquire the density and polish of ivory on their opposing

The freedom

surfaces.
is

of articular motion remains, butr

attended with a kind of rustling noise that produces

no inconvenience

to the person. I

have seen

many

case?

of this singular disease. Dr. Fabard, former surgeon

the artillery of the guards,

opening

his

body

is

a striking example.

ot"

On
were

after death, the articular surfaces

found deprived of their cartilages, and in appearance

appears that these cartilaginous concretions

like ivory. It

more commonly formed

are

tions, as in those of the

in the

ginglymoid

articula-

knee, of the jaw, and of the

feet,

and the

sulci

either because the inter-articular cartilages,

of these joints favour the conglomeration of the cartilagi

nous particles that are detached, or because the secretion

is

more copious

are orbicular.

in these articulations than in those

When

which

these substances are produced, thev

are loose and moveable in the joint, and pass from one
side to the other. If they

round the
person
ble

feels

but

when they touch

is

In the

When

there

moves about, forms tumours on

where: sometimes
it

move

case, the

the ligaments or the capsule of

the joint, escapes on the least pressure,

where

first

acute and piercing, and obliges the

patient to remain at rest.

it

in the knee, they

no pain, because the cartilages are insensi-

the joint, the pain

tion,

form

patella, or its ligaments.

it

is

but one concre-

the exteriour of

and appears

else-

becomes fixed between the condyles,

remains a long time, without inconvenience

to the patient,

who supposes that it is dissolved but it

new symptoms. To the acute pain, ge
;

reappears with

nerafly succeeds a swelling of the knee, in consequent*

MEMOIRS, &C.

64

of the stagnation of the synovia, the absorption of which

cannot go on, by reason of the irritation that takes place

and hence there is a stricture

and stoppage of the absorbents. All these symptoms united, leave no doubt of the existence of cartilaginous conin the capsular ligament

cretions of the joint.

We are ignorant of the primary causes of this

which may be various

sential causes, are blows, falls,

fine,

affection,

the exciting, and perhaps the

es-

and violent shocks, and

in

every mechanical cause that acts on the proper

substance of the cartilages,

where these conglomerating

and fall into the articular

particles lose their adhesion,

cavity,

and give origin

known by
by

to the concretions!.

They

are

the pain that attends while they are forming,

the difficulty of

moving the limb, by a swelling of

the

knee, and the protuberances at different parts of the

joint,

according to their change of place.

point

them

little

inconvenience

When

out.

The

patient can

small and soft, they produce but

but

when

arrived to a certain size,

they impede loco-motion to a great degree, and produce

a sympathetick irritation that injures internal

To remove

these

consequences,

it

symptoms, and

life.

to prevent unpleasant

indispensably necessary that these

is

foreign bodies should be removed.

This operation has

been performed in two modes: by cutting through the

soft parts, directly

by the
the

shortest

over the cartilage, and extracting

way

or by

making

opening of the teguments

it

the incision so that

shall not

be immediately

over that in the capsular ligament. It appears that

Sifri-

Monro, Reimaras of Edinburgh, and

Gooch, have pursued the first plan ; but they had to contend with symptoms so serious, that the attention of

son, Alexander

physicians have been called to the

management of

this

CAMPAIGN AT BOULOGNE, &C.

65

Bromfield and Hunter were the

second plan; and

who

has brought

first who adopted the

has since been followed by Desault,
to perfection (vide his " Journal de

it
it

Chirurgie."

This consists in making the opening in

the skin, as far as possible from that in the capsular liga-

ment:

in order to effect this,

drawn

considerably beyond the part where the opening

is to

he directs the former to be

be made in the capsule.

After the operation, he

unites the edges of the

tact

wound, and retains them in conby adhesive plasters. But this exact union is not free

from inconveniences.

The very strong pressure which

the adhesive plasters and the retaining bandage produce,
sometimes induces

irritation and inflammation of the

with such symptoms as generally attend them. This

joint,

re-union should be

made with

great care, and the dress,

ings should not press too hard

on any part of the

joint.

CASE FIRST.

Jacques Antoine Merlin, a native of Mezieres,and one

of our grenadiers, entered the hospital of the guards with

an acute pain that he had experienced

his left knee.

He

for a long time in

had an intermittent of an irregular

also

type.

On

examining him,

I immediately discovered a hard,

loose,

moveable substance

that

was a

it

in the knee.

cartilaginous concretion,

immediately proceeded

to extract

patient admitted. I found

febrile affection,

and

it

it,

had no doubt

and should have

had the

necessary

first

to

state of the

remove

the

to restore the strength of the patient.

This was effected by suitable remedies, and

after

twenty

days, he was in a condition to be operated upon. In order

that the operation

Vol.

xi.

might be attended with the wished

I

MEMOIRS, &C.

66
for success, I

made

the incision of the teguments at a

considerable distance from the articulation. After having

fully

extended the

leg,

pushed the cartilage from the

internal to the external side of the knee.

under the
foreign
ly

patella,

body with

my

fingers,

sion under the vastus

it

strong

make a

protru

about three fingers'

externus,

The articular

breadth above the articulation.

pushed up. After fixing on

to

capsule

I then cut

and a portion of the subjacent muscle.

it

was

instantly expel

Without attempting

led through the incision.

was

through the

the spot, I cut

the capsule over the cartilage, and

this

it

and by pressing

upwards and outwards, caused

skin,

While passing

produced no pain. I seized on

it

to re-unite

the lips of the wound, I applied a very simple dressing,

taking care to dip the bandages which were to surround

the knee in camphorated wine,
ful

which

to prevent pain and inflammation.

I have found use-

No

unfavourable

symptoms ensued, and the wound was completely cicatrized in twenty-five days. His cure would have been
more speedy, had his health been better.
The cartilage that I extracted was of a white colour,
of the size of an almond red on one side, and polished
on the other. Mr. Vauquelin analyzed it, and found that
:

it differed

sis

but

little

from

common

proves also that this cartilage

and a concrete mucus ;

sult follows

when

these

for

it is

cartilage.
is

formed of albumen

observed that the same

two substances and

put into water or diluted acids.

This analy-

re-

cartilage are

67

CAMPAIGNS A* BOULOGNE, &C.

CASE SECOND.

Berens, a grenadier of the imperial guard, was sent to

the hospital with an acute pain of the

continued for some time.

He was

left

knee that had

often obliged to stop

suddenly while walking, by the removal of a hard body

(which he said he could

to the

mobility

from one side of the joint

Indeed, on examination, I found two

other.

moveable

feel,)

cartilages of the size of a large

was

such, that

on the

almond

least touch,

their

they receded

from the finger, and lay hid in the joint. In order to extract them, I was obliged to press them up with one hand,

and

to operate

ration

with the other ; on

was more

tedious than the

successful. After extracting these

wound were
straps it was

of the
sive

this account, the ope-

first,

two

but

placed in contact by
cicatrized

it

was

equally

cartilages, the lips

means of adhe-

on the ninth day, and the

moving his leg. I am unacquainted with the cause which gave rise to the growth of
the
this cartilage, but from all appearances, it was more
lapatient
the
which
under
diathesis,
gouty
a
effect of

patient felt

no

stiffness

in

boured, than of any external cause. I had reason to suspect that the cartilages which surround the extremities

a
of articulating bones, were in part absorbed; for, besides
distinct rattling noise,
this

which was perceived on moving

joint, there was an incipient anchylosis in

it.*

For the shape and size of the cartilaginous concretions

which were taken from the subjects of the two foregoing
*

cases, see plate

68

MEMOIRS, &C.

Essay on Cerebral Epilepsy

To

conclude the account of the diseases which act

principally on the osseous system, I shall detail

some

cu-

rious cases of a species of cerebral or idiopathick epilep

But before I enter on this detail, I beg to be in

dulged in some reflections on the means of distinguishing
sy.

between the symptoms of true epilepsy, and of that

which

is

simulated

and I

cy of some remedies for

then point out the

shall

disease

this

effica-

which have been

successfully exhibited in analogous diseases.

It is

not always easy for a physician

who has

not had

great experience, to ascertain the difference between true

and simulated epilepsy; because there are some men,

who, in order to be exempt from military duty, will
bear the most severe

tests

without evincing any signs of

pain.

I think

and

will

it

to reflect

be only necessary to

moment on

the

class the disease,

manner

in

which volun

tary and involuntary functions are performed

to distinguish true from

in order

Let us supmost common.

What are the phenomena that accompany its parox
ysms, and what difference is there between the accession of true epilepsy., and the accession of that which is
feigned? These signs may be divided into those which
pose that

it is

simulated epilepsy.

the cephalick, which

are permanent, and into the signs

ysm. The former are equivocal,

as in simulated epilepsy.
or hereditary,

more or

less

it

But

if

is

the

which attend the parox

if

the disease be recent,

the disease be chronick

produces a uniform series of symptoms

prominent, which the practitioner

knows

at

CAMPAIGNS AT BOULOGNE, &C.

sight,

and quickly analyzes.

a few words, with

69

I shall lay them down

some remarks that are necessary.

in

celebrated professour of the university of Montpel-

Her, says that the lengthening of the facial triangle

uniform and pathognomonick symptom of

Without pretending

to

deny an

is

this disease.

from a source

assertion

me

so respectable, the author of it will pardon

for obser-

ving that the disease must have existed from infancy in

the patient, before such a change in the frame of the
face could take place,

and that

it

must be caused by an

organick defect in the thick portions of the superiour

make

maxillary bones, so as to
acute.
in the

bones of the cranium,

brain

itself.

Yet the

resides

the meninges, or in the

in

alteration

more

the facial angle

But most generally, the cause of epilepsy

of these parts cannot

influ-

ence the form of the face, unless in consequence of rachitis,

or some other taint which affects the evolution of

the bones that compose

it.

That

this

angle

is

more acute

we can easily conceive; for

we know that in the negro, whose facial angle is more acute

than usual in some epilepticks,

than in the European, the intellect

it

more

is

limited: but

does not thence follow that the lengthening of this an-

gle

becomes a cause of

epilepsy.

At

least

it

is

useless to

seek for the certain symptoms of a disease in the geometrical variations

of the face,

when we can

distinguish

it

without trouble by means of other and more correct indications that

anatomy and physiology

In the epilepsy, of which

we

furnish.

speak, which has

in the head, the brain is either directly

changed

its

seat

or indirectly

and hence the symptoms that mark

its

acces-

sion; such as a dull pain in the head, vertigo, and the

falling of the

person,

if

he be erect: a change

lectual faculties, in the voice, speech,

eyes arc

more or

involuntarily,

less distorted, the

and

in the intel-

sight.

The

muscles contract

and in a convulsive manner.

All these

70

MEMOIRS, &C.

symptoms may be

simulated, especially

has acquired that habit by practice.

when

the person

But he cannot,

for

example, imitate the emission of thick and frothy saliva,

which

is

secreted during the accession, nor the dilatation

of the pupils, wliich

is

not dependant on the will. In the

real epilepsy, the pulse is slow,

and seldom strong; in

the other, on the contrary, like the respiration,

it

is

hui%

and the contraction of the muscles is not simulta

neous, as in the true epilepsy: and the person cannot disried,

tort his ejes as

done involuntarily in the former case.

is

In proportion as the disease acts on the nerves of animal

life,

so does

disturb

it

and paralyze the

functions.

dition to the injury of the intellectual faculties,

In ad-

an invo-

luntary hanging of the superiour eye -lids ensues, an in-

head forwards, on account of the small

clination of the

contractile power

which gives
and the gait is irre

of the extensor muscles,

the face an appearance of stupidity,

gular and tottering.

These symptoms are always more or less evident in

epilepsy of the same species above mentioned, especially if the disease

be hereditary and chronick, and can-

who have

not be mistaken by those

But

is it

the cranium or of the

success
tail,

I think

confirm

me

it is,

membranes
and the

its

return.

This

its
is

sician, unless the epilepsy

But

little

experience.

of the brain, with

facts that

in this opinion.

not necessary to regulate

riod of

possible to prescribe for organick lesions of

For

any

I shall soon de-

this

purpose

it

is

accession, or to fix the pe-

not in the

power of the phy-

be accidental or sympathetick.

internal or external prescriptions, that

have the pro-

perty of dissolving osseous or lymphatick tumours, such

is

enlargement of the bones, exostoses, fungi, and indu-

rations of the

membranes, by removing

atc the disease

and

its

consequences

this

cause obvi-

CAMPAIGNS AT BOULOGNE, &C.

71

The remarkable success that I have had in the treatment of inveterate venereal exostoses, by the internal use
of the muriatick acid,

and by the application of mercu

rial

preparations and vesicatories on these tumours, has

led

me to

same means might

believe that the

also

be em-

ployed, with equal advantage, in exostoses of the crani-

um,

duce epilepsy. But

be

which often

or indurations of the dura mater,

tried

it

is not sufficient that these

in-

mean?

once or twice ; they should be continued for a

long time, with suitable variations

when

the virus

is

de

stroyed, the repeated use of blisters should be persist

ed

in.

The

following cases

may

tend to inspire confidence in

these remedies

case first.

Louis Lombardi, a grenadier of the guards, aged 22,

was admitted

into the hospital for

mours on the head. They

red on the surface. This
parts affected

he was

fluctuated,

man

felt

two anomalous tuand were slightly

constant pain in the

in a soporose state,

and had

fre

quent attacks of epilepsy.

The two tumours were opened with

strument.

We

um, opposite

a cutting in

discovered a deep caries of the crani

to

table of the bone

these small

was

abscesses.

The

internal

perforated, and slight pulsations

of the dura mater might be perceived below the open

The

ings.

discharge of pus from these abscesses had re

licved the patient, as

mater.

it

had before pressed on the dura

The epileptick paroxysms were

of shorter duration

less frequent,

and

but the caries advanced, and the

symptoms became more

acute.

The

epilepsy could be

72

MEMOIRS, &C.

re produced at pleasure,

by making gradual pressure on

one of the fungi of the dura mater, which rose above

the opening of the caries: these fungi were proportioned
to the size of the apertures.
thirtieth

we
that

day

patient died about the

The

On

after his admission.

opening the body

two fungous tumours on the dura mater,

appeared to have been produced by the same cause*

discovered

from which the caries

arose.

It

was easy

to see that the

caries

had perforated the cranium externally and

nally.

The two fungous tumours

inter-

pressed the brain

im

mediately opposite to these apertures, and brought on the

The

epileptick paroxysms.

striking analogy that these

tumours bear to those which attend caries of the cranium,

confirmed syphilis, for which I have

in consequence of

often successfully prescribed antivenereals

tiek acid, induces

me

and muria-

to believe the fatal termination

the above case might have been prevented,

if

of

these re-

medies had been sooner exhibited.

CASE SECOND.

Barthelemi Thevenet, a
tered the hospital with
fulous appearance,

on

On

aged twenty

his neck, attended

the head and epileptick

had been subject

fusileer,

six,

two enormous tumours of a

fits,

to

en-

scro-

with pain of

which he informed us he

for several years.

inquiry, I found that in 1802, he

which was thought

A gun shot wound

had had

syphilis,

to have been treated methodically.

that he received six years after, while

* The patient had never been able to answer

the questions put to him relative to this cause ; but we
supposed it
to be the consequence of the venereal virus,
as he had a
stigma on the penis, which arose no doubt from
a chancre,

-CAMPAIGNS AT BOULOGNE, &C.

73

with the army of Spain, in the anteriour part of the

thigh,

was followed by the hospital fever, and the hosWhen the wound healed, he felt violent pains

pital sore.

in the

head that yielded

to

a spontaneous purulent

dis-

charge from the ears, in the fourth month of his stay in

the hospital.

Some time after, this discharge stopped, and

a buzzing and deafness succeeded in the same ear.

had vertigo and

dition

paroxysms. In

slight epileptick

he entered the hospital of the guards.

He

this con-

The

plication of several leeches to the temple, blisters

ap-

behind

the ears, and internal remedies alleviated the symptoms,

and promoted the formation of a bubo or abscess in the

groin, which was unfortunately prevented from suppurating, by resolvents. From this period the paroxysms
of epilepsy became more frequent and violent, the glands
of the neck tumefied, and two or three of

The

patient

was now removed

into

my

them burst.
Always

wards.

suspecting a syphilitick cause, I prescribed anti-syphiliticks,

combined with such medicines

The

scrofula.

fluctuation

being

as

fell

When

the es-

was suddenparoxysm of epi-

off about the fifth day, the patient

ly surprized in the night

lepsy, followed

by a

violent

by a complete hemiplegia of the

with a suspension of his

side,

in

apparent in both tu-

mours, I applied caustick potash to them.

chars

were proper

intellectual faculties,

left

and

of the use of his senses. Notwithstanding this state of

stupour, he pointed out a painful part at the hypochon

drium of the paralyzed

side.

large blister being ap-

plied there, immediately relieved him,

tick

fits

were suspended.

always the same, that

is,

of motion and sensation.

and the epilepBut the hemiplegia remained

the limbs remained

A few

days

incapable

after, the pains of

the head increased with the epileptick attacks,

and the

patient being in great danger, I ordered a blister to the

Having shaved
Vol. ii.

head.

his head, a considerable

i

tumour

MEMOIRS, &C.

74/

was perceived on

the right side, formed

by

the

squamous

portion of the temporal bone, and the inferiour part of

second projection at the top of the crathe parietal.

nium, gave

it

the shape of a cone.

The

first

blister

co-

sensible

vered the crown of the head, and produced a

in his symptoms. I then prescribed a dia-

improvement

phoretick drink for him, acidulated with muriatick acid

an antipills of camphor and opium in the evening, and

syphilitick solution, one ounce to be taken in the morning in milk.* I gradually increased the dose of camphor
to a

gramme a

day.

The

pain of the head moderated,

the paralysis evidently improved, and the epileptick pa-

roxysms were suspended.

New abscesses

having formed

on the neck, I applied the caustick potash to their fluctuating points: a secuml blister was applied to the neck ;
and a

third

on the tumour of the temporal bone. The

same regimen and remedies were continued.

Sensation and motion gradually returned to the para

lyzed limbs.

The

patient daily recovered the use of his

senses and intellectual faculties, but he periodically

chills of the left side of the

felt

body, to which succeeded an

undulatory motion of the extremities and of the head.

This phenomenon took place more especially in stormy

weather.

The

suppuration of the sore of the neck being sup-

pressed by some

of epilepsy, but

unknown
it

was of

causes, he

in re establishing suppuration in

and

had a new attack

short duration.

in applying a fourth blister

I lost

no time

the scrofulous ulcers,

on the tumour of the tem-

* This solution is thus made: R. hyper-oxygenated mercury, muriate ammonia, opium, a. a. half a gramme, dissolve them in Hoffman s liquor, q. s. add this to one litra
of aq, dist.

&C

CAMPAIGNS AT BOULOGNE,

75

increased the dose of camphor, and persisted

ptisan, the
in the use of the muriatick acid in the same
dose of which was gradually increased. All these means
pie.

still

produced excellent

effects,

and the patient was

visibly

improving. But in a short space of time he had frequent

and very severe epileptick attacks, although they were
short.

The

blister to the

head was renewed, and one was

applied also to his right arm.

One day
violent

while paying him a morning

by

epilepsy, followed

paroxysm of

visit,

he had a

convulsions,

and an extreme prostration of the vital powers. I ordered

the eighth blister to be applied to the temple I also ad
ded bark in substance, ether, and generous wine to the
powerful antispasmodicks that he was using. For the
:

arm a

blister of the

cautery

was

substituted,

and the

dis-

charge kept up. Since the above attack, Thevenet has

had no more the paralysis has entirely left him, and he
:

has been gradually restored to the complete use of his

physical and intellectual functions.

The

scrofulous ve-

nereal ulcers have healed, the bony projections of the

cranium have disappeared, and his head has resumed its
natural shape

in fine, I think that

of a disease that
cially at

We

is

he

is

completely cured

generally considered incurable, espe-

a stage so advanced as in this case.

may now

inquire to

employed, the cure

believe that they

which of

the

of this disease is to

all

means
be

that

were

attributed. I

co-operated, but the chief benefit

was derived from the vesicatories and the muriatick

acid. The following case seems to confirm this opinion

MEMOIRS, &C

76

CASE THIRD

Dutertre, a chasseur,
past had

been subject

44 years of age,

for a

year

to attacks of cerebral epilepsy,

which frequently returned. By falling on his head at the

accession of a late paroxysm, he broke the vessels of
the integuments that pass from the right temporal region
to the

aponeurosis of the crotaphite muscle.

The

conse-

quence was a sero-sanguineous effusion, inflammation,

and a large abscess, for which he was brought to the hospital of the guards.

Emollients were used for several days, and

when

the

became evident, I opened it

great quantity of pus was dis-

fluctuation of the abscess

by a

large incision.

charged, and the patient obtained immediate

rected

him

ded muriatick acid

he also took

opium; the dose of the

to a

relief.

I di

to use a ptisan of valerian, to

gramme each

latter

pills

which was adof camphor and

was gradually increased

day.

The wound became clean and cicatrized: his counte

nance, which at the period of his admission was much
altered, resumed its ordinary appearance, and
this soldier, who never again had a return of the
disease reco
vered as completely as the subject of the former
case. In
this the abscess

which formed under the teguments

produced no doubt the same effects as the vesiccatories

did in

the former case.

CAMPAIGNS AT BOULOGNE, &C.

The memoir on

my

amputation, which formed a part of

surgical account of the

several years since,

many

is

army

of the east, published

inserted here, because

observations that

were made during

of which I have already given a history.

also

added some

77

facts that

it

contains

the campaigns

To

it

I have

occurred in the subsequent

campaigns, and properly belong

to this dissertation

MEMOIRS, &C-

78

MEMOIR

ON AMPUTATION.
A FTER the battle of Fontenoy, the royal academy of
-*-*- surgery

to

" Isitadviseable

proposed a prize question

amputate immediately after gun- shot wounds, or should

the operation be deferred." This question could not

answered

in a satisfactory

who had performed

and

on the

the operation

medal

to

field

of battle,

The academy

in refusing

Le Comte, because

his doctrine

in the military hospitals.

to adjudge the

be

manner, except by surgeons

was not confirmed and supported by his practice, gave

wished the military

the publick to understand, that they

and

hospital -surgeons alone to

be candidates for the

prize.

The medal was

given to Faure

but

have not adopted the principles of

twenty years of

continued

all

practitioners

this author.

Since

war has brought our

to the highest degree of perfection,

we

art

can have but one

opinion on this subject. After having acted so long as

surgeon

in chief

have ventured

to

issued from the

and inspector general of the armies, I

examine the various opinions that have

academy, and

to

attempt to

settlement of this great question,

most important
*

make

a final

which I consider the

in military surgery.*

The fundamental

part of this

which

memoir formed the

sub-

defended in the special school of

medicine at Paris, in 1803, for the degree of doctor of phvsick. (See No. 1, " Recup.il des Theses, 4to.")

ject of the thesis

79

CAMPAIGNS AT BOULOGNE, &C.

If

it

be said that the amputation of a limb

operation, dangerous in
fortunate for the

its

wounded, who are

and consequently, that

state,

we

in a mutilated

left

shall gain

by preserving a limb, than by amputating

rity

we

and success,

shall

ving that amputation

it

is

a cruel

is

consequences, and always un-

more honour
it

with dexte-

answer triumphantly by pro-

an operation of necessity,

that

affords a chance of recovery to those unfortunate per-

sons

who must certainly

die

under any other treatment,

and although there be no doubt that amputation

is

indis

pensable to the safety of the wounded, the difference

of opinion relates to the nature of the cases which deci-

dedly require
operation.
is

much

it,

and present

We can even add

positive indications for the

that the chance of success

when

the question

was

Indeed Fure informs

us,

greater at present, than

proposed by the academy.

that of near three

hundred amputations, which were

performed after the

battle of

successful, while

Fontenoy, thirty only were

more than three-fourths have recovered

some of whom even lost two limbs
success, 1st, to a more correct know-

after our amputations,

We ascribe this

2dly, to more
more simple, speedy,

ledge of the proper time for amputating

methodical dressings

and

less painful

3dly, to a

operation than has been heretofore per

formed.

Of

When
that

it

ately.

a limb

is

Primitive, Amputation.

so

much

cannot be saved,

The

first

it

injured

by a gun-shot wound

should be amputated immedi-

twenty -four hours

is

the only period du-

ring which the system remains tranquil, and

we

should

MEMOIRS, &C

80

hasten during this time, as in

dangerous diseases,

all

to

adopt the necessary remedy.

In the army,
sity of

1st.

many

circumstances enforce the neces-

primitive amputation

The

tion of the

inconvenience which attends the transporta-

wounded from

the field of battle to the mili

tary hospitals on badly -constructed carriages ; the jarring

of these

and

wagons produces such disorder

in all

wounds,

in the

the nerves, that the greater part of the

ed perish on the way, especially

if

it

wound-

be long, and the

heat or cold of the weather be extreme.

The danger of remaining long in the hospitals.

it conThis risk is much diminished by amputation
verts a gun-shot wound into one which is capable of be2dly.

ing speedily healed, and obviates the causes that produce

the hospital fever and gangrene.

Sdly. In case the

on the

field

tion should

wounded are

of battle:

it is

of necessity

abandoned

then important that amputa-

have been performed, because when

pleted, they

may remain

com

several days without being

dressed, and the subsequent dressings are

accomplished. Moreover,

it is

it

more

easily

often happens, that these un-

fortunate persons do not find surgeons sufficiently skilful

to operate, as

we have

military hospitals

seen

among some

were not organized

nations

like ours.

whose

CAMPAIGNS AT BOULOGNE, &C.

Si

f)f Cases which require immediate Amputation

CA-SE

When

a limb

is

is

The

necessary.

away by

carried

ing of a grenade or

FIRST

bomb,

least delay

by

a ball,

the most

the burst-

prompt amputation

endangers the

life

of the

wounded.

The

skin then has been violently dilated and lacerated^

the muscles broken

and vessels

cut,

and irregularly torn

and forcibly stretched

off

have been crushed and fractured more or

These

ly.

first effects

are followed

the nerves

finally, the

by a general or

commotion, by numbness of the injured

tial

the greater part of

bones

less extensive-

the truncated limb,

part,

by a

par-

and

painful

wounded extremity, that is particularly

distressing to the patient and by a local obstruction that
precedes erethismus, which soon takes place. The&cewiorrhage is more serious than is generally supposed often
commences in a few minutes after the wound has been
inflicted, and would soon terminate the sufferings of the
wounded, unless he received the most speedy assistance.
agitation of the

I may even assert, that without the assistance of the flying ambulance, by which the wounded were always

dressed on the field of battle, a great number woidd have

died

from this

cause alone.

If amputation be not promptly performed, pain

on, a fever

is

lighted up,

irritation continually increases,

vulsive motions. If the patient

these

first

Vol.

symptoms, the
ii.

comes

and the functions are disordered:

solids,

and shows

itself

by con-

should not sink under

after being forcibly dis-

98
tended,

fall

into a complete atony, gangrene takes place

in the stump,

and

its

injurious effects are

with

difficulty

obviated.

From this short view it

is

easy to conceive, that in this

case amputation should be performed immediately. If

it

be delayed, and a single dressing alone applied, the con

sequences above enumerated

At

bombardment of the fort of

volunteers were wounded: one had

Strasburg, during the

Kell, in 1792, three

his

may be expected to succeed.

arm, another his fore arm, and the third

away by

the bursting of a

to the hospital of that city,

his leg carried

bomb. They were removed

under the direction of Mr.

Boy, a surgeon of the first class. He temporized with

them several days- before he amputated, and neither of
thorn survived.

During the
the

retreat

from Mentz

wounded who had

tation

performed

until

to Frankfort,

their limbs shot off,

some time

after,

many

of

had no ampu-

and not one of

them recovered.

When
formed

Saourgio was taken, two amputations were perNice, in hospital No. 2, (one of the arm and

at

the other of the fore-arm) nine or ten days after the

wounds had been

On my arrival

inflicted,

at

and both these

soldiers died

Perpignan, I visited two soldiers at

whom amputation had been performed seven or eight days after the 14th July, 1791,
when they were wounded. One had a leg carried away,
and the other had lost his right arm. Notwithstanding all
the Brutus hospital on

my care, one died

of tetanus, and the other of gangrene.

In the month of August, 1B05, two cannoniers of
the

by discharging the artillery, had each one hand

carried away, and the whole anteriour surface
of the body
scorched. They were engaged in charging
the piece, and
M they were ramming down the cartridge, a spark of
guards,

fin

CAMPAIGNS AT JB017X0GNE, &C.

that

S3

remained in the gun communicated with the powder.

The right hand of one artillerist was torn off between

the two rows of the carpal bones, and carried more than
200 paces. The left hand of the other artillerist was torn
off

with the fore-arm at the elbow

equally as
cles

were

joint,

and carried

The tendons and integuments

far.

also lacerated,

of the musand had not amputation been im-

mediately performed, the most alarming symptoms must

Jhave ensued.

As

was present

in the hospital

when

the

two men were brought in, I operated on them instantly.

Both operations were successful, although the burns of
the face and thorax in both were very severe and extensive.

I shall

two

make some important

cases,

deductions from these

and on the speedy cure of

deductions shall appear in a

their

work that

stumps

these

I intend to publish

on gun-shot wounds.

CASE SECOND.

When a body is projected from a cannon, and strikes a

limb so that the bones are fractured, and the soft parts
violently contused, extensively torn

and broken up, am-

putation should be instantly performed, otherwise

the disorganized parts will soon
the

symptoms

certainly ensue.

that

fall

into gangrene,

all

and

appeared in the first case, will most

MEMOIRS,

84

&C

CASE THIRD.

When

a large portion of the soft parts and the prin

cipal vessels of a limb (of the thigh for example) are carried

away by

ball,

and the bone

is

fractured,

tion should be immediately performed

amputa

for besides the

consequence of a great loss of substance, the limb must

of necessity fall into sphacelus, in consequence of the rapture of

its

blood-vessels.*

* That a limb does not of necessity fall into a state of

sphacelus in consequence of the division or rupture of its
principal blood-vessels, every surgeon well knows. The success that follows the common operation for aneurism of the
principal arteries of the extremities, would alone render
the doctrine of our author on this point inadmissible.
are yet perhaps ignorant of the extent to which the large
arteries of the body may be tied, without producing a fatal
termination. Mr. Abernethy, and other surgeons of Europe, have reported four cases in which a ligature was applied on the external iliack artery for aneurism seated high
up in the groin, and the patient recovered completely. Dr.
Dorscy of Philadelphia has also given us the account of a
similar operation by himself, attended with the same favourable results.
On the 27th of July, 1812, Mr. Williams of this city,
aged about thirty years, was wounded by a ball which penetrated the abdomen, and opened the abdominal aorta.
The haemorrhage was profuse. Dr. Gibson, in presence of
several physicians, dilated the wound, and applied two ligatures on this artery, above its division into the great iliacks;
and the haemorrhage ceased. On the third day after the
operation, the circulation and warmth were re-established in
the inferiour extremities: he survived the operation twenty-two days, and finally died of peritoneal inflammation.
On examining the body after death, the aorta abdominalis
was found to have been tied, and divided at the part before
mentioned. Did the blood in this case circulate from the
heart to the inferiour extremities, through the internal mammary and epigastrick arteries, as suggested by Dr. Cocke?
The publick have the promise of a more minute account of
this interesting case from Dr. Gibson.
Tr.

We

85

CAMPAIGNS AT BOULOGNE, &a

CASE FOURTH

When

a large ball strikes the thick part of a limb,

breaks the bone, cuts and tears the muscles, destroys the
great nerves, and yet leaves the principal artery entire,

immediate amputation should be resorted

to.

It is ren-

dered necessary by the destruction that has taken place

in the limb,
to

its

and by the concussion that has been given

whole substance.

CASE FIFTH.

If a spent or rebounding ball strike a limb obliquely,

without causing a solution of continuity in the skin, as

which

resist its action,

such as

the bones, the muscles, tendons,'the aponeuroses,

and the

often happens, the parts

vessels

may

be broken and

torn.

The

nal injury must be ascertained and

tured under the soft parts, and

if

if

extent of the interthe bones be frac-

there be ground to sus-

pect that the vessels are lacerated (which

by

may be known

the enlargement, and a kind of fluctuation) amputa-

tion should be

performed without delay* But sometimes

the vessels and the bones have been spared, and the

muscles alone have been almost

Then an

incision should be

made

totally disorganized.

in the skin,

according

* This is the opinion of the celebrated Percy, who has

also met with such cases. See his reply to the board of
"
health, inserted in his excellent work on " Fyrotechnia

MEMOIRS,

8b

&u

by

to the advice of Lamartiniere:

this

means, the thick,

black blood

escape, and the conse-

quences

incision

may be permitted to
may be predicted. This

sary before amputation, in order to

also neces-

is

become acquainted

with the extent to which the parts are disordered.

To

such an injury of the internal organs,

tribute the death of

many

persons

who

may we

at-

a long time

for

have been supposed to die by the commotion produced

in

the air by a ball that brushes past the different parts of

the body, or changes or intercepts the column of air
serves for respiration, just as

it

is

which

about to enter the

trachea.*

Although

this opinion

of surgeons, and by

may

has been admitted by a

be easily convinced of

tentively,

bodies,

1st.

its

the direction

fallacy, if

pass.

we

aerial fluid

and

lastly, the

which are

2dly. the internal injuries

motion by the

sole-

ball. 3dly.

properties of elastick bodies, such as the

integuments, the cellular

by a

solid

through

observed in persons whose death has been attributed

ly to the action of the air set in

we

consider at-

and motion of hard

and their action on the

which they

number

a great portion of the physicians,

membrane, &c. when touched

ball

All physicians agree that a solid body in

through a

fluid, acts

base of which

is

moving

only on a column of that fluid, the

nearly equal to the surface of the solid

body.t

Thus a common
equal to

its

ball in

passing through a space

diameter, displaces a portion of air, that

when compared

to

the

volume of the

* See a treatise on gun-shot wounds

The memoir of Lavacher inserted
academy of surgery.

ball

is,

as three

by Ravaton.

among

those of the

CAMPAIGNS AT BOULOGNE, &C.

This

to two.

87

being divisible, and like the sur-

fluid

rounding atmosphere in its properties, is divided,

gives
way on all sides, and mingles with the general
mass
air. The effects of this aeriform
substance can be
of no consequence, and there can be no doubt
that if the
smallest solution of continuity take place in
our bodies,
it must be from the action
of the ball itself.

of

we consider that the rapidity of a ball from

Besides, if

gun diminishes
thedi stance,

in

we

an inverse proportion to the squares of

shall find that the

has traversed before

it

space which the bullet

arrives at the mark to whichit

was

directed, will have considerably

weakened the velocity

of this projectile, and consequently must
entirely destrov
the velocity of the column of air which
precedes it.
Physicians

who

posed, support

it

support the opinion to which I

by a

particular experiment, of

am

op

which I

shall give a succinct account.

By means of an air-gun, they shoot a bullet

mass of argillaceous earth, placed on a deal

into a soft

board, at two

thirds of the distance to

which the ball can be thrown.

Instead of finding a hole in this soft
earth equal in diameter to the ball, we find an opening two
or three times
as large, and of an oval form. These
physicians refer

to

the action of the air impelled forward

they contend that

soon as

by

the ball,

and

ceases to carry forward this

air as
passes through the mass: so that
the particles

it

it

of this paste are separated in every

direction, and leave

anexcavation.

But is it not more probable that this

phenomenon is
owing to the oblique motion that the ball describes
on
two lines which it describes in entering this soft and
non-

elastick substance,
first

and

in passing out of it?

instance, the ball has

when
gives

it-

it

rebounds, the

by

its

resistance

commenced

its

elasticity,

in the

parabola, and

new motion which

and

For

the plank

causes the ball tc

MEMOIRS, &t,

88

its first line, and to follow a different course

These two angles, which are more or less obtuse at

vary from

the points of incidence

and

we may

reflection, I think

say, cause the separation of the particles of argillaceous

by the sudden projection which the

struck by the ball gives them;*
and they give way more easily because they have no
earth ; this is increased

part of the plank that

is

elasticity

The

motions which the bullet performs

different

course, and the elasticity of the skin,

how the

internal injuries take place without

solution of continuity,

The

ball

moves

in

it

meets any part of our body,

to turn

on

When it

but after the ball has passed to a certain

tion.

its

and the attraction

takes on an irregular motion that causes

axis in a diagonal direction.

arrives at the

end of

round part of our body,

strike a

tion of

it

its

its
it

course,

if

it

chance

to

passes over a large por-

circumference by means of

its

curvilinear

mo-

In the same manner does the wheel of a coach pass

obliquely over the thigh Or the leg of one

ed on the ground

same

it

in proportion to the size of the

distance, from the resistance of the air

of gravitation,

an external

and often without an ecchymosis:

would carry them away

projected body

in its

explain

a rectilinear course by the projecting

cause. If at this instant

it

may now

as in the case

and

in this

who

stretch-

is

case the result

is

the

above mentioned. The most elastick

parts yield to the blow of the bruising agent, and such

as resist, as the bones, the tendons, muscles,

aponeurosis, are fractured, broken, and torn.

and the
some-

It

times happens that the vicrera are also torn.

At
more

first sight,

attentive

nal disorder.

every part appears to be sound

but a

examination leaves no doubt of the inter-

The ecchymosis under such circumstances

cannot always appear externally, because the vessels

which pass from the skin

to the internal parts are

broken

CAMPAIGNS AT BOULOGNE, &C.

tip, so that

the blood

89

effused into the deep cavities pro-

is

duced by the rupture of the muscles and other

and cannot penetrate the texture of the

sions then can only

be

known by

Experience supports

this

parts,

These

skin.

effu-

the touch.

reasoning.

Have we

not

seen a ball knock off the helmet, the hat, the cartridge-

box, and knapsack of the soldiers, and other portions of

theirdress,withoutinjuringthem?
ries

away

The same ball that

car-

body of his comrade

thence it passes between

an arm, often touches the

without doing him the least injury

the thighs of another soldier, and they scarcely have an

ecchymosis where they have been

ball

may

separate the

of the thorax

arm from the

may not be

and

slightly bruised,

in such cases only can ecchymosis take place.

Again, a

trunk, and the organs

injured.

Captain Meget, while marching at the head of a co-

lumn of

infantry at the battle of Altzey, fought

March

by the army of the Rhine, had his left leg

almost entirely carried away by a large ball, while the
leg of his lieutenant that was in juxtaposition with his,
experienced no injury. The general commotion (which
30th, 1793,

was very

made

violent)

and the rigorous cold of the season

The immedi-

the captain's situation very critical.

ate amputation of the thigh arrested the progress of the

symptoms, and he

w as

able to support the fatigues of a

removal

to the hospital at

from the

field

of battle,

Landau, about

where

I shall omit the accounts of

that I

performed in similar

Captain Buffy of the

other amputations

cases.

artillery,

Rhine, was wounded by a

Jeft

many

five leagued

was completed.

his cure

in

the

bomb which

army

of the

disorganized his

fore-arm, and grazed his head, so that the lateral an-

teriour

brim of his hat was cut off close

Vol.

ii.

to the

crown

his

MEMOIRS, &C.

90

nose was also skinned. Yet, he had the courage to com

mand his company for some time, and was then brought
to

my

was

ambulance, where I amputated his arm, and he

well on the 30th day.

When

a bullet strikes a part of the body obliquely,

which follow the

produces the

effects

ball, but in

less degree.

makes

bullet

it

partial stroke of a

various windings that a

The

limb are also matter

in the fleshy part of a

of surprize.
I think that the case of

I return to the subject.

am

delay endangers the

ved

which

speaking requires immediate amputation: the least

we

that

struck

I have obser-

wounded.

of the

can discover the ruined condition of the

teriour of a limb

and the

life

by

the touch,

loss of sensibility in the parts that

and

by

finally,

in-

by the want of motion,

the incision

which

have been

I have recom-

mended.
In order that I

may

support the principle advanced in

opposition to the opinion of

leave to

At

make a

the seige of Roses,

from the trench to

similar.

Both

teriour part,

many

authors, I shall

beg

digression.

two

artillerists

my ambulance,

their shoulders

by large

The

balls

were brought

with wounds nearly

had been grazed on the posthat had nearly completed

had a small ecchymosis on the

whole posteriour region of the thorax, without any ap
parent solution of continuity. He breathed with difficulty and spit a great quantity of frothy vermilion blood.
their parabola.

first

His pulse was small and intermitting, and

ties cold.

He

his extremi-

died about an hour after the accident, as I

had predicted.

opened

his

body

in

presence of Mr.

Dubois, inspector of the military hospitals of the

army

who honoured me with his prethis seige. The skin was sound,

of the eastern Pyrenees,

sence during a part of

the muscles, the aponeurosis, the nerves, and the vessels

CAMPAIGNS AT BOULOGNE, &C.

of the shoulders were broken and torn ;

9i

the scapula

crushed, the spinous processes of the corresponding dorsal vertebrae,

bouring ribs

and the posteriour extremities of the neighwere fractured: the spinal marrow was fill-

ed with blood, the parenchyma of the lungs towards these

was broken, and

parts

there

was a

considerable effusion

into both cavities of the thorax.

The second

artillerist

died with the

same symptoms

three quarters of an hour after he entered the hospital.

On

opening

his

der as in the

body, I found the same internal

first.

In the army of Germany,

my

under

observation,

have always convinced

propelled

disor-

me

many

and

investigations

when

that orbicular bodies

by gun powder have acted

where any part of it has been

directly

Jiving body,

came

similar cases

minute

on the

injured

CASE SIXTft

When

the bursting of a

bomb

or the stroke of a ball

has fractured the articular extremities, more particularly

those which form the knee, or the ankle-joints,

when

the ligaments

which surround these

and

articulation?

have been torn or broken up, immediate amputation be-

comes indispensably necessary.

The same
bury

itself in

indication will present, if the foreign

body

the thickest part of one of the articular ex-

become wedged into the articulation, so

cannot be extracted by simple or ordinary means.*

tremities, or

that

it

This advice should not always be followed; for in some

where the ball is made of lead, and i no larger than

cases

MEMOIkS, &c.

92

By this means alone can the acute pains which always

succeed to fractures of the great articulations be obviated
and

also spasms, violent convulsions, acute fever,

the

considerable tension and inflammation of

limb: but

if

and

whole

the voice of experience will not be heard,

and the amputation be postponed, the parts will soon

b</

disorganized, and the life of the wounded endangered.

It is evident then in this case, that amputation should

be performed within the

twenty -four hours at

first

twelve hours, or within

furthest, if

we

wish to save the pa

tient from sinking under the consecutive symptoms.

Fame

himself advocates this practice in

some

species of

wounds

CASE SEVENTH

Has
a

a large biscayen, a small ball, or the fragment of

bomb

passed through a limb, and denuded a large por-

tion of its bone, without fracturing it?

though the

soft parts

may

saved, yet amputation

violent shock

is

appear as

if

In

this case, al

they might be

not less indicated. Indeed, the

which such a cause produces, has agitated

and disorganized

all

the parts.

The medullary

substance

broken down, the vessels are lacerated, the nerves

distended beyond measure, and rendered insensible, and

is

the nervous fluid can no longer circulate in

muscles have lost their

and

irritability

elasticity,

and

them

the

their circulation

have ceased. Yet, before a decision be

made, the symptoms which characterize

this disorder

a musket-ball, it may remain many years in the joint, and/

perhaps, during life, without causing much inconvenience
after the first symptoms
Tr

CAMPAIGNS AT BOULOGNE, &C.

93

should be attentively considered. This rule will not ap-

where the bone is very superficial, and is

anteriour part by nothing but skin.
The following symptoms will appear: the limb is in
sensible, the foot becomes cold, the bone partly uncover

ply to the leg

covered on

ed, and

if

its

your inquiries are extended further,

it

be

will

found deprived of skin, and even of periosteum to a great

The

extent.

concussion

obstructed

propagated

is

functions are disorganized

all

to a distance

heavy and watry:

finally, the

the eyes

falls,

vvounded person

is

The

retarded.

is

small and concentrated: the face

is

the

the operation of the intellectual faculties

suspended, and the general circulation

pulse

the secretions are sensibly

is

in

such

a state of anxiety, that he cannot remain long in one po

sition,

and requests

because

it

we

tion instantly

speedily removed,

When

all

these characteristick signs

should not hesitate to perform amputa

for

same day, and the

amples will

maybe

burthensome, and produces very acute pahi

is

in the knee-joint.

are united,

that his leg

fully

otherwise the leg will sphacelate the

patient soon die.

confirm

The

following ex

this:

Lieutenant Charles Henri Despres, thirty -two year?

of age, of the chasseurs of the Rhine,

lb.

12, 1793, in the forest of Beval.

the skin

sfarface

The

upwards round

to the anteriour

of the leg, and carried

tibia.

The
its

fibula

was

away almost

latter

all

the skin-

shattered, and the tibia frac-

condyles, without being displaced.

sensation and motion of the limb

had

passed through

at their inferiour

tured near

ball

ball

and the gastroencmii muscles

part, turned obliquely

of the

was wounded by a
September

shot in his right leg, at the affair of

also carried

wound was

away

were destroyed.

the calf of the

dressed according to

The
The

left leg.

This

and

I im-

art,

mediately amputated the right thigh. After having at-

MEMOIRS, &C.

94

weeks at the house of his

general Landremont, he was removed to Weis-

tended
uncle,

this officer for several

semburgh, where

During the
an

artillerist

his cure

was completed.

siege of Roses, of

was brought

to

which

I before spoke,

me who was wounded by

had ploughed up the anteriour part of the leg in

an oblique line from its internal and inferiour parts near
the tcndo Achillis, and about two centimetres from

ball that

and external part of the

which covered the anteriour part of

the malleolus to the superiour

calf: so that the

the tibia,

was

skin

entirely detached

from the inferiour to

The teguments of the calf had

a wound which was small when compared with the size
of the ball that had passed through them. Some portions
of the muscles were torn and contused the bone was
the superiour extremity.

fractured, but not displaced

lent, that

foot
I

was

the shock had been so vio-

was disorganized

almost the whole leg

cold,

wished

to

the

and the pulse small, &c.

amputate immediately, but

consult one of

my

colleagues

felt

inclined to

at

hand: he

who was

thought that amputation should not be performed, and

that the limb might be saved.
tion to this decision,

I submitted with hesita-

and only made some incisions in the

disorganized skin, and applied the dressing for fractures,

after

wetting them in sea-water.

The

critical situation

which we then were, did not allow me to attend to

this man, so that I might operate at another period. X
in

therefore sent
first class at

that

him

to

my

friend Ribes, a surgeon of the

the hospital of Figueres, with a request that

he would amputate as soon as possible.

Before he

did so, he in his turn consulted the chief officers of the

medical

army who were then

staff of the

They

advised that

night

all

it

should be postponed.

his leg sphacelated,

at Figueres.

The same

and he died the next day.

95

CAMPAIGNS AT BOULOGNE, &C.

A case
young

nearly similar

The

practitioner.

came under

the care of this

unfortunate termination of the

induced him to propose the operation immediately

first,

same surgeons opposed it, and decided

the primitive symptoms should be permitted to sub-

in this: but the

that

was then performed on the day

side: the operation

pointed, but could not save his

ap-

life.

After the battle of Eylau, I met with two officers of

the imperial guard,

the preceding.

induced

me to

whose cases were nearly

The repugnance

similar to

they had to amputation

consult one of the most celebrated practi-

who was

tioners in France,

then in the

army

he also

thought that the operation should be postponed, under

by treating
wounds complicated with fracture.

the opinion that the limbs could be saved

them

as in cases of

In one of these
third day,

officers,

gangrene took place on the

and he died on the eighth or ninth

after the ac-

cident.

The

other, after undergoing the

tomsfrom
and

most dreadful symp-

erethismus, deep-seated suppuration, gangrene,

exfoliation of several pieces of bone, has retained

his leg,

but his foot remains withered, and deprived of

motion, and the leg

itself is

considerably curved,

shortened several centimetres, and has chronicle

.ulcers.

He now

regrets that his leg

is

fistulous

was not amputated.

CASE EIGHTH

I shall add another case in which primitive amputation

is

lation,

requisite: that

is,

when

a great ginglymoid articu-

such as the elbow, and especially the knee

is

opened by a cutting instrument to a very great extent,

and a sanguineous

effusion takes place in the joint.

In

MEMOIRS,

96

wounds

these

the synovial

&.C.

membrane, the ligaments,

and the aponeuroses inflame, from

sion, rupture of their

their imperfect divi-

membranes, and from the contact

of the air.*

tumefaction and erethismus of the parts soon ensue,

fistulas, caries, fever from

and acute pain, abscesses, deep

num-

absorption, and death follow. I have seen a great

ber perish from

this species

of wounds, because the ope-

been postponed from a hope that the limb

might be preserved. I shall report some cases which arc
ration has

in point.

Joseph Grandi, a horse-grenadier, was brought

to the

hospital

on the second day after he had received a sabre

wound

in the right knee-joint

vided the patella through

its

the instrument had di-

whole extent, and had

ted the condyles of the femur.

affec-

A very considerable hae-

morrhage immediately ensued, which a surgeon of the

village unsuccessfully attempted to arrest

sion

but this did not prevent the blood from being poured

into the articulation,

lar

by compres-

membrane.

and

into

all

the surrounding cellu-

was not thought advisable

to perform
amputation then, on account of the existing symptoms
he died from an immense abscess produced by the effusion
It

of blood,

which extended up to the

inferiour part of the

thigh, with complete destruction of the soft parts,

denudation of the os femoris.

tally destroyed,
in the

and the

caries

The

cartilages

were

and
to

had already commenced

spongy substance of the articulating bones

* See a note, p. 179, vol. I. of this work, on the causes

of
inflammation in wounded cavities. Perhaps, by adapting
our practice to the theory there detailed, the necessity of
amputation in these cases may be advantageously dispensed
and the limbs saved. Tr

CAMPAIGNS AT BOULOGNE, &C.

John Lapaix, a grenadier of
thirty,

97

the imperial guard, aged

received a sabre-cut on the superiour part of the

He came two leagues on foot to the hospital,

saw him. The wound was about three centime*
tres in length, obliquely outwards and downwards. The
tendon of the extensor muscles of the leg was cut at the
right knee.

where

articulation

opened: an unc-

tuous fibrous fluid of a reddish colour

was discharged

edge of the

patella,

and the

from the wound, which I

I did

via.

wound,

easily recognised as the syno.

not hesitate, knowing the danger of such a

to advise

amputation before the invasion of the

symptoms, which would of necessity ensue, but he objected to

it.

Being obliged

the lips of the

wound

to

temporize with

it,

drew

as nearly together as possible, to

exclude the air from the articulation, and to prevent the

effusion of blood into

it.

The common remedies were

used, but were not sufficient to obviate the

that soon appeared.

The

that the leg should

be amputated,

was performed on the

ration

and

his condition

fifth.

and the operation

calm succeeded the ope-

promised a favourable termination,

the 15th day the suppuration ceased without

apparent cause.

grenadier, himself, requested

a copious suppuration took place in the stump,

when on
were

symptoms

All the means that I used to renew

useless: he died

have seen

it

of ataxia two days afterwards.

many

others perish in consequence of

similar wounds, because amputation had not been per-

formed.*
* These cases are not to be admitted as conclusive evidence of the necessity of amputating, when large joints are
wounded. In the first case, Grandi was brought to the hosand in the sepital taro days after he had been wounded
the kneehaving
after
leagues
two
walked
Lapaix
cond,
joint opened bv a sabre. Is it then surprising that fatal inflammation should ensue, where, perhaps, every necessary
cause is combined to produce it? What would have been
;

Vol.

n.

MEMOIRS, &C.

When wounds that penetrate into the articulations are

gmaH and unattended by internal effusion, they may be
generally cured, provided the means that are used to
unite the edges of the wound do not press so hard on the
parts as to destroy their circulation.

Whence

arises this

difference, since the air penetrates into the articulation

in

one case as well as in the other?

make a few

On this

subject I shall

observations in the sequel.

Amputation

is

not equally necessary after

wounds

of

the same kind that affect the orbicular joints, such as the

shoulder and the wrist. True, these

wounds

by some unpleasant symptoms, but they

are followed

are less violent

than the symptoms of the above mentioned wounds. I

am

not fully able to point out the causes of this diffe-

rence, yet I
tions,

am

of opinion that the ginglymoid articula-

being provided externally with a larger quantity of

fibrous parts, without doubt receive a proportionate quantity

of nervous filaments, and of the principle of vitality.

Their interiour surfaces are more susceptible of irritation

and inflammation: and

in proportion to their size

danger to be apprehended from

If the

wounds which

time, require amputation,

injure

their

is

the

wounds.

two limbs

at the

same

we

should not be afraid to amputate them both immediately, and in quick succession.

I have performed this double amputation with a success

almost as uniform as in cases where one limb alone was

removed.
I shall here confine myself to the report of a single
case, as being the

most remarkable.

the result in these cases, if their wounds had received

immediate surgical attention in the comfortable and temperate
wards of a hospital? Tr.

CAMPAIGNS AT BOULOGNE,
Morgand, a

Pierre

one of the
just as

first

of his battalion

He

vember, 1794.*

99

volunteer, aged twenty-seven,

was blown up by

it

&C

had

who

was

entered a redoubt

enemy, on the 6th of No

face and hands scorched:

the
his

blow, the skin

away by a fragment of stone,

leg was injured by the same
was not broken, hut the shock was so

great, that the

whole limb

was

his right leg

carried

near the knee-joint, the

left

same

into sphacelus the

fell

ni-ht.

and

I immediately amputated the right thigh,

my

colleagues requested that I should defer the operation

the

left,

on

on account of the apparent soundness of the

limb Yet the leg was cold, of a blackish colour, and

without sensibility or motion.

We tried

medies on the morning

succeeding day, gangrene

oi the

appeared in

The alarming

it.

my

brought 'over

colleagues to

all

the usual re-

situation of this soldier

my

opinion, and

it

was

decided that amputation should immediately be performed. I took care to cut off this thigh as high

up as the other,

keep up an equilibrium.

to

and diarrhoea which had already made

appearance, with insomnia and with delirium at

The slow
their

fever

intervals, left

on

this

in

the

life,

me

man; my
day,

and

little

hope. I lavished

were

and I had the

finally,

If a limb be

rent parts,

but

visits

all

my

care

as frequent in the night as

satisfaction of saving his

completing his cure.

wounded

at the

same time

in

two

diffe-

and one of these wounds require amputation,

(suppose for example, a

wound

of the leg, with

commi-

nutive fracture of the bones, and a second of the thigh

without fracture, or any severe injury) the simple

wound

art,

and

See the campaign in Catalonia for an account of

thi6

of the thigh should then be dressed according to

explosion,

MEMOIRS, &C.

100

the fractured leg immediately amputated, if the articulation of the knee be uninjured. If it be necessary to am

putate at the thigh,

we

wound

of

that the operation should

be

need not attend to the

the leg.

But yet
deferred

may remark

delirium or convulsions instantly succeed a

if

wound. In such a

symptoms, the

means should be used

efforts of nature must be
case,

watched, and the operation

the

may be

to allay the

attentively

resorted to during

calm.

first

Amputation should be performed

ner, and

at several

strokes.

The

a circular

in

man

section of the skin, of

the cellular and other subjacent membranes being made,

drawn back by an

they should be
tion of the skin

and

assistant.

cellular substance,

is

This retrac-

favoured by cut

ting t he frcena that confines them around the surfaceof the

muscles.

The

plan which

many

practitioners "adopt, of

seizing the skin with forceps or their fingers, to dissect

it

up, of stretching

it

forcibly,

ful dissections with a bistoury,

The

and separating
is

muscles should then be cut

to

down

to the

circular section, as high as the retracted

permit.

It

to the

to prevent

sawing

filth,

bone by a

teguments will

to divide the muscles

bone completely, and

its

off the

ligature on

by pain

sometimes necessary to make a third

is

sometimes a fourth or
adhere

it

be carefully avoided.

all

projection

at

cut,

which

a sufficient height

the operation

is

finished

by

bone, and the immediate application of a

the vessels, taking care to cut off the ends

of the ligatures even with the stump.

A conical stump
quence of
*

with an inverted base

this operation

and

it

is

easily heals.*

the conse-

To

retain

Doctor Davidge has made an improvement in the mode

of amputating the thigh and of dressing the stump, so

that it shall not be onical. Instead of making the incision
of the skin and cellular membrane entirely round the limb,

CAMPAIGNS AT BOULOGNE, &C.

the edges of the

wound

together, nothing

is

101
required but

a roller, applied moderately light, in a circular manner,

and a piece of linen

of

lint is

split to

cover the wound.

then placed below, which

is

A pledget

kept on by two lon-

gitudinal compresses that cross each other at right an-

completed by applying a bandage

of a convenient length, without passing it over the end
gles.

The

dressing

of the stump:

muscles

is

is

by means

controlled,

of this

and

bandage the action of the

their retraction prevented.

Uniting bandages, such as the double-headed roller,

and others of a similar description, should not be used.

They cramp and

and prevent that fanecessary to produce a

fatigue the parts,

vourable state of fulness which

laudable suppuration.

The

is

subsequent dressings should

be mild and simple, such as the digestive balsams, to

which may be added those

less tonick,

articles

that are

more or

according to circumstances. Particular care

should be taken to keep the circumference of the

very

clear, in order to facilitate

wound

cutaneous transpiration.

its inferiour and superiour surface, about an inch in width. He divides these portions of skin and cellular substance with a scalpel in an angular manner, so that the apex of an angle of r.bout 4.5 degrees shall look towards the body of the patient, while the
two sides of the angle shall meet the ends of the circular incisions at the base. The skin and cellular substance are
then dissected up with greater facility to the patient and
operator, and when the operation is completed, the edges of
the soft parts are brought into contact in a line that shall
be vertical when the patient sits or lies on his back. Doctor Davidge observes, that the ligatures may then be drawn
down to the most depending angle of the stump, and
through the same part the pus will be freely discharged,
without fear of the consequences that follow its retention in
the conical stump, or when the aperture of the wound is
made horizontal; that union by the first intention may thus
take place between the largest part of the divided surfaces,
and the recovery of the patient be more speedy, while
the extremity of "the stump remains sightly and conveni-

he leaves a small space undivided on

ent. Ta.

MEMOIRS, &C.

102

The

plan that I have just proposed

all cases,

with

even

flaps;

in those

which

in

when

my

opinion

berless inconveniences. I have

may be

amputation
is

is

adopted in

performed

attended with

num-

had opportunities of com-

paring the two methods, and the uniform success that

has followed the circular amputation, has convinced
that

it

possesses

the flaps, as

still

me

more advantages than the operation with

recommended by some modern practi-

tioners.

Amputation

at the artioulations, or, to

rectly, extirpation of limbs,

flaps.

These

speak more cor-

should be performed with

flaps will soon unite

with each other, and

adhere together over the articulating surfaces, which

need not

exfoliate, because they

by the contact of the

ment.*
In

short, after

air,

have not been changed

nor touched by a cutting instru-

having amputated according to either

plan, good attention should be paid to the treatment: for

it is

not sufficient that an operation has been performed

with dexterity, but that the unpleasant symptoms which

may succeed it, should be obviated or removed.

Of

Consecutive Ampictat'von.

If it be possible to point out the cases in

tation should

be immediately performed,

which amp

it is

impossible

priori, to decide on those cases in

amputation

is

necessary.

which co7isccutive
For example, one gun shot

* According to the opinion of Mr. Bell, this cartilage

cannot unite with muscle; and although the air may not act
on the cartilage, yet this substance will be removed by the
operation of the absorbents whenever it is no longer ukp
6
ful.T*.

CAMPAIGNS AT BOULOGNE, &C.

wound may be cured by

ther that

is less

103

the usual treatment, while ano-

dangerous

on account of

in reality, either

the unhealthy constitution of the subject, or on account of

the traumatick fever,

tima

may

require the adoption of the ul-

In every case,

ratio.

general rule be ob-

if this

served, every indication will be properly

is,

fulfilled,

which

not to perform consecutive amputation, unless every

On

attempt to preserve the limb has become nugatory.

this point of doctrine, I differ

from Faure.

This practitioner delays amputation in cases which he

of the second kind, not that he may attempt to
save the limb, but that the primary symptoms may pass
calls cases

off.

The

operation between the fifteenth and twentieth

day, appears to him less dangerous than

immediately after the wound.

to

him, the

effects of the

ceased the wounded

:

putation, the very

mous: the

At

according

concussion from the ball has

man becomes

name

when performed

this period,

reconciled to the

am-

of which terrifies the pusillani-

debility of the subject

removes the apprehen-

sion of the bursting out of the blood after the operation

finally, in

summing up

his opinions,

he lays

an axiom that " immediate amputation"

dangerous in

its

consequences.

To

is

it

down

as

generally very

support this theory,

he reports the cases of ten wounded

men whom

he re-

served after the battle of Fontenoy, in order that he might

perform consecutive amputation on them with more sue*

cess, and this he tells us was complete.
This division of cases requiring amputation into two'
kinds,

is

contrary to nature, and has done

much

harm;,

very frequently the partisans of Faure have not dared

to

resort to primitive amputation, the dangers of which they

had exaggerated: and again, they have performed consecutive amputation without any success.

The

effects of the

concussion from the

ball, far

from

being aggravated, diminish and insensibly disappear,

104

MEMOIRS, &C.

after the primitive operation.

So long

continues to be violent, the solids aiv

a^ this concussion

.n

a state of consi-

com pie

derable tension, but afterwards undergo a

The

circulation of the fluids

is

is

so disordered, that

is

and the system

the functions are imperfectly

all

The proximate

performed.

cause of

all

the sensible parts,

whether distant from, or con-

tiguous to the seat of the injury.

of the

nTves and

symptoms
body that dis

these

all

the violent percussion of the extraneous

turbs

by the shock

disturbed

that follows on the re-action of the solids,

atony.

The

rupture and

wounds

the obstruction of the vessels of all

The

kinds, also form a part of the proximate cause.

spee-

dy amputation of the limb must then produce a favourable change of the whole system. The distended nerves,
being divided, are set at liberty, and the fluids circulate

more

easily

the irritation

dreadful symptoms,

is

which

empty themselves and

is

always attended by

The

assuaged.

obstructed vessels

contract: strangulation, inflam-

mation, and ercthismus, which are always complicated

with extensive laceration, are thus prevented.

It is

then

evident that the concussion, far from forbidding primitive

amputation, should induce the surgeon to decide on

This

is

also the advice of Lamartiniere

John Carreau, aged

time with Maugran

fifty,

it

and of Boucher

was wounded at the same

was almost entirely

his right leg

away by a fragment of stone that produced a vioconcussion in the right thigh his left leg was frac-

carried
lent

tured

by

the

same blow. Like Maugran, he

face and hands burned.

right thigh,

I immediately

and dressed the

left

operation

tion,

and without doubt prevented the

that

the

had

his

leg according to art

The

removed

also

amputated the

effects

of the
fatal

commo-

symptoms

must have succeeded. The wound of the stump soon

CAMPAIGNS AT BOULOGNE, &C.

cicatrized: there

was a

105

considerable necrosis of the frac-

tured leg, which retarded his cure, but

it

was complete

before the end of the fourth month.

Mr. Morcau, aged thirty, an officer of the etat-major of

the army of the eastern Pyrenees, received a ball under
the fort of Figucres, November 20th, which disorganized the left arm below the insertion of the deltoid muscle

hence I was obliged to amputate very near the shoul-

The

der-joint.

violent concussion that the bullet

duced was followed by a large ecchymosis

had pro-

in the

stump,

attached to the shoulder, which indicated the necessity

of performing the operation at the scapular articulation

and

acknowledge, notwithstanding the

successful

result of this case, that I did not entirely fulfil the in-

dication.
less

The

small stump that

and very inconvenient.

have taken

place,

also

reserved,

tery did not

fall off,

As

was

use-

had more serious

would not

had the operation been performed

singular

this

at

phenomenon occurred during the

treatment of this wound.

the stump.

was

after the operation, that I believe

symptoms
the joint.

He

but

The ligature of the humeral arwas retained in the cicatrix of

has occurred frequently since, in

my

have devised a mode of extracting it which

seen
in the article under the campaign in Austria.
will be
I may remark that the cases which I have already re-

practice, I

ported, sustain

them

my

the concussion

doctrine, because in every one of

was very alarming. Neither should

for the wound-

the fears of the patient defer the operation

ed will dread

its

consequences

less,

immediately after the

accident than after the expiration of twenty-four hours,

when he shall have time to calculate on all his chances.

Our

illustrious

Pare makes

this judicious

works

Vol

ii.

remark

in his

&C

MEMOIRS,

lOo

Every one who

may

acquainted with physiology,

is

perceive the errour of the last objections of Faure rela-

The instantaneous

tive to the bursting out of the blood.

discharge of the vessels of the limb,

which takes place as

soon as they are divided, prevents the internal disorder

which might take place immediately on tying them and

as the globules of the fluid which fills them are in
:

contact as far

up

as the heart, the slightest resistance di-

minishes the action of this organ, that

is

moreover depri-

ved of a quantity of venous blood with which the capillary

system would have supplied it had the arteries remained
undivided.

An

equilibrium

established,

is

and nature

soon accommodates herself to the change that

is

produ-

ced, as experience has taught us.

I shall not speak of the obstruction that takes place in

the capillary vessels of the stump, because

it

must pre

cede suppuration, without which the divided parts can

not lay close and cicatrize. Yet,
great,
ill

it

will

prove injurious

consequences

may be

if

inflammation be too

when

this is the case, its

prevented by venaesection, anti

spasmodicks, cooling internal medicines, and finally, by

applying leeches and emollients to the stump.

my theory, and demon

and land surgeons, that the first or

Experience coincides with

strates both to naval

primary symptoms that succeed wounds requiting amputation, are more to be dreaded than such as follow primi

Of an immense number of the wounded

who were amputated within the first twenty-four hours

tive amputation.

after the terrible

and memorable

1794, dut few died. This fact

colleagues,

June
by many of

sea-fight,

attested

and particularly by Mr. Fercoe, chief

geon of the Jcmmapc,

letter:

is

1st,

my
sur-

I here subjoin an extract of hr?

CAMPAIGNS AT BOULOGNE, &C.

fi

107

A great number of amputations were performed

the wounds were received,

mediately after

engagement, June

men were

1st,

in the

im-

naval

1794. Sixty of these amputated

taken to the marine hospital at Brest, and

placed under the care of Mr. Duret

died of tetanus

the others

all

of these, only two

were cured. One had both

arms amputated. The surgeon of the ship Xeme.

by the English) by the advice of their
surgeons, postponed the amputation of which many of

his

raire, (taken

the

wounded were

port ; but they

When in
city of

all

in

need, until they should arrive in

died on the passage."

1796 I was sent to the army of

surgeon in chief, I

ness of the loss of

many

was

Italy in capa-

also obliged to

of the

be a wit-

wounded, because the

surgeons had embraced the doctrine of Faure. General

Bonaparte perceived that

in case hostilities

were renew-

ed, a flying ambulance alone could prevent similar misfortunes ; and it was by his orders that I established the

three divisions of ambulance that I have described in this

work- *
Since this time, the

army has always been provided

during an engagement with such apparatus as

is

necessa-

ry to perform amputation in the shortest possible space

of time.

Even

the sight of these ambulances,

which arc

always attached to the advanced guard, animates the

them with the greatest courage. I

here give an anecdote of Ambroise Pare.

soldiers,
?,hall

and

inspires

* For the speedy construction of these ambulances I am

indebted to the care and attention of his excellency count
Regnault de St. Jean d'Angely, agent general for the hospitals of the army of Italy, who was specially entrusted with
their organization.

MEMOIRS, &C.

108

Being urgently

was

by the duke of Guise, who

solicited

wounded men
was

besieged in Mentz, to attend to his

who were

without assistance, this great surgeon

presented to the discomfitted soldiers in the breach: they

immediately exclaimed with the most lively joy, " Should

we now

be wounded, none can die

Their courage was renewed, and

Pare

is

among

us "

an

their confidence in

expert surgeon contributed to the preservation of the

place,

and the destruction of a formidable army assem-

bled before

it.

In short, inquire of

those invalids

one or two limbs, and they

that they

will almost

had been amputated shortly

within the

first

If Faure

still

who have

lost

always

you

tell

after the battle, or

twenty-four hours after being wounded.

have followers, I invite them

the field of battle during an engagement.

to repair to

They

then

will

soon be conivnced that without primitive amputation, a

great

number

Egypt,

wounded must of necessity die. In

was most completely demonstrated.

of the

this truth

I here insert a letter on this subject

a surgeon of the

first class,

who was

from Mr. Masclet,

detached to Alex

andria

" In the marine

lors

hospital of this port, I

who were wounded

in the

saw eleven

each had had a limb amputated within the

four hours. In five cases, the operation

formed on the arm,

in a sixth,

first

twenty-

had been per-

on the fore arm,

all in

fair

way

two
They

in

others on the thigh, and in the three last on the leg.

were

sai-

naval battle of Aboukir:

of recovery.

we have had but three ampuwhich were performed on the se-

In our military hospital

tations of the thigh,

venth or eighth day after the battle, and they

few days

thodically performed,

all

died a

although it had been meand they had laboured under no

after the operation

CAMPAIGNS AT BOULOGNE, &C.

109

ibrmidable symptoms before the ope ation was undertaken. Experience has confirmed your principles on this

occasion."
I

am, &c. &c.

MASCLET."

(Signed)

During the war

North America

in

in

1780, the sur-

geons of the French army performed a great number of

amputations according

prevailing

the

to

opinion in

France, that an operation should not be attempted until

the primary symptoms have ceased.

who had

the contrary,

The Americans, on

the courage to amputate immedi-

ately, or within the first

twenty -four hours where

wounded

but a very small number: and

yet,

required

it,

lost

their

Mr. Dubor, then surgeon major of the regiment of

Artois dragoons, of whom I learned the fact, asserts that

the condition of the hospital in which the

wounded

French were accommodated, was in many respects su

periour to that where the wounded Americans were
placed.*

Even

admitting that by a concurrence of fortunate

cumstances, on which
of the

we

wounded may escape

symptoms,
putation

it

it

cir-

cannot always depend, some

the danger of the primary

proves nothing in favour of consecutive am-

only shows

how

nature

may

possibly rise su

periour to a disease.

After twenty or thirty days, the prognosis

unfavourable, and amputation

is

is

equally

decided on: thus

all

the previous sufferings of the patient have been in vain

moreover,

art

now requires

that nature, almost exhausted

by her great and protracted

Is

it

efforts,

should begin

surprising then that the operation

is

anew

dangerous!

* See the inaugural thesis of this gentleman, defended in

the school of Strasburg, September 16th, 1803

MEMOIRS, &C.

110

If nature rise superiour to

all

these obstacles, the suc-

more probable,

cess of the operation will doubtless be

but in this case, instead of performing amputation, the

surgeon should redouble his care to

assist

nature in sa-

ving the limb, under the supposition which I have adit can no longer be injurious, but may prove

vanced, that

useful to the individual.

From

this period, the future

become more and more

prospects of the

brilliant.

soldiers congratulating themselves

advice of their surgeons

is

on having opposed the

who wished

this period of their hopes.

wounded

I have often heard

to mutilate

I shall soon

show

them

that

at

Faurp

not exempt from blame in this respect.

Wlien Consecutive Amputation

is

required.

CASE FIRST

When

the mollification is not circumscribed.

ceed methodically,

we

should

first

To pro-

inquire into the nature

of gangrene, and the causes which produce it. If it be

from an internal and general cause, it would then be
rashness to amputate before nature had completely defined

its limits.

This species of gangrene

ed from that which

that precede

I call

is

distinguish-

traumatick, by the symptoms

and accompany

it.

These symptoms arc

such as arc observed in the nervous ataxia, or adynamia.

In this case, the operation should be deferred, and the general causes opposed by regimen and internal

reme

dies.

But if the gangrene be traumatick, no time should be

tat in removing the limb above the sphacelated part

CAMPAIGN9 AT BOULOGNE,

&C

111

This amputation will terminate successfully, more especially

when

the deleterious principle has not

Many facts which support

ously absorbed.

my memoir on traumatick

are reported in

been

copi-

this doctrine;

gangrene.

CASE SECOND

When there is

If a limb

a convulsive spasm in the wounded limb.

be cut

soon as tetanus appears,

off as

ah"

communication between the origin of the disease and

the general system is cut off. This division of the vessels,

by unloading them, removes the nervous pains, and destroys the convulsive mobility of the muscles. These
first effects

are followed

equilibrium of

all

sleep,

and re

establishes

the

parts of the body.

The momentary
augment the

a general collapse, which pro

by

motes the excretions and

by amputation cannot

pain produced

existing irritation. Moreover, the pains of

tetanus far overbalance those which arise from the opera

tion,

make

it

more supportable, and diminish

sity of the pain, especially

when

the inten-

the principal nerves cf

the limb are strongly compressed.

CASE THIRD

Vitiated suppuration.

It oft&\

wounds, complicated with

the best directed care, suppuration

bony fragments are enveloped

sition to unite

weaken

happens

in

gun shot

fracture, that in opposition to

becomes

in pus,

putrid,

and the

and have no dispo

hectick fever and colliquative diarrhoea

the patient, and in this extremity amputation

ha:~

MEMOIRS, &C.

112

sometimes saved the life of the patient, by exciting pain,

by re animating the languishing powers of the system,
and by producing inflammation in the stump.

''ASE

Bad

of the stump. The cure of amputated

sometimes arrested in the hospitals by a fever

state

stumps

is

The stump

of an alarming character.

which

FOURTH

tumefies, the skin,

at first contracted over the surface of the

protrudes,

is

retracted,

nized. If this particular affection recur, the

comes changed
is

wound,

and becomes extensively disorga-

wound be

into a fungous ulcer, the healing of

which

prevented by a deep-seated change in the bone, and

erosion of the soft parts.

projection of the

bone

fre-

quently takes place, from a retraction of the superficial

muscles that have not been divided sufficiently low down.

This projection also takes place, when care has not been
taken to keep the muscles in a proper position, as respects

by methodical dressings, and a favourable posture of the stump during the

treatment of the wound. In either case it has been proposed, not only to saw off the portion of the denuded

the extremity of the divided bone,

bone, but even to cut off the end of the stump on a level
With the skin. To me this operation appears useless, and

may

prove dangerous

1st.

By

vessels,

2dly.

which may arise from these

which are deep, and tied With difficulty.
the haemorrhage

By the

violent irritation

which takes place

in the

remainder of the amputated limb, the sensibility and irritability of which have been increased by the previous
injury. It will then
tore,

which

first

be better to abandon the work to na

separates the portion of dead bone, and

Jig

CAMPAIGNS AT BOULOGNE, &C.

gradually restores the retracted and depressed muscles,

by means of a vascular production, and a

traction

common

divided,

and the

tion

have ceased

to living parts

when

species of at-

they have been

irritating causes of their original separa.

The

to act.

cicatrix advances

from the

circumference to the centre, and approximates the skin

by a

About the fifty fifth day after the opeform of the stump disappears, and the

circular fringe.

ration, the conical

cicatrix gradually goes on to take a suitable shape.

duty of a surgeon then in this case

is,

The

to assist nature

without interrupting her work, that would be prolonged

by meeting with

obstructions. I have seen

many stumps

of amputated thighs in this condition, which, after having

thrown

off their superfluous parts,

resumed the proper

6hape. This disproves the utility of sawing off the

bone

a second time. In short, the conical form seldom takes

place
to the

when

the operation has been performed according

method recommended by me.

In what cases we should attempt

to

preserve the limb,

al)

though amputation appears

to be indicated,

and has

been advised by authors.

In general,

if

and there be no

the

body of a bone be crushed by a

loss of

ball,

substance of the soft pa its, or

rupture of the principal nerves or vessels, amputation

is

not required and the preservation of the limb should be

attempted according to the indications.

These are

inci-

sions, extraction of the foreign substances, simple dres-

sings, proper positions of the limb, the

dages or

rollers, cooling

many -tailed

medicines internally, and

ble topical applications. Spirits, unguents,

Vol.

and

oils

bansuita-

should

MEMOIRS, &C.

114,

simple

be prohibited, and the most

remedies

alons

tfd opted.

General Morangier,

Egypt

in

who was

a second time wounded

Aboukir was a

at the last battle of

striking ex-

possibility of preserving a limb, notwith-

ample of the

standing the extensive cdmminutiVe fracture that

accompany a wound of

His wound was

it.

riour extremity of "the right

By

tion of the elbow.

may

in the infe-

arm, very near the

articula-

enlarging the wound, by extract-

ing the splinters, and by dressing

it

methodically, he

was

many other cases which I

show with what circumspection we should

completed cured. This, and

could adduce,

act in such a case:

we

mities in particular,

should spare the superiour extre-

which may be of the greatest im-

portance to the individual, although disfigured.

neral rule

Indeed,

is

This ge-

not applicable to the inferiour extremities.

when they

are affected with carious ulcers of

the articulations, they are rather injurious than useful.

Loco-motion
attraction

is

performed with

difficulty,

and stagnation of the

the limb, by the constant irritation which

up.

The

and there

is

an

fluids in the interiour of

is

there kept

obstruction enlarges the ulcers, inflammation

and gangrene often succeed, and these unfortunate invalids envy the condition of those who walk with artificial
legs

Authors have also recommended amputation

when the
ruptured, although the soft
but the success which has attended

principal artery of a limb

parts

may be

spared

is

the application of a single ligature, in

commands
putation. I
tice of

many

similar eases,

means before we proceed to amhave seen two cases of this kind in the prac

us to try this

Desault

three under the care of

Mr. Billard,

at

CAMPAIGNS AT BOULOGNE, &C.

Jftrest,

and a fourth

is

115

given by Mi\ Bourguet of Beziers.

This case merits the attention of the surgeon.

grenadier of the imperial guards had his humeral

artery divided by a sabre, in a duel. His

life

was endan-

gered by a gangrene of the fore-arm, which took place

after the ligature

had been applied on the artery. I has-

wound

tened to amputate the arm above the

the gangrene

was not circumscribed, and the

although

patient

was

saved.

I shall report some cases of wounds of the superiour

extremities,that were cured without amputation, although

complicated with extensive comminutive fractures.

these cases in the hospital of Perpignan, and to the

saw

care and talents of

owe

they

my brother,

Dr. Francis Larrey, do

their recovery.

volunteer, aged thirty -four, had about one -third of

the right humerus shattered, near

which

also

slightly

injured

its

middle, by a ball

the soft parts.

He was

sent to the military hospital of Perpignan, under the direction of

were
were
a

in a

my

brother, a surgeon major.

bad condition,

callous,

and

foetid sanies.

filled

their edges

His wounds

were turned

up,

with fungous flesh that discharged

These signs induced me

to suspect a ca-

ries of the bone, and the presence of splinters

by the

introduction of a probe I ascertained the existence of

the

latter".

I even found a kind of

new bone which

nature had produced to supply the want of the old. I

extracted the splinters through suitable incisions, and he

was discharged, cured, in one month and a half. The

limb was slightly shortened, but retained almost all its
motions.

MEMOIRS, &C.

116

John Fayolle, aged twenty -six, a volunteer in the bat,

talion of Arriege, had the body of the left humerus shat,
tered. He was cured in three months ; the arm retained
some of

its

movements.

William Fougere, aged

thirty, a volunteer,

had the

bones of both fore-arms shattered by a ball, near the

wrist-joints

yet he was cured in a short time, and re-

tained the use of his hands.

Many

other similar cases occurred in the different ar-

mies under

my

care, in

used, and with the

I shall

now

same

which the same means were

success.

prove that of ten

who were amputated

by Faure, long after the battle of Fontcnoy, six, at least,

might have been cured by the usual treatment, and the
others should have been amputated immediately.

CASE FIRST.

Faure reports, that a soldier who had the head of the

humerus carried away by a cannon ball, which fractured
the acromion, and destroyed a great part of the deltoid
muscle, had the

arm amputated at the articulation twenwound, and that he was completely

ty-one days after the

cured in two months, counting from the day of the operation.

Admitting that the extirpation of the arm

culation

was

indicated as I suppose

it

was,

it

at the arti-

should have

been done instantly, for the reasons

I have before given

head of the humerus could not have been carried
away by a cannon ball, without disorganizing all the parts

for the

which surround the

articulation.

Nothing then remained

CAMPAIGNS AT JIOU^OGNE, &C.

117

but some flaps of the pectoralis major, latissimus dorsi,

and

were attached

teres major, that

humerus, separated from

its

head. It

prompt and complete removal of

relieve the patient

to the portion of the

is

this

then evident that

dead limb would

from a foreign body, and prevent the

multiplied dangers which he must surmount to arrive at

Admit

a cure.

that the

wounded man, on whose arm

Faure operated on the 21st day, was cured

tion of two months:

on

at the expira>

the conduct of this practitioner

this occasion should not serve as a rule- to his succes-

sors, because a single fact can never establish a principle

To

his doctrine I

oppose a series of cases, which prove

that amputation should be performed immediately, and

under other circumstances that the head of the humerus

be extirpated entirely, or removed by fragments.

CASE SECOND.

He

speaks of a simple fracture of the body of the

mur by

fe

a ball, without considerable lesion of the soft

parts, for

which amputation was performed on

the for-

tieth day.

do not disapprove of

ence has tau

;ht

me,

this operation

that all

then

it

for

my

experj

fracture of the

and in general demand amwhich cannot always be done idHBedtately, and

thigh, are very dangerous,

putation,

wounds with

s lould

b performed afterwards.
:

MEMOIRS, &C

118

CASE

The subject
dyles,
lation.

and

here had the femur fractured at the con-

this fracture

This

man was

and was cured

TniB.lt

extended nearly up to the

articu-

not operated on until the 42d day,

in three

months.

This case required immediate amputation. The violent

symptoms that took place a short time after the blow,

and which, by the confession of Faure himself, made
the situation of the patient extremely critical, confirm
this assertion.

CA8E FOURTH.

ball had shattered the radius, and fractured the ulna near the elbow -joint, without destroying much of the
soft parts.

The wounded man was

ceding cases,
tion

was performed. Here,

sufficed,

treated as in the pre-

until the forty-second

had the

cut up, and the

splinters

in

my

day,

when amputa-

opinion,

it

would have

been extracted, the aponeuroses

wound dressed with

care, according to

previous direction, with a view of preserving the limb

CASE FIFTH.

was indispensably necessary

wounded man was sphacelated.

Consecutive amputation

because the hand of the

We cannot know whether the

nature of this

wound

re-

quired an immediate operation, because Faure does not

speak of the symptoms which were connected with it.

CAMPAIGNS AT BOULOGNE,

&C

1155

CASE SIXTH,

Would seem

to

have required immediate amputation,

on account of the extensive laceration and the violent

concussion of the parts

We

the forty -fourth day.

was not performed until

may easily conceive what danyet

it

gers the patient had to encounter during such a tedious

treatment.

CASE SEVENTH.

A ball
tured the

struck the radial side of the metacarpus, fracfirst

bone, and injured

some

tendons.

Faure

amputated the fore-arm, on the forty-sixth day, with

complete success.

Army

surgeons often cure such

out having recourse

to

wounds

easily, With-

amputation

CASE EIGHTH.

A soldier had the os calcis carried away by a cannon

ball,

which ruptured

putated

forty -six

the tendo Achillis.

His leg was am-

days after the accident.

I think that this case

might be classed with those in

which the operation should have been deferred, because

I think the limb might have been saved by the usual
means. I have seen examples of such a result

MEMOIRS, &C.

120

CASES NINTH

&

TENTH

These required immediate amputation

as they are

si-

milar to those which I have taken into consideration for

merly, I shall pass them in silence.

Under any circumstance amputation should be

resort

ming

it,

but

when

there

is

the last

a decided necessity for perfor

there should be no hesitation in amputating

mediately, that

is,

im

before the invasion of the primitive

symptoms. If they have taken place when the surgeon

is

called to the assistance of the

wait until they are removed.

rience can alone
cepts of

make

good surgery.

wounded, he should

In short,

talents

and expe-

a profitable application of the pre-

CAMPAIGNS IN SAXONY, &C.

121

CAMPAIGNS
SAXONY AND PRUSSIA.

IN

IT was

to

have been expected that the

battle of Austerlitz

tions

from forming any new

ted with

result

would have deterred

coalition

of the

foreign na-

Prussia uni-

yet

Saxony, and clandestinely prepared

to

march

against France.

The grand-army had not yet left Germany, and the

its commander had led him to halt in the
territory of our allies. The sudden march of the SaxoPrussian army induced the emperour, who had quitted
foresight of

Paris on the last of September, 1806, to appear, in a very

short time, at the

head of

his troops.

Having resolved

meet the enemy, he passed Mentz on the

first

to

of Octo-

ber; then, with the greatest celerity, crossed Southern

Franconia, and directed his march towards

Saxony,

through Aschaffenburg,Wurtzburg, and Bamberg, commercial

geously

cities

and Schlaitz.
encountered
ry,

of considerable size,

situated.

that are advanta-

Thence he advanced

on Baruth

Here the troops of our advanced guard

some detachments of Prussian caval-

and the enemy then perceived the approach of the

grand army, which advanced

perour was

Vol.

ii.

at

in three

columns.

The em-

the head of the central column, with the

MEMOIRS, &C-

122

infantry of his guard,

marches from

my

Paris.

that

had

come on by forced

His cavalry, which I attended with

move with such

flying ambulance, not being able to

rapidity, followed this column. It passed

by Gera

the direction towards Jena, inclining to the

left,

to take

so that

two columns, by describing a line converging

point, and by making forced marches,
flight come up with the centre.
The two armies were in view of each other on the
evening of flic 13th of October. The night was entirely
the other

towards

this

occupied in leading the different corps to their positions,

and

in reconnoitering the Prussian

army.

The famous
The

battle ol Jena was

commandant of the guard being directed to watch the
enemy's movements at Gera, was unwilling that I should
leave this corps: I regret that I was not in the engage-

fought on the following day.

ment, and could not unite with

the

wounded on

my colleagues in assisting
Yet at Gera we re-

the field of battle.

ceived a large portion of those

who were wounded by

the shock of the opposite wings of each army.

them

I had

collected together in the castle of this city,

with the assistance

ol"

the surgeons of the flying

ambuand dressed them. Some severe

lance, I operated on,

wounds

where,

which were generally

were done within the first twen-

required great operations,

successful, because they

ty-four hours.

I shall dispense with observations on those

wounded

at

Jena:

I shall

merely

state

who

were'

what was repor

ted to me, that the most serious

wounds could not be

dressed until some time after the battle, either because
the divisions of ambulance were at too great a distance
or because the soldiers

were able

who were

slightly

wounded and

walk, had entirely occupied the attention of

the surgeons during the first day The best plan that can
to

be adopted in such emergencies to prevent the

evil

con

CAMPAIGNS IN SAXONY, &C.

who

sequences of leaving the soldiers

wounded without

assistance,

is

128
are

severely

to place the ambulances

as near as possible to the line of battle,* and to establish

head -quarters, to which

the

all

wounded, who require

delicate operations, shall be collected to

by

be operated on

by expert surgeons under his

Those who are dangerously wounded should
receive the first attention, without regard to rank or disthe surgeon general, or

inspection.

tinction.

They who

wait until their brethren in arms,

who

may

degree

are injured in a less

are badly mutila-

have been operated on and dressed, otherwise the

ted,

latter

would not survive many hours ;

rarely, until the sue

ceeding day. Besides, with a slight wound, it iseasyto

re-

pair to the hospital of the first or second line, especially

who

ihe officers,
tion

generally have the

finally, life is not

The

brilliant victory of

ony and

means of transporta-

endangered by such wounds.

Jena decided the

fate of

Sax-

The Saxons detached themselves from

make a separate peace.
day after the battle, our army marched in

Prussia.

the coalition to

The

third

pursuit of the different corps

overthrow.

The imperial

Gera, also had orders

where

which had escaped from the

guard, which had remained at

to join his

majesty

at

Naumberg,
am-

I arrived with a part of the surgeons of the

bulance several hours before the imperial head quarters.

As

the

warmest part of the engagement had taken place

latter city, a great number of the wounded had

near the

been transported

thither,

and several churches were

with them. I had attended

to all

the

wounded

filled

that

found on our route, and I should have continued to ope

rate

on those

who were most

severely

wounded, had I

not been obliged to follow the emperour, who, with the

* The flying ambulance alone has the advantage of beinp

able to follow the rapid movements of armies.

124

MEMOIRS.

Imperial guard,

Sec.

was considerably

But 017
Percy, who had been in

colleague, inspector-general

in advance.

the battle, lost no time in giving the necessary assistance

it was required. As
we had no wounded.

wherever
engaged

the guards

We marched with rapidity to

had not been

Mersburg, and entered

Yet our advanced
it.

Halle just as the enemy evacuated

guard had a severe action at the entrance of the

which the Prussians were

defeated.

This

new

city, in

disaster

precipitated the retreat of the remainder of their army.

We were ready to

render the

wounded immediate

as-

sistance.

Halle

is

one of the largest

lebrated for

its

Saxony ? and is cehad not lei-

university; but at this time I

sure to take a view of

we

cities in

it.

By

forced marches, in

two days

reached Wirtemberg, a city famous for the reforma-

tion of Luther,

whose tomb

the university.

The Elbe, which runs near

gives

it

merce

is still

seen in the church of

this city,

a picturesque appearance, and renders

flourishing.

its

After remaining here one day,

com-

we left

Saxony, to enter the sandy territory

But for the forests of pine and larch which

the fertile lands of

of Prussia.

cover this country,

it

would appear

like

the deserts

of Lybia: no one would suppose that he was approach

ing one of the most elegant and brilliant capitols of Eunor would any person think that one of the greatcommanders of modern ages would have taken up

rope
est

his residence in the midst of these arid plains,

without

admitting, at the same time, that in surmounting

this
difficulty, he achieved one of his most important
enterprizes.

We soon arrived at
sulated

by canals of

Potsdam, a delightful

fresh

little city, in-

water from the Havel.

It has
a roya! pa!a-e, and magnificent parks. It may
be compared to Versailles for its regularity, and for
the elegance

CAMPAIGNS IN SAXONY, &U.

and grandeur of

its

and

In the Lutheran church

palace.

this city are erected the

12i5

tombs of Frederick the

his father. I could not behold, without emotion,

chair in which F /ederick the great died

arm

ture and effects

which had been

of

great,

the

the furni-

and the apartment

his,

which Voltaire had occupied.

we

After three days,

which

is

but

two

out for Charlottemburg,

set

leagues from Berlin.

It is also

a small

royal city intersected by canals. It contains also a great

number of barracks, a very

park

this palace

and an elegant

fine palace,

one of the king's pleasure-houses.

is

The French emperour remained in it several days, to reunite the different corps of his army which had been in
pursuit of the enemy, who had made a stand at several
places, fought obstinately,
treat

beyond

While

and then continued

his re-

the Oder.

remained

Charlottemburg, I took a view of

at

environs, and examined with the greatest interest the

its

fortress of

d'&uvre

On

Spandau, which

may be

in fortification.

the 27th of October the

emperour entered Berlin

with his etat major, and his guards.

a body,

considered a chef

came

him

to offer

marched before him

The

magistrates, in

the keys of this great city,

to the king's palace.

and

This was un-

doubtedly one of the most glorious days the emperour

Napoleon ever enjoyed.

While this monarch was occupied in regulating the
administration of the Prussian government and that of
his

army, the marshals of the empire, his lieutenant

enemy, and attacked him in his

generals, pursued the

last

intrenchments

tified

posts

troops,

on the Oder.

were taken by

viz. Custrin,

may

pity of

Magdeburg, which

several

or surrendered to the

Stettin,

these I

Thus

and Frankfort.

particularly notice the rich

is

for-

French

Among

and commercial

advantageously situated on

MEMOIRS, &C.

126

the Elbe, at the confluence of several rivers

is

its

one of the strongest fortresses in Prussia.

citadel

After these

places were taken, and a part of Prussian Poland

been invaded, the king of Prussia,

who had

had

already re-

of cavalry with him,

and had but a small number

made proposals of peace, and re-

quested an armistice.

The emperour acceded

treated to a great distance,

to his re-

quest.

Such was the result of this short but brilliant expedition, which the emperour proclaimed as a campaign, at
the

same time expressing

his satisfaction at the conduct

of his army, in his order of the day, issued on the 30th

of October.

The

imperial-head quarters and the guard remained at

Berlin during the

month of November. In

time, a second line of troops, under the

king of Holland, advanced

into

the

mean

command

of the

Hanover and Swedish

Pomerania. Another, under the

command of marshal
army of Italy took

Mortier, covered our rear, while the

possession of the mouths of the Cattaro.

While I remained at Berlin, I visited the monuments

and the curiosities of the city. I waited on the celebrated physicians

who

reside in

it,

and

visited the

academy

of sciences; I presented to the royal academy a copy of

my account of Egypt, and was received in the most flat-

manner by its members. To the attentions of

Messrs Humboldt, Walther, father and son, Herman,

tering

father and* son, and

of celebrity,

At

am

Forme, professours and academicians

more particularly indebted.

the house of the

first,

saw

the rare collection of

animals and plants which he brought from the

Among them

I noticed particularly,

an

new world.
uncommon am-

phibious animal, which holds a rank between fish

and rep
tiles. At the house of the celebrated
Walther, I saw the
anatomical museum that the king had

purchased for

CAMPAIGNS IN SAXONY, &C.

400,000 francs.

It is

127

a rich and extensive collection of

anatomical preparations of every part of the body, and of

both sexes, together with the various products of conception.

This

museum

contains also a series of pathological

preparations of every description; but the preparations of

the vascular

and nervous system were not so interesting

same kind in the museums of Soemmering

as those of the

and Prokaska.

Among the

most superb buildings of the

city, are the

Composite order, the arsenal, some

Lutheran churches, and the king's palace. The city is

Italian theatre of the

surrounded and intersected by canals, which are alwavs

with the waters of the Spree. On one of the prin-

filled

cipal stone bridges is placed

derick William, of bronze.

an equestrian statue of FreThe horse and its rider are

Of one entire piece.

While we remained at Berlin our army was very

Here I had a part of the city hospital prepared

healthy.

for the reception of the imperial

guard

and

in

it

we

re-

ceived such as had fevers, external diseases, accidental

wounds,
service,

With

syphilis,

&c.

I superintended every part of the

and paid particular attention

the exception of

some severe

to the

accidents,

wounded.*

we had no

very interesting cases.

About

the end of

December, our

soldiers, in order to

avoid the severity of the cold, that

commenced very

suddenly, shut themselves up in chambers, Well heated

by

cast stoves, as is the custom in this country, and many of them were attacked by asphyxia some who were
:

immediately brought into the hospital, and received

able assistance,

were restored

to

life

but others

fell

suit-

vic-

tims to this cause.

* Dr. Castel, of the ambulances of the guard, had
the
care of those who were sick of fevers, and treated them
with the greatest success.

MEMOIRS, &C.

128

On
mena

opening their bodies, I observed the same phend-

had long before remarked

that I

in those

who

died

of asphyxia from water, and deleterious gas, such as the

These appearances have been but

carbonick gas, &c.

some late writers.

In those who died from the above cause at Berlin, the
whole surface of the body was turgid, and of a violet co-

imperfectly described by

lour

of a darker or lighter shade, according to the de-

The

clivity of the parts.

were destroyed;

functions

its

had

cutis

when

pended, and

secretions

its

membrane was

this

and

lost its elasticity,

were

divided,

sus-

was

it

coloured here and there with collections of vessels that

were

filled

with very thin black blood. (In persons

have been drowned, the skin which

is

who

in contact with,

by the water, does not undergo the same

changes.) The subcutaneous vessels were likewise inand

is

acted on

jected with black blood

brown, and

its

The limbs were

and the joints moved with ease, as

persons

The
the

when

was

the colour of the muscle

fibre softened.

the case in

is

pliant,

drowned

they have not been affected by the frost.*

lungs were distended and

mucous membrane was

in

filled

with black blood;

a state of ecchymosis, and

the bronchial vessels filled with gas that could be dis-

charged by pressure.

were

full

ted, as in those
sults
first

it

The

of the heart

arterial cavities

of black liquid blood, the intestines

who have been drowned.

will be easily believed, that

were spot-

After these

animal

life

re-

had been

invaded, as I have already remarked in the cam-

paign in Piedmont,

when speaking

of those who. were

drowned.

The organs
tions:

of sense

first

muscular power

consequence

is

the

fall

cease to perform their func-

is

paralyzed,

of the person,

if

and the
he be erect

the animal functions are gradually arrested,

sequently those of internal

life.

It

first
:

all

and sub-

would appear as

CAMPAIGNS

IN SAXONY, &C.

125

doctors Portal and Bichat have observed, that the brain

and the nervous system which

arises

from

are almost

it,

suddenly paralyzed by a rapid transmission and diffusion

of the deleterious carbonick principle, that

is in

the

first

place absorbed by the lungs and carried to the brain with

the arterial blood; and in the second place diffused

through the apertures or pores of the skin over the

capil'ary system, subcutaneous nerves,

decomposed and the

instantly
life

The

through the muscles.*

bility,

are destroyed. Organick

and

in all proba-

galvanick

fluid is thus

sensible parts of animal

life

supported, be-

is still

cause the red blood, although blackened

by

the absorp-

tion of the carbonick acid gas, continues to stimulate the

and supports the action of the internal

heart,

Hence

The

death.

bodies of those

who have

organs.

died of asphyxia

very soon putrify, and their decomposition

When asphyxia
ner, they

dered

vital

the pliancy of the limbs continues even after

who have

liable to

rapid.

is

does not terminate in this

been acted on by

its

fatal

man-

causes are ren-

a putrid nervous fever, from which they

have a tedious and

difficult

convalescence.

When

the dis-

ease has been very severe, the skin of the most promi-

nent parts of the body

As

carbonick gas

phere,
is

it

circulates

falls into

is

on the

much

gangrene and sloughs.

heavier than the atmos-

floor of the

chamber

in

which

it

disengaged, and rises up on the sides of the room accor-

where the soldiers were

seized with asphyxia, they who were nearestthe stove and
ding to

its

quantity. In the place

lay on the floor with a small quantity of straw, (which

scarce in large cities)

were

first,

is

and most dangerously

carbonick gas be absorbed by the pores of the skin,

why will it not act on the band that
has long been immersed in it, or why does it not act on the
more delicate coats of the stomach, and on its nerves in an
injurious manner when taken into that viscue? Tr,
*

If

as our author supposes,

Vol.

ix.

130

MEMOIRS, &C.

affected.

The

unfortunate

corporal of the detachment to which these

men

belonged, with three other soldiers, es-

caped without injury, because they were lying on beds,

or on the tables in the room near the windows, and at a
distance from the stove.

gerous repose by the

'1

hey were roused from

reveillie

this

dan-

but their faculties were

benumbed, and they had violent pain* in the head.

One of them was able to rise and open the window,
and the air began to ivvive him but he was alarmed
;

when

he found that none of his comrad

and that those

move.

He

Some

'ay

difficulty

soldiers

answered him,

on straw and on the

called for aid

bed. and with

gy.

who

shook those

floor, did

not

who were on

the

aroused them from their lethar-

came

opened the

to lvs assistance,

doors and windows, called in physicians, and everything

was done

that could be thought

of.

Three of them were

soon resuscitated, but remained unwell for several days.

Five of them were carried into our hospital, as I

it

in the

morning:

we were

not able to re-establish the

principle of life in three of these.

We discontinued our at-

tempts, and placed them in a well -ventilated

twenty-four hours.
dies

were opened

At

visited

chamber

for

the expiration of this time, the bo-

in the presence of all

my pupils, and we

found the appearances that I have already enumerated.

The

assistance

which was given

to the other

two,

who

exhibited but few signs of animation, re-established the

organick functions, but

tions of

snow over

jyrUa alkalies

all

in

an imperfect manner. Fric

the surface of the body, frictions

and alcohol, cupping and

scarifications,

derate venisection from the jugulars, with

mo-

a view

of
gradually unloading the veins of the head; acidulated
drink*, cordial stimulating draughts, and at times emetick

potions were given:

subsequently bitters; the bark and

was used with advantage: but in one of these

men, gangrenous eschars were formed on the region of

the canella

131

CAMPAIGNS IN SAXONY, &C.

the sacrum,

and on the angles of the scapula, and retardHis comrade

ed

his convalescence.

ly,

and the organs of speech and

also recovered slow-

intellect

laboured a long

time under great debility.

As asphyxia from this cause

occurred again in different

parts of the cantonment of the guard, I took measures

prevent

to

tions

on

in future

it

this subject

request,

some

direc-

order of the day,

in the

effect.

early and intense cold of the winter, succeeded

abundant rains and thick

mick

my

at

were inserted

which had the desired

To the

and

catarrhal affections

fogs,

which produced adyna-

and diarrhoeas

in

many

of our

men

they easily yielded to the treatment that was indica-

ted.

But

the most serious disease

spread rapidly
ces

was of a

among

was the

syphilis,

our soldiers, and in

serious character. It

many

was necessary

which
instan-

to

com-

bine febrifuges ortonicks with the antisyphiliticks, accor-

ding to the complication.

and

We

lost

but few of our sick,

the health report of the guards that

was

issued this

campaign, might be considered as favourable. The departure of the

army

for

Poland put an end

to the action

of these causes of disease, and the soldiers in general during the march, soon regained their strength and former
vfffour.

MEMOIRS, &C

112

CAMPAIGN

POLAND

IN

*,""'"'*"*'

THE sudden marchand

of the Russians towards the ca-

pital of

Poland,

the certain information that had

been acquired of a coalition between the king of Prussia

and theemperour Alexander, hastened the renewal of hos-

The campaign opened in Poland about the midof November. The emperour Francis set out for Ber-

tilities.

dle
lin

with

his

crossed the

We

guards on the 25th of the same month.

Oder

at Custrin, a strong populous city ad-

vantageously situated on this river.

tered Prussian Poland. Although

The next day we

it

santly since our departure from Berlin, the roads

yet passable, and

we

en-

had rained inces-

were

Posen on the 30th,

whither the emperour had repaired on the evening of the

27th.

arrived at

The advanced guard with

my had reached the borders

possession of

The

Warsaw and

the cities on

its left

bank.

magistrates and inhabitants of Posen received the

emperour with acclamations of

days in

several corps of the ar-

of the Vistula, and had taken

joy.

We

remained some

this city, celebrated for the resistance

the troops of Charles XII,

principal convents

were used

who

took

it

as hospitals,

it

made to
The

in 1703.

and I had one

of them appropriated exclusively to the reception of the

sick of the imperial guard. I frequently visited the hospitals of the

army and

city, in

order to become acquainted

CAMPAIGN IN POLAND, &C\

with their diseases. In one of the

133

latter, I first

remarkable disease of the hair which authors

saw

that

call Plica.

(Plica Polonica.) I attended carefully to this affection,

and acquired every necessary information concerning

it

from the physicians, and from the patients themselves.

In short, I

ther

it is

attended to the progress of this dis-

strictly

ease during

my

stay in Posen, that I might decide

and may be removed without

factitious,

whe-

difficul-

But I had need of a greater number of facts to estamy opinion in a positive manner. I postponed my

ty.

blish

researches to resume them afterwards at

Warsaw. Be-

our arrival at Posen, our troops suffered but

fore

little,

notwithstanding the bad roads and the severity of the

weather.

They had

generally procured a shelter on their

march, with good food, and good straw on which to

sleep.

The

during the

severe cold, and the dryness which succeeded

first

of

December, contributed

during our stay in

this city.

We

had but

to their health
little

disease;

some accidents happened from the carbonick gas of the

stoves, which were too much heated.
On the 2d of December, the anniversary of the coronation of the emperour was celebrated, and on the same
day he announced to his army by proclamation, the arrival of the Russians on the right bank of the Vistula the
same Russians who on the same day of the preceding
;

year had been vanquished at Austerlitz. By a solemn

decree, he instituted the " Temple de la Gloire," and ordered that

it

should be erected on the scite of the church

Magdalen

of

at

Paris.

Silesia capitulated,

On

the

same day, Glogaw

and was given up

to the

in*

French ge-

neral.

Before the 15th of December, several corps of our ar

my

had crossed the Vistula and had reached Warsaw,

Thorn, and several other important places, and hastened

MEMOIRS, &C.

134
to

meet the enemy, whose advanced guards they imme-

diately repulsed.

The emperour

set out

from Poscn on the 15th of Dec.

and we arrived

in the night with the imperial guards,

on the evening of the 22d, and forthwith

passed through this city. One corps of our troops advan-

Warsaw

in

ced

to the

Bug, and crossed

on the morning of the 23d.

it

enemy, and the intrenchments that

he had thrown up in places intersected by canals and by
the branches of several rivers, were carried at the point
of the bayonet. Every obstacle was surmounted, and

The

our

batteries of the

army advanced with an uninterrupted march

Lithuania, pursuing the enemy,

who

into

retreated on Pul-

stuck.

The

imperial guard

which

I followed

with

my

ambu-

lance, did not halt at the passage of the rivers: the divi-

them all, and re-esta

marched night and day, in or-

sions that preceded us had forced

We

blished the bridges.

der to join the imperial headquarters.

very

difficult,

pest, attended

Our march was

frost and a
which surprized us

on account of the

violent tem-

with

in the mid-

hail,

dle of the night. Copious rains succeeded these severe

frosts

and rendered the roads almost impassable.

rived at

ged

Golominn on the 27th

to halt

on the

were wounded

in

way
an

We ar-

at night, after being obli-

to dress

affair that

some of

the guards

who

took place in the even-

between our cavalry and the troops of the enemy.

Some of them received wounds which were severe, but

ing,

terminated favourably.

I shall speak of

them again

when reverting to Warsaw.

From Golominn the imperial guard continued to advance on Pulstuck. The roads became worse after we
left that city.

and

we

came up

It continued to rain incessantly

upon

us,

continued to march through a thick clay that

to the girths of the horses, in

which the

artillery

CAMPAIGN

IN POLAND, &C.

136

was every moment mired, and a great number of the

fast. Our army never perform'
ed a more difficult and tedious march. Under these cir-

baggage-wagons stuck

cumstances, the advantages of our small ambulance carriages were evident, as they were fixed on two wheels,

and from

and

their height

great part of the

easi-

even than the

ly than the carriages with four wheels, or

bat-horses.

more

lightness, travelled

wounded above mention

ed had not been dressed: they were attended to by the

my

surgeons of

ambulance, and I had them conveyed to

Pulstuck, which

we

surgeon of a corps,

The

entered on the 30th.

who had

principal operations, attended

assisted

imperial

Mr. Gale, chief

guard remained here but a short time.

me

to

perform the

them during our

stay in this

city.

The

march of the enemy, whose rear guard

precipitate

only could be attacked at Pulstuck, at Ostrolokenka, and

Narcuw,

at other parts of the

reasons of which I

back on Warsaw.
the Vistula
perial

am
It

the bad roads and othei

ignorant, caused the

the important advanced posts

army

to

fall

took position on the right bank of

head quarters returned

to

and the im-

the capitol

with the

guard.

The

which

frost

day of our march

set in

on the 31st of December, the

for Pulstuck,

improved the roads, and

next day our wagons were borne by the frozen

arrived with

nuary.

my

ambulance

The wounded from

at

Warsaw

clay. I

on the 3d of Ja

Pulstuck and Golomin were

then removed hither, and I prepared a separate hospital

for the

wounded and

not continue loc.

shortly

series of cloudy

commenced, and

sible condition. In
the soldiers
es, the

sick of the guards.

left

The

frost did

and rainy days

the roads in the worst pos-

g moral, this short expedition fatigued

more than

that in Russia.

dampness and mire

to

The

forced march-

which they were exposed

136

MEMOIRS, &C.
and comforta-

in bivouac for several nights, without food

ble drinks, had

number
which
namia.

weakened them.

sick of catarrhal

and

We

had a great

also

bilious or gastrick fevers,

young persons were complicated with adyBut proper care, good regimen, and the salu-

in

removed these diseases, toge

and the army soon became healthy

brity of the cantonments

ther with their causes,

Our
in

troops on the borders of the Vistula

were generally

good condition. Their wounds were attended with no

Those of the articulations, although

were cured by the means that are pointed out in
my campaign in Egypt. I shall merely notice as I go
on, some cases that appear to be most interesting.
unusual symptoms.
severe,

A trumpeter of the corps of

mamelukes,

who

with the

chasssurs of the guard had charged on a strong, welldisciplined corps of cossacks

was wounded by one

armed with keen

scapulo-humeral articulation

was

laid

the humerus entirely cut off from the

arm was

in short, the

scimeters,

of them in the right shoulder.

open

The

the head of

body of the bone:

held only by the tendons of the

Jatissimus dorsi and pectoralis major, and by the nerves

and axillary
the success

vessels.

which

We dressed him on
had

in

the

field.

From

a similar case at Salehyeh in

Egypt,- 1 entertained hopes of his recovery.

After ha-

ving extirpated the head of the humerus, I tried to reunite the wound but a momentary success attended my
:

endeavours.

A tedious march and unfavourable weather,

produced the most alarming symptoms.

at

Warsaw,

first

favourable

in the fistulas

arrival

moment. Counter openings were made

which had formed round the

dressings were applied, and

To my

great

joint.

Mild

warm camphorated

sweetened wine was used according

the parts

On my

I decided on performing amputation at the

or

to the shite of the

and agreeable surprize, the

CAMPAIGN IV POLAND, &C.

137

symptoms abated and finally disappeared. After several

weeks' attentive treatment by Mr. Paulet, my adjunct,
the

wound

healed and the humerus formed an anchylosis

with the scapula. This mameluke returned to France perfectly restored.

Three chasseurs, who were

the

by

less severely

joints of the superiour extremities,

the

same

treatment.

The

re-union

wounded

were

was not

in

also cured

exact,

and

the bandages did not impede the circulation in the capillary

vessels of the articular

of the wound.

lips

membranes, nor

in those of the

supporting bandage and the simple

means before mentioned were sufficient.

was presented in the affair at Golominn.

A curious case

A brigadier of cavalry, while charging, was wounded

by a

from the

ball

light artillery

which grazed

his left

arm but instead of a contused wound, the ball (which

was nearly spent) produced only an ecchymosis of the
;

part injured, and a small division of the skin that appearif made by the point of a sabre. This wound
which appeared simple to my colleague, was dressed as
usual, and the wound went on to suppurate without any
unpleasant symptom. Towards the ninth day, the discharge became sanious, and of a black colour, which led

ed as

the surgeon to suspect a piece of carious bone: he probed

the

wound, and

to his great surprize discovered a hard

sonorous body, deeply seated

in the interstice,

the biceps and brachialis muscles.

and by means of a pair of forceps, extracted

body.

first

this foreign

dreadful haemorrhage immediately succeeded,

which he arrested,
returned.

between

He dilated the wound,

it is

true,

by compression, but

it

soon

He had had three returns of haemorrhage when I

saw him. The case seemed

plication of a ligature

Vol,

ii

on the

to

me

to require the ap-

artery, or the amputation of

MEMOIRS, &C

138

The

*he arm.
ficult,

was

former operation was rendered more

because the swelling of the edges of the

considerable, and the

painful.

Under

arm much tumefied and

the circumstances

which then

could not perform the latter operation.

wound very deeply down

tirely divided

ately ceased,

to the artery,

dif-

wound
very-

existed, I

dilated the

which was en-

by the bistoury: the haemorrhage immedi.

and I entertained hopes of preventing its

return by the application of a styptick, such as the digestive, acidulated with sulphurick acid, mixed with
bark

and camphor, and by an uniform and graduated comarm and fore-arm by compresses wet

pression on the

with

warm

camphorated wine, sulphurick acid and

alu-

The haemorrhage appeared no more: he regained

strength: the arm being long without pulsation
in

mine.*
his

and ulnar

the radial

skin had lost

its

had nearly withered the

epidermis and its animal heat. But the
arteries

powers of the parts were gradually restored: the muscuand deep-seated vessels performed the duties of the

Far

humeral artery, which was obliterated. The pulse re

was quite cured on the. 65th day

turned and the patient

He has since been sent to the warm

springs to re-establish the motion of the affected limb.
The foreign body which was extracted from the arm

after the accident.

of this man proved to be a portion of the point of

a sabre about three inches in length, and ten or twelve
lines

which the ball had met in its progress, and

had driven before it into the thick part of his
arm. It
in breadth,

fs

difficult to

the

account for this phenomenon

but I vouch for

fact,

* No astringents can arrest the haemorrhage

from the
brachial artery when divided: and it would
be highly culpable to trust to them. In this case,
compression alone or
the retraction of the artery
could have checked tho

morrhage.

Tr.

he'

CAMPAIGN

139

IN POLAND, &C.

In the affair at Gotominn, some of our soldiers had

wounds of the head, with division of the bones of the cranium and lesion of the meninges, and the cortical substance of the brain

men

these

recovered completely.

That part of the army which had passed the Vistula

went into winter-quarters but that part of it intended
:

for the conquest of Silesia continued its operations until

the surrender of the last fortified place.

While

Warsaw,

I remained at

directing the service of

the hospital of the guards, I examined everything interesting

which

which

that capitol presented. I realized the

my

had of pursuing

inquiries

on syphilis and gonorrhoea, which

appeared more

I endeavoured also

virulent in Poland than elsewhere.

to turn

me

to

wish

on the plica, and

every remarkable appearance which the wounds

or acute diseases presented in this

new climate, to

the ad-

vantage of the young surgeons of the army, and of the

guards, by setting apart a day in each

week for a

conference on the wounds and diseases of

Whatever could give

my

clinical

hospital.

us information relative to the topo-

graphy of Poland, and the character and manners of

was

inhabitants,
cially if

it

introduced into our lectures,

could apply to the practice of our

more
art.

its

espeI wjv$

about to commence a complete course of military surgery,

and had made every preparation

we were

end of January
paign.

We

While

left this city

at

Warsaw,

not occupied by
the

become

sited those

my numerous

march

of the army.

duties, in inquiring into

their causes.

In or-

perfectly acquainted with the plica, I vi-

persons

in the hospitals.

series of

it,

employed the time which was

endemick diseases of Poland, and

der to

and

obliged to

to follow the

when at the
begin a new cam-

for

who had
The

this disease,

result of

experiments which were

immediate inspection, and

my

both in the city

inquiries,

and of a

made under my own

in the presence of several

MEMOIRS, &C.

140

French and Polonese physicians confirmed me in the

opinion which I had already formed of the nature and
caus
th

of this pretended disease. I carefully collected

facts

which

observed, and

made them

a memoir which I addressed to the

all

the basis of

This me-

institute.

paced at the end of this campaign.

The month of January passed away without any remarkable occurrence. But some partial attacks of the
enemy obliged the emperour to put his army into motion,
moir

an

is

we left Warsaw on
The snow was about
i

meter about
ficulty

away

we

the

first

of February.

three feet deep, and the thermo-

six or seven degrees

below zero: with

dif-

re crossed the Vistula, as the ice .had carried

The

were diwhere the advanced guards

of the grand duke of Berg had already met those of the
Russian army, that retreated after a very short resistance.
the bridges.

imperial head-quarters

rected towards Wittemburg,

Notwithstanding the rigour of the season, our troops

pursued the enemy vigorously, and endeavoured to at-

The imperial guards marched immediately

advanced guards of the grand duke the etat-

tack him.
after the

major Followed the guards

at a certain distance,

and

hal-

ted at Liebstat to form establishments of various kinds.

My

colleague,

was necessary

Mr. Percy, took every measure which

for the organization of the hospitals,

the reception of several hundred

the

first

them on

engagements

and

who were wounded

in

we had

dressed a great part of

On

the 6th the cavalry of

the field of battle.

Berg attacked the enemy at Hoff, and

made a most brilliant charge. We had but few wounded;
they were immediately dressed and removed to the nearthe grand duke of

est hospitals: the

number

Russians, on the contrarv,

of dead and dying on the

this affair

seemed

my's army, when

to
it

field.

left

The

a oreat

success of

promise the entire defeat of the eneshould halt to fight a pitched battle

CAMPAIGN IN POLAND.

141

but he rested on Prussich-Eylau, an advantageous posi-

with redoubts and batteries of heavy can-

tion, fortified

non: his rear guard had halted in advance of

this city,

behind a village which stands on the road a short half

He was

league from Eylau.

and before noon a

until night

was
was

directed

above mentioned

in this

in the

which had been

devoted the

v<

at its

to the

to direct their dressings.

in

the

prepared to receive them,

mainder of the day and

all

the

the assistance they required.

There were several wounds

arm

time

most spacious house

hastily

night in rendering them

of the

at this

engagement conveyed

and

village,

I had them collected

we

was present

it.

the major general the prince, to have all

by

who were wounded

and

which continued

fought,

but the imperial guards took no part in

the only inspector that

place,

immediately reconnoitred,

was

battle

demanded amputation

that

scapular articulation, and also of the

thigh and leg. These operations were generally attended

with success.

Being aware

that the

enemy had

which commands Eylau,

the guards

at the

halted on the

hill

entrance of the forest,

and the corps of the army which followed it,

The cold had now become

passed the night in bivouac.

more intense;

the thermometer had fallen in the

morn-

ing from the 8th to the 13th and 14th degrees below ze-

At daybreak, our troops having reconnoitred the

enemy without being able to judge of his force, descen-

ro.

ded the

hill

entrance
then

is

filled

ter in the

that fronts the basin of Eylau, into

through a very narrow

with ice and snow,

summer

season

is

defile.

which the

This basin,

a handsome lake of wa-

The advanced guard advanced

towards the enemy, and the imperial guard, with some

other divisions of the army, de-ployed on this basin.

The Russians

finding themselves strong, and in a

vourable situation, prepared to

make a

general attack

fa
on,

MEMOIRS, &e

142
our troops.

A brisk cannonade very soon commenced on

both sides, the two armies approached, and the battle be-

came very

bloody.

The

was

victory

when

doubtful,

vi-

gorous charge from the imperial cavalry decided the fate

was

of the day in our favour. This battle

as severe as I

ever witnessed.

Although the infantry of the guard was not engaged,

suffered very much from the fire of the artillery. In the
morning I had placed an ambulance in the barns which
stand on the left of the road as you enter the city ; but
unfortunately they were open on every side, the straw
it

having been removed

liged to lay our

mixed with snow, and a

the line
rial

were

were ob-

the remains of this straw,

number of

large

the guards of

collected here. I then attended to the impe-

guard, but according to a rule

dressing those

first

who were most

which

The

intense that the instruments frequently

who held them

for

I established

grievously wounded,

without regard to rank or distinction.

of the pupils,

We

for the horses.

wounded on

fell

cold

was

so

from the hands

me during the operations.

Fortunately I enjoyed an unusual vigour, doubtless pro-

duced by the great interest which I

so

many brave fellows.

The desire which we

wounded, enabled us
difficult duties.

all felt

to

felt for

the safety of

save the lives of the

to persevere in the discharge of our

Night came on, and we had not been

able to satisfy the cravings of nature. In the midst of such

heart-rending scenes,

how

could

we

but the performance of our sad but

I operated

attend to any thing

humane task? While

on one, I heard the most pressing

milar services on every side.

calls for si-

After the operation, a sur-

prizing calm, and a kind of internal satisfaction succeeded to the cries of these soldiers, which they expressed by
the most lively acknowledgments.

CAMPAIGN IN POLAND

143

In the midst of such endless obstacles as were here

presented,

by our

was

cold, I
difficult

still

and of the

common to

not

to

and the severity of the

perform several delicate and

arm at the
extremities where it

operations, such as amputation of the

shoulder-joint,
is

local situation

enabled

inferiour

perform

it

with numerous sutures of

the face, for the complete division of the soft walls of the

mouth,* also of the nose and

ears.

wounded began to revive,

enemy made an unexpected moveattack our left, where our ambulance was staThose of the wounded who were able, fled;,

Just as the spirits of our

the right

ment

to

tioned.

wing

of the

others attempted in vain to follow them, in order to

escape

this

unexpected attack of the enemy. But

couraged them, and resolved to

ignominious

safety.

made

die, rather

wc

en-

than seek an

haste to finish the section of

leg which I had already begun, and declared to

wounded my fixed determination not to abandon

post. All

my

pupils rallied round,

the

my

and promised not

to

desert me.

In

who

this difficult

conjuncture,

Mr.

Pelchet, the

officer

directed the ambulance, arrested the flight of his in

valids

and wounded.

He

also found

means, even during

the greatest want, to procure the provisions which were

necessary for our

wounded and those of the line. Here

was advantageously used to

also the flesh of the horse

make

An
of the

broth.

impetuous and well timed charge on

enemy by the

this

winds of snow, prevented the consequences

dreaded by our wounded. All again became

we were

column

cavalry of the guard, through whirl-

enabled to resume our operations.

so

much

quiet,

and

All the se-

wounds of the guard, and a great portion of those in

the line were operated on and dressed within the first
vere

There were no salivary

"rounds

fistulas in

consequence of

th<

MEMOIRS, &C.

144

twelve hours. Until then

we

could take no repose.

We

spent the remainder of the night on the frozen snow,

around the

fire

of the bivouac of the ambulance.

I never passed such a painful period

mind been
suppress

courage

so

much

affected; I found

never had my

it

impossible to

my tears, even while I attempted to support the

of my wounded. I had the mortification of see-

ing several of them die, whose

wounds

required amputa-

tion of the thigh at the hip-joint, because the unfortunate

we were

circumstances in which

placed, the excessive

and the want of room prevented mcfrom perform-

cold,

ing these operations, which

and dangerous. The

are in themselves difficult

brave fellows corrobo-

loss of these

rates the opinion that I have

advanced of the necessity

of performing these operations in similar cases.

Next day

at

day break

we resumed our labours among

many of the line, and

our wounded, and attended also to

had those of

of the Russian prisoners. I

who were most

house

in

Eylau, with such as had amputations of the

thighs and legs, and others

ded

my wounded

severely injured conveyed to a large

in the

who were dangerously wounmany of whom I had

head and thorax, on

operated with the trepan.

The French and

-Russian

received into this small town,

wounded could not all be

where the etat- major and

the imperial guard were, for fear that an epidemick might

be produced by crowding them together, and by the

copious suppuration which would take place on the third
day.

The extreme want

to

which

we were

reduced, in

the midst of a country covered with

snow, abandoned
and devested of every resource, enforced the necessity of removing them. The empercur

by

its

inhabitants,

foresaw that

it

would be better

to

expose our wounded

to the vicissitudes of a tedious, long,

and

difficult jour-

ney, than to see them perish from causes which

it

would

CAMPAIGN

IN POLAND.

145

to remedy. Moreover as yet he was igno

march of the enemy. The remo-. al of the
wounded was ordered, and within the first twenty -four

be impossible

rant of the

hours

who were most

those of the guard

all

wounded, were sent

Mr.

I wrote to

who remained

surgeon

Paulet,

Warsaw

at

wounded

in

an extensive

adjunct,

general

with part of the

Inowraklaw,

lance, forthwith to repair to

ated for that purpose

severely

off.

castle, that

by marshal

ambit-

to receive the

had been appropri-

Bessieres.

We

had an opportunity of observing the advantages

again
o? the

form and lightness of our ambulances. They were able

guard through the miry roads

to follow the cavalry of the

from Pultuska, and

ty-five leagues

also to traverse the

from Eylau

snow and

ice

fif-

Inowraklaw, beyond the

to

Vistula.
I shall attempt to point out the advantages of

remo-

ving the wounded immediately after a battle,

when

they

cannot be accommodated in the vicinity of the

field

with

security,

and with the advantages which they

In advancing

this opinion, I

am

require.

supported by experi-

ence, and his majesty, without doubt, recollected the success that attended the removal of the
siege of St.
this

Jean d'Acre

army on

at the

Egypt, when he directed

it

attended with similar suc-

measure. I had found

cess in the

wounded

in

the Rhine, and the Eastern Pyre-

nees.

Indeed the serious disadvantages can not be obviated,

which must

arise

into a hospital after

many wounded
Adynamick affections and

from bringing too

an

action.

the hospital sore are caused

by the abundant suppuration

of the wounds, and other animal secretions

and

fears of the

dition

and

loss,

wounded, while
depress the

spirits

reflecting

on

the grief
their con-

of each other, and in-

Tease their distress. These causes induce simple wounds,

Vol.

it

MEMOIRS, &C.

146
and a

fortiori, large

and complicated wounds, to assume

an unfavourable character, and their termination is but

too often fatal. The wounded should be removed to different places immediately after an

and

ternal

internal motion

engagement.

The ex-

which takes place while tran-

sporting thorn from one place to another, excites and

promotes the functions of the organs

are in motion, the circulation

is

the muscles

all

and the

accelerated,

cretions go on: suppuration takes place in a

gree

the sloughs are soon deiached

cillation of the

by

subjacent vessels, the

se-

proper de-

the increased os-

wounds become

and approach each oth r by

the gradual expansion of the vessels and by this geneclean, their edges drvelope,

exc ment they close together, or contract adhesions

by means of the slight inflammatory swelling which
succeeds The external air, which is always more pure

ral

than that of close dwellings, imparls an activity to the

secretions

the,

tinually taken

wounded man
Being

less

cutaneous transpiration

up by the

is

moreover conand the

free current of air,

has nothing to fear from

consequences, than

repercussion.

its

occupied with the danger of the

wound

with their personal

by various

objects,

and

its

preservation,

they care less for their misfortunes. Their attention

tracted incessantly

or

is at-

their spirits

are supported. In short, whatever vicissitud-s

may

at-

tend these removals, they a r e not, nor ever can be, as

pernicious as the multiplied causes of accessory diseases

which come
great

into action in those establishments,

number

of sick and

wounded

extremes of temperature are also

a.e united.

where a

The two

less injurious to the

wounded when they are moving in the open air,

when they are at rest in the wards, that in general
badiy ventilated. In the former case the wounded

than
are

pass

through the different degrees of temperature in a gradual

and almost imperceptible manner, especially when they

CAMPAIGN

147

IN POLAND.

take care to keep themselves well covered during the

night,

and

and

be well protected from moisture. In the

even impossible

it is

To

to

case on the contrary, the transitions are sudden,

latter

to prevent them.

these physiological arguments in favour of removing

wounded, should be added others of a

the

To

ture.

the

commander

admit these, and

to

it

na-

political

belonged to

arrange such plans as would best

serve the interests of the

rits

in chief alone

wounded, and support the

spi-

of the soldiers.

After the severe engagements which

siesre

we had

at the

we were reduced to two dreadabandon our wounded on the

without food, or any resources,

of St. Jean d'Acre,

ful alternatives, either to

shore, without a shelter,

by the Arabs of the desert, or to convey

them, mounted on miserable beasts of burthen, or to
march them on foot eighty leagues, beneath a scorching
sun, where they might be deprived of fresh water at
to

be cut

off

that time

we

had but a small quantity of buiscuit, and a

goat skin of water, which they could have consumed in

oTx day:

we

did not hesitate to adopt the latter

though most of these

soldiers

or had lost a limb, they arrived in

or advancing towards a cure.

part of

them

and

were severely wounded,

Egypt

either cured,

We did not lose a fifteenth

yet the heat of the desert

was extremely
khamsyn

great, and they experienced the effects of the

on their

route.

In Poland, notwithstanding the severity of the cold,

the badness of the roads, the imperfection of our

means

were badly constructed,

of conveyance by
and travelled with difficulty on account of the thaws and
successive frosts in short, notwithstanding our want of
carriages that

provisions, and the fatigues of a long journey,

ded

men

dition,

generally arrived at Inowraklaw

where

their cure

in

my woungood con-

was speedy and complete.

We

MEMOIRS, &e.

148

and yet there were a great

were very severe and
wounds
number of them whose
complicated with other diseases:* viz. certain wounds
the thigh,
of the thorax and head and amputations of
with the hospital fever, which had appeared in the hos
had re
pital at Eylau. It is probable, that if these men
scarcely lost one of eleven,

they must have perished from this

complication, which no doubt would have been epide
mick, as it previously was at Brunn. I assisted in placing

mained

in this city,

number of wounded in the carriages, who were scarce

I felt apprehensive that
ly able to move on their beds
they would expire in twenty -four hours: but they arrived at their place of destination without fever, and with

their

wounds

clean and in good condition.

result so

favourable must fully justify such a measure in the opi-

nion of some persons

who considered

removal as an

this

was nawitnessed
the
wounded,
and
tural for the condition of the
repugnance with which they set out. Here the justness

act of barbarity: but they

no doubt

pity, as

felt

of the sentiment of the prince of physick

was

verified

" admorbosecctrcrnos, extrema remedia, fyc." It is tr,uour transportation was made with great care each con;

voy was attended by a number of the

to the

medical

staff,

by

sub-officers,

officers

belonging

and nurses who

could render every necessary assistance to the

wounded

Their lodgings and their soup were prepared before they

arrived at their stations,
before.

The

titled to the

on

by

sub-officers

who were

intendant commissary, Mr. Dufour,

is

sent

en

thanks of these soldiers, for his zeal and care

this occasion

and great praise

is

due

to

my

fellow

surgeons of the ambulances and of the guard, for their

devotion at this

and

crisis.

Tetanus did not appear among the wounded guards,

was informed that few of the line were attacked by it

CAMPAIGN IN POLAND.
I shall notice those

wounds

common phenomena, and

that

were attended by un

required important operations.

Captain Labit, 69th regiment of the

the first

cannon
part
joint,

The
to

wounded

that

was brought

ball disorganized his left

The
and

to

was one

of

ambulance.

line,

my

arm

at

was bounded above by

injury
I

149

amputated

this

in a short

superiour

the shoulder

my

limb according to

operation was prompt and successful

Thorn, and

its

plan.

he was sent

time after I was informed, had

been perfectly cured.

A dragoon of the sixth regiment was

ambulance with a

wound

of the

left

brought to our

shoulder, loss of sub

stance of the deltoid, fracture of the head of the humerus,

and laceration of the brachial plexus, which doubtless

caused the acute pain which he suffered. Notwithstand-

was then extreme, I retained sufficient firmto remove the arm at the articulation.
This was followed by a perfect calm he soon fell asleep
while enveloped in his cloak, and slept until next morn
ing, when he was sent to Thorn.

ing the cold

ness in

my hand

A young officer of the light infantry

afterwards, with a

A part of

pectoralis major,

dious and
this piece

wound

the head of the

was brought soon

nearly similar to the above.

humerus was driven under

which rendered the operation more

difficult.

The

difficulty consisted in

of bone, and in detaching

it

the subscapulars muscle that confined

pressed

downwards and

completely successful.

inwards.

te-

extracting

from the tendon of

it

on the side of

the scapula, without injuring the axillary artery,

it

tin

The

which

operation

wis

MEMOIRS, &C.

150

captain of the sixth regiment of cuirassiers,

was among

the

first

that

were brought

to

my

who

ambulance,

presented one of those rare cases, in which limbs are car-

away by

ried entirely

The

ted.

if they had been amputahad taken place about a

a ball, as

division of the limb

centimetre above the elbow joint.

who had
lint

Some of

the surgeons

before seen the wound, had applied a pledget of

and a simple dressing on

to believe that

this

stump, and had led him

he might escape without an operation but

:

which had succeeded, and a kind of painnumbness induced him to call loudly for it.

the acute pain

ful

made

the section of the flesh about four or five centi-

metres above the accidental division, and the bone

sawed
of the

and

off

much

del! oid

was

higher, near the insertion of the tendon

He became

muscle.

slept so soundly

instantly

on the snow, that

it

composed,

was necessary

awaken him in order to place him on the horse that

was to convey him to the hospital. I may observe that the
humeral artery was torn off more than four fingers breadth
above the end of the stump, and I had some trouble
to

in laying

bare and tying

it

it.

This broken artery pre-

sented a conical enlargement of that extremity next the

trunk, which might be called a true aneurism: a circumstance

which induced

gature round

it.

This

me

to use the needle to pass the

officer

li-

recovered under the care of

one of his regimental surgeons.

Richard, a chasseur of the guard, also had his right

arm

away irregularly by a large ball near its

was found necessary to amputate at the joint.

carried

middle

it

In these cases, and even

tion of the

arm

left as to

bone can be sawed

deltoid, the
his

life

if

off

when

there has been such a por-

allow of amputation, unless the

on a

wounded man

with the insertion of the

will have a better chance for

level

amputation be performed

at the joint,

than

CAMPAIGN IN POLAND.
when performed on

arm above

the

muscle. Experience has taught

me

when speaking

particular notice,
tions of the

arm

I shall

it.

the insertion of this

the superiour advan-

tages of the former operation, and

opportunity of confirming

151

I have

make

it

since had an
the subject of

of consecutive amputa-

In the case of Ri-

at the articulation.

chard the operation was very promptly and easily per

formed, according

to

my

very well in the narrow

plan.*

wound

operation, and the cicatrix

Suppuration went on

that

was

left after

was complete on

the

the thirty-

seventh day.

Amputation of the thigh was generally followed bj

and in those cases where I was able to operate

success,

immediately, the stumps were not at

all

conical. It often

happened, when the precept which I have inculcated in

my memoir

on amputation, was not followed, and the

operation had been postponed too long, that the stump

appeared conical
muscles were

after the first dressings,

irritated

by the

first

because the

degree of inflamma

and their retraction was much more violent, than

when the section is made before erethismus takes place
The following cases will illustrate this

tion,

Thomas, a

corporal of chasseurs, had his right knee

by a cannon

principally destroyed

performed amputation of

his

ball.

I immediately

thigh at the usual place: but

I took care to carry the incision of the muscles as high

up
last

as possible,

and

to

saw

off the

femur even with the

section, without re uniting the edges of the

according

them by

to

my

custom and principles. I approximated

a split roller, and a

my

* See in
tirpation of the

wound

campaign

arm at

in

narrow compress applied

Egypt the memoir on the

the shoulder.

ex-

MEMOIRS, &C.

\.)Z

circularly.

He was removed

to the hospital of the guard

with others, and soon recovered.

amputated the thighs of Julien and Hennequin,

same regiment, on account of wounds of the knee

I also

of the

from grape-shot, that fractured the articulating portions

The former had

of the bones.
left

his right,

and the

latter his

was crushed at its

biscaijen was found,

thigh removed. In this the femur

lower part, and in that a large

wedged

two condyles of the fewas performed in the same manner,

in the thick part of the

The

mur.

operation

and with the same success.

The same

operation

was performed on Messrs. Ri-

chard, Arnoult, Wauderkern, Bigot, and Varoclos of the

guard, for grape-shot wounds of the knee, with fracture

of the articulating portions of bone and of the femur

two of these died during

rance and the

their

seventy

fifth

day.

As

shall

cured before the

shall not detail their cases,

also pass over a great

I partially amputated the

all

others arrived at

wounds were attended with

putations of the arm, fore-arm,

toes

The

and were

their

no uncommon appearance, I

and 1

removal, from intempe-

effects of the injury.

their place of destination,

and

foot

number

of other

am-

leg.

of

Mr. David, whose

were carried away by a cannon-ball, which fractured

-,ome of the

bones of the metatarsus. This operation

succeeded, as

all

dertaken

others of a similar kind that I had un-

another argument in favour of amputation at

the joints.

was

Mr. Hanwhich had been disorganized by a ball, as

fortunate in preserving a portion of

nequin's leg,

high up as the tuberosity of the

tibia.

amputated

CAMPAIGN IN POLAND.

153

through the thick part of the condyles; the

wound

of the

stump was healed entirely before the seventy-eighth day,

and he walked securely, and very conveniently, on a
wooden leg. I shall again speak of this mode of operating.

The

and 10th days of February were

extremely severe, and the whole army suffered much,
and

6th, 7th, 8th, 9th

who were still in bivouac.

and a great number of officers,

particularly the guards,

Almost

all

the soldiers,

were more or

less indisposed. Several who had been exposed to intense cold were so imprudent as to place their
feet near the fires of the bivouac ; or they who were un-

expectedly affected by the cold during their repose on the

10th (at which time the temperature changed, so that the

thermometer rose above zero, and a thaw succeeded)

affected by the gangrene from congelation. Our

were

wounded escaped, because they could not approach the

In the sequel is given a memoir on this gangrene.
They who escaped this accident were affected with diar-

fire.

rhoea, dysenterick flux, catarrhal

and rheumatick disor-

which may be attributed to the sudden changes of

temperature, to unwholesome provisions, and the use of
ders,

the waters of the Eylau, that like the water throughout

Poland, is scarcely potable. These mucous disorders contiuntil our return to the borders of the Vistula, and

nued

while the winds continued at the west and south

They were

also complicated, in a great

many

west

with
an ulceration of the gums and apthae of the mouth.
lew doses of ipecacuanha, given at first as an emetick, and then in infusion, with the use of opium, bitters,
cases,

we procured from the

on both banks of the Vistula,) ab-

wine, vinegar and brandy, (which

towns

that are situated

lution of the ulcerated parts

Vol.

ii.

with diluted mineral acids.

MEMOIRS, &C.

154

and the return of the north north-east winds, removed all

these symptoms, and re-established the health of the
army.
After this battle her majesty was pleased to confer

me

my honourable

and

on.

Mr. Percy, the crossof the commandant of the " legion d'honneur;" on several surgeons, who well deserved particular marks of
respect for the zeal with

colleague,

which they attended

ded, she conferred the order of knighthood.

to the woun
Of this num-

ber were Doctor Ribes, and his colleague, Mr. Jouan, of

the emperour's household,

who had

ambu-

rejoined our

and had

lance after several engagements,

assisted

me

in

wounded on the field of battle.

The head quarters and the guards halted at Eylau,
while the main body of the army pursued the enemy
ac.es the immense forests that extend to Plegel, behind
which the Russians rallied and took a position. The thaw
dressing the

which had rendered the roads impassable, and the exhaustion of our troops, no doubt induced the emperour
to

remand

us to the banks of the Vistula, there to take

up our winter-quarters. Accordingly

lau

on the 17th of February

the surgeons of the

we set

during the

out from

first

army were engaged, under

the orders

of Mr. Percy, in dressing the French and Russian

ded, to

whom

it

was impossible

to attend

Ey-

eight days

woun-

in the first

twenty -four hours, and they were successively removed

to the hospitals established in the cities on the
the Vistula.
field

The

of battle

left

bank

of

interment of the dead that covered the

was attended

to; they

were

chiefly

Rus

sian.

We passed by

Lamberg and

Liebstadt,

and on

the

28th of the same month reached Osterode.

The imperial

guard went into cantonments at

and extended

itself to

this place,

the neighbouring towns.

CAMPAIGN IN POLAND.

The main body

of the

army took post behind

sargue, on a line with Liebstadt,

binghen

we were much

in

Morninghen, and El

and

which

would be impossible
privations

we endured

we

to tell

stood

what

fo-

near the Vistula,

cities

the resources for forming magazines,

pecially good wine, of

It

the Pas-

want of provisions and

rage for several days ; but in the

we found

155

much

and

es-

in need.

fatigues, sufferings

in this short

campaign

MEMOIRS, &.

156

MEMOIR
ON THE DRY GANGRENE PRODUCED BY
FROST, OR THE GANGRENE FROM
CONGELATION

ONE

which

of the most unfortunate occurrences to

our troops were subjected after the

the freezing of their

toes,

feet,

battle,

noses and ears.

few of the advanced guard were able

to

was
But

avoid these con-

sequences of the excessive cold.

In some cases the gangrene was confined to the

epi-

dermis, and to the toes and nails; in others mortification

attacked the true skin to a greater or less extent

lost their toes

Physicians

or the whole

who have

consider cold as
the time

and

when

to the

its

this

convinced that cold

exciting cause. But

is

some

written on this mortification,

if

we

attend to

its

progress,

disorder takes place, to

phenomena

foot.

accompany

that

only

its

it,

we may

predisposing cause.

be

Du-

ring the three or four days of extreme cold thaL_preceded

mercury was as low as 10,

and
degrees
below zero, (Reaumur)
15
11, 12, 13, 14,
and until the second day after the battle, not a single sol
the battle of Eylau, while the

dier complained of being frost-bitten, although

we

had

passed these days, and a great part of the nights of the

5th, 6th, 7th, 8th and 9th of February on the snow, and

under the most severe

frost.

The imperial

guard, in par

CAMPAIGN IN POLAND.

15?

snow, without much ex

ticular,

remained on duty

ercise,

more than twenty -four hours, and none

in the

complained of frost-bitten

feet.

The

oi'

them

temperature was

suddenly raised in the night of the 9th and 10th of Fe

bruary, so that the mercury ascended to three, four, and
five degrees

above zero.

morning of

the tenth,

copious

was

of sleet on the

fall

the precursor of the

which took place the next day, and continued

time. There were immediately a number of the
the guard and of the line,

who complained

for

thaw
some

soldiers of

of acute pains

and a disagreeable prickthe extremities, which were slightly swelled, and

in the feet, torpour, heaviness,

ing in

of a dark red. In some I perceived a slight redness

about the base of the

toes,

the foot: in others the toes

and on the upper surface of

had

lost their sensibility, heat

manner dried. They

all assured me that they had felt no symptoms of pain during the period of severe cold which they were obliged
and motion, and were black, and

support in bivouac on the

to

in a

5th, 6th, 7th, 8th,

9th of February, and that until the 10th,

when

and

the tem-

perature was raised to eighteen or twenty degrees, they

had

felt

nothing of congelation.

painful pricking in the feet, that

Then they first felt a

was succeeded by numb-

ness, stiffness, immobility, and weight, with a sensation

was not

of cold at the

same time, but

were able

go into the town, or to the

ac

to

to

warm

the greater

it

severe.
lire

They who

of the bivou-

themselves, were most affected: fortunately

number followed

the advice of

my colleagues

and myself. We directed them to rub the parts immediately with snow, and afterwards with camphorated
brandy, which prevented gangrene in those cases where
it

had not already taken place; but

suddenly
fire

its

in those

progress

who were
was

it

appeared almost

permitted to approach the

rapid, but generally limited to the

MEMOIRS, &C.

156
toes:

foot, but sel-

sometimes extended over half the

it

dom rose above the ankles.

The sphacelus of the foot should not be confounded with
gangrene of the

Happens, and

skin. It often

have seen

cases in which the skin of the foot, to a greater or less

extent, has been deprived of

life,

while the vessels, the

the deep seated nerves, the tendons, the ligaments, and

the bones, have remained sound: in these cases, the pa

pain

tient feels

when

the subjacent parts are touched:

can be moved, and retains

the foot

Moreover,

this

gangrene

superficial

is

internal heat.

its

and cannot be con-

sidered as similar to the sphacelus of the foot that de-

prives

na of
it

it

of motion, of sensibility,

life.

The

and of all the phenome-

patient cannot feel that he has a loot,

appears like a foreign body suspended to his

and

leg.

In

any case, the nature of the disorder should be well ascertained before amputation

medies should precede

is

resorted to, and general re-

it.

I shall attempt to explain the progress

ment

of this gangrene, or rather the

the causes which produce

and develop

modus operandi

of

it.

Cold acts on the living parts by blunting the sensibility

of those organs

pression

which are subjected to

the natural heat

is

immediate im

its

repercussion of caloriek takes place: the pores are closed

the fibres and the capillary vessels

At

the action of the cold

kles and loses

and the

power
ui

vital

is

painful: the skin wrin-

natural colour.

powers

into a state of c

Yet, the animal heat

resist this sedative

and contracting

that opposes the return of the fluids: the capillary

is

obstructed

fications are

ty

its

is

fall

and flow more slowly.

traction: the fluids are condensed,

first,

absorbed, and a discharge and

more

easily

when

its

extreme rami-

Ktakened. The skin becomes red, its sensibili-

blunted, anjl

ii

the effects of the cold continue,

it

dually becomes extinguished and torpour soon takes place

CAMPAIGN IN POLAND, &C.

The

parts

may remain

this state of

lo9

for a longer or shorter period in

asphyxia without losing their

life

and

if

the

removed by degrees, or the person affected by it

pass gradually into a more elevated temperature, the

cold be

equilibrium

may

be easily re-established with the func-

and the disposition that the parts

tions of the organs,

have

to

fall

into

gangrene

who

trary, persons

denly from a temperature

more

removed

is

but

by

are thus affected

at

if

on the con-

cold pass sud

the freezing point to one

elevated, an obstruction of the parts affected must

of necessity be produced

and

be considerable, the

if it

vessels lose their elasticity altogether,

become paralyzed,

and sometimes burst, or are torn asunder: and hence

follow blisters and cracks, or fissures of the part.

course of the fluids in the vessels

is

interrupted

The

there

is

a redundance of carbon, the parts turn black, and gan

grene is abundant. Infection is propagated to all those
parts
cold.*

which have been siezed on,

or affected

Thus the gangrene advances

resistance

from the

powers.

Now

it

by the

meets with

the systaltick

vessels, the irritability of the cellular sub

motion of the
stance of the

vital

until

membranes and

of the skin, which had re

sisted the action of the cold, resist the principles of the

gangrene, and

far

from absorbing them, the extremities

of the capillary vessels which convey blood, and the

lymphaticks being irritated by these heterogeneous qua

lities,

become

obstructed and inflamed

circumscribed, and a

the dead and the living parts.

perficial, the

line of separation
It"

the gangrene

is

formed between

the mortification be su-

sloughs are generally thrown off between

* Is it necessary in this case to resort to contagion to

explain the progress of this gangrene? Cannot the extension of the disorder and death of parts be satisfactorily accounted for on the principles which have been laid down irr
explaining its first production ? Tr.

'

MEMOIRS, &C

160

the ninth and thirteenth days: they leave a

wqpnd

or ul-

cer which soon heals. If the whole of a limb be deprived

of

life,

nature of herself

is

not sufficient to

remove the dead

many obstacles to surmount

can seldom overcome them. The resistance

parts, because she has too

least she

at

al-

most always surpasses her power, and the patient sinks

consequence of the absorption that takes place

when

in

the

sloughs are detached, and suppuration has opened the

mouths of the absorbents. This absorption

nick

life:

affects orga-

a slow fever ensues, with colliquative diarrhoea:

the gazeous exhalations

from the gangrened parts disor-

der the organs of respiration, and concur with the matter that

has been absorbed, in producing a genera] debili-

ty of the functions,

may
this

and death. After some time, gangrene

pass immediately to the neighbouring parts; but

can never happen before the ninth or tenth day,

when

the sloughs

fall off:

the vessels

and the

cellular tis-

sue are then prepared to absorb, but that does not always

take

place,

tionary:
rate

it

may remain

and then the disease

sta

becomes defined, and the dead parts sepa-

from those which retain their

vital

power and action,

and the general functions are not disturbed. The dead

parts

fall off,

the sores

which are the consequence, soon

heal up, and the patient recovers.

Such was the progress of gangrene from congelation,

and such were the phenomena which
land, and I can assert that

it

it

presented in Po-

never appeared

until the

temperature was suddenly raised from a very low to a

high degree above zero.

am even

of the opinion,

that if persons

be subjected to the influence of the cold a

long time, even until they are seized with asphyxia, unless

a second sedative or narcotick cause act internally

in concert

not take

deed

we

with

it,

that partial or general death can

place from the severity of the weather. In

see travellers

who

cross the Alps

and Pyrenees

CAMPAIGN

IN POLAND, &C.

161

during the intense frosts without experiencing any acci

dent, while the cold remains the same. I have had an op-

portunity of proving this fact myself.

The Polonese choose

the time of the most regular cold to undertake the long

and

difficult

journeys with their sledges from Siberia:

they avoid these journeys

when

the temperature

is

vari-

able, because they are then afraid, as they have informed

me, of

the effects of congelation.

While

was

in

North

America, several persons who had been shipwrecked,

at Belle Isle, near NewfoundMay, 1788, had passed several
lying under the snow during a pe-

and were found by us

land, about the end of

days on

this island,

any accident.

riod of intense cold, without experiencing

On the

morning of our arrival, the temperature changed,

and two of them died suddenly, and the

others

fell

feet of several

into gangrene.

About the end of the winter of 1795, when I was in

the army of the Eastern Pyrenees, we passed suddenly
from an extreme degree of cold
ture: a great

those

number

who were

to an elevated tempera-

of our soldiers,

at the siege of

more

especially of

Roses, had their feet frost-

some of the advanced centinels were even found

dead on their posts during the first 24 hours of the frost,
and though we had remained fifteen ortwentydaysunder
the influence of the rigorous cold, none of the soldiers on

bitten

the advanced posts presented themselves with frozen

limbs at the ambulances over which I presided, until the

thaw commenced.
During the conquest of Holland, a great number of
soldiers

had

report of

their feet frost bitten, but according to the

my

Vol.

colleagues, the gangrene did not appear

it.

MEMOIRS, &C.

162

thaw commenced, although the soldiers had

long been exposed to the snow and heaps of ice.*
until

the

Experience proves

by taking care not

may

that this accident

to approach a

fire,

be averted

or to be subject-

ed to the sudden action of heat on the parts benumb-

ed by the cold

AH

this

proves that cold

disposing cause of the gangrene.

to the parts

which

is

only the pre-

Heat suddenly

have been rendered torpid

may

be considered as the ex iting cause. Let

ciple

be once established, and

it

applied

by

cold,

this prin

will be easy to prevent

the effects of congelation.

When

called early to a person

who

has

si

ffcrcd

severe cold, so that the parts have been deprived of

and

tion

heat,

and

their

sensibility

from

mo-

blunted, no time

should be lost in recalling vita'ity to the parts affected.

Frictions of snow, or an ablution with water in

which

has been dissolved, should be immediately made.

ice

The

pure oxygen that these substances contain, and the calo

rick

which

set at liberty

is

by the blood

friction

being absorbed

in the capillaries, stimulate the vessels,

vivify this fluid.

the blood

by the

The

its fluidity

vessels

resume

the circulation

is

their

and

action, and

re-estabiished,and

continuance secured by the successive application of

its

spirituous

and camphorated tonicks,by the gradual use of

cordials internally

by dry warm

frictions

over the surface

and by continued and moderate exercise, f

snow or ice cannot at first be procured, red

of the body,

When
wine
*

may be

used cold, or vinegar and camphorated

Mr. Paroisse, first surgeon to the king of Spain, made

acquainted with these facts.
f The theory of inflammation, as advanced by Lubbock
and Allen, and published by Dr. Wilson, will fully explain
the manner in which this gangrene takes place, and will
lead to the correct mode of treating it, which consists in
giving tone gradually to vessels and parts that are much
debilitated.
Tr.

me

CAMPAIGN IN POLAND, &C.

brandy, or the parts

163

may be immersed in well

water, &c.

But the sudden application of calorick should be avoided,

and it must be admitted very gradually, or gangrene
and advance rapidly. This shows that the

will ensue

saying " contraria contrariis curantur"

When

true.

no other

fined,

and strengthen the sound parts

them.

The

is

in contact

with

strength of the patient should be supported,

febrile affections
first,

well de-

removal of the dead

parts,

At

is

means should be used than those which

will prevent contagion, facilitate the

an4

not always

is

gangrene has taken place and

removed

if

they exist.

emollients should be applied, while the cortex

given in combination with

and good food

common bitters, good wine

in small quantities.

superficial, these

generally suffice

If the mortification

means, with the

:

but

if

be

efforts of nature, will

gangrene have seized on the

substance of the whole

member,

and the means pointed

out, will be sufficient.

the

powers of nature

The

or-

gans become debilitated by the process of exfoliation,

and before

it is

completed the patient dies of exhaustion,

or in consequence of absorption from the sphacelated

part.

have seen a great number of such cases, while

spontaneous cures without the assistance of art are rare:

besides, the

stump

loss of the foot is

convenient

The

that remains in such cases, after the

uneven and painful, and becomes

when a wooden

leg

is

in-

applied.

best plan then will be, to cut off a portion of the

becomes defined and

by the inflammatory line of which I have spoken
above. Yet amputation should not be postponed too long,
because the patient may grow weak and die, especially
mortified limb, after the sphacelus
limited

if

the sphacelus be extensive, as

and

in our last

three
ver,

campaign

in

was

the case in Poland,

Madrid. At the

young conscripts who had had a

were

frost-bitten

latter place,

putrid nervous fe-

on a night of April,

in

which

MEMOIRS, &C.

iti-i

the thermometer descended to eight degrees, after ha-

ving been during the day at nineteen, and next day as*

cended

A cold

to twenty.

same time and produced

every one
defined,

who was

wind blew

north-east

at the

the colick

and rheumatism in

in the hospital.

The gangrene was

and the three young men with the exception of

which their disease had left them, were in

the debility in

improvement. I proposed the operation, but it

was rejected, under an expectation that the powers of
state

,f

thrown

nature would cause the dead parts to be

grew weaker, a slow

they

all'

off.

They

fever from absorption ensued, and

died before the twenty-first day after the gan-

grene came on. Amputation,

when performed

seasona-

bly, shortens the labours of nature, and secures the patient, without increasing the loss

bly sustain.

The

which he must

invaria-

general effects of absorption are to be.

obviated by the use of cordials and antiscepticks, and especially

by good bark:

that called loxa

is

the most effec

tual in gangrene.

The

amputations that I performed, and the use of the

means above

detailed

land, in Poland,

and

in

were resorted

to in

Newfound

Spain with complete success.

This gangrene from congelation,

is

different in its

gress from that which I shall call traumatick, and

will

be the subject of another memoir.

After returning from Eylau, the

month of March
and the Pasargue.

from

pro

which

this line to

situated

in

army passed

all

the

cantonments, between the Vistula

JJut several- corps

were detached

take possession of the principal cities

on the mouths of these rivers, and on the borders

OAMPAIGN IN POLAND, &C.

of the Baltick in Pomerania.

Some

sieges of considerable duration

of

I6d

them required
were re

before they

duced.

During the

first

eight or ten days of

March, we had

rainy or foggy weather. This cloudy, moist weather pro-

longed the catarrhal and putrid affections: but

as the

and wounded were removed in succession from one

hospital to another and to Thorn, and other cities, situated
sick

left bank of the Vistula, the appearance of an epide

mick was prevented, and the strength of those persons

on the

was secured who had passed through

The

of disease without difficulty.

snow and

derable: the

the intense cold

we had already found,

ring our

was

inconsi

which returned

middle of March, contributed greatly, a*

the

about

the different stages

mortality

wounded, and

preventing disease, in resto-

in

in re-establishing the health of

our troops.

As

the resources of the cantonments of Osterode,

and

by the guard and the army were exwas probable that the lakes or marshes,
which are common in Poland, would be opened by the:
thaw that now threatened us, his majesty was induced to
remove some corps of the army and of the guard nearer
the places occupied

hausted, and

the Vistula.

it

In consequence of taking

the emperour

removed

his

ami the guard took quarters

viz.

this

head -quarters
in the

new

position,

to Finkeinsten,

surrounding

cities,

Rosenburg, Reysemburg, &c. I fixed myself in the

latter

with the ambulance.

We

were here

in

want of

every thing: the cold continued during the month of

April, but
the

was

when

the sun

became more elevated above

horizon, and the snow and the

dissolved,

places,,

ice

became necessary

which might

also produce

on the ponds

to

disease

leave

these

among

the

Camps for the guard and for the main body

army were formed in the moM; healthful situations

troops.

of the

it

MEMOIRS, &C.

166

This removal, and the construction of barracks gave the

but
soldiers a salutary exercise. From this time we had

few

sick.

The camp

was placed on an elewas remarkable for the

of the imperial guard

vated plain near Finkeinsten. It

of
beauty, uniformity, and internal distribution

bar-

its

have acquired

racks: every soldier seemed suddenly to

and of the
ihe dexterity of the architect, of the joiner,

mason.
weathcr.of spring produced a number
consequence
of cases of anthrax, or malignant tumour, in

The

first

warm

of the imprudence of the soldiers,

who

lay

on the grass

Some of these
in the heat of the sun, near some marshes.
have
tumours, of a character like a carbuncle, would
proved

fatal, if

I had not speedily used the

means

that

campaign near the Maritime Alps.

are pointed out in
Perhaps this disease was caused by using the flesh of
some animals that had been sick of an epidemick, which

my

prevailed

in

the country at this period.

quest of the commissary general, I

At

the

examined the

re-

diffe

rent parks of cattle belonging to the army, and discovered that the animals received there from a distance, were

from fatigue and bad pasturage, disposed to have a diarrhoea, with inflammation in some, and putridity in
others. Anthrax appeared in a few. This epidemick was
of short duration. I directed, that the sound cattle should

be separated from the diseased as soon as they arrived,

and confined in separate pastures. The return of good
weather, with good pasturage, soon restored them.
I also inspected

all

the regimental

guard that had been erected, and

hospitals of the

I established

some

de-

pots for the reception of our sick on the route from the

imperial head quarters to the grand hospital of

klaw. Marienwerder, Strasburg, &c. &c.

Inowia

CAMPAIGN IN POLAND, &C.

we

In these cantonments

May that were

and

very

16?

spent the months of April

fine,

and

in the

mean time Dant-

zick and several other fortified places were taken, or sur-

rendered to the French troops.

Confe rences had commenced, and negociations

were about

for a ge-

when

the Russians

unexpectedly attacked our advanced guards.

On the news

neral peace

of this

tial affairs,

which was followed by several par

attack,

first

to be opened,

marched with

the emperour

his guard.

We

passed Custadt and advanced on Heilsberg, where the

enemy had taken

fronts the city,

ed by deep ditches and

we

He

a position.

bounds

its

that

protect

the 10th of June,

his regiments of the

fusileers of the

difficulty of the

hill

is

In the evening a brisk

between some of

advanced posts, and the

weather and the

On

rivulets.

appeared before the enemy.

action took place

occupied a

western side, and

guard

but bad

ground prevented the

affair. Of the fusileers, about 200 wen

who were collected in the barracks of a

success of the

wounded,

neighbouring camp which the Russians had abandoned

in the morning.

chief

ot"

In

engagement, general Roussel.

this

the etat-major of the guard,

was

killed

by the

bursting of a shell that fractured the right temporal bone

and produced
all

so violent a concussion of the brain, that

the functions of sensitive

was deprived

life

of perception:

all

were suspended.
his

He

limbs were para

lyzed, and the sphincters relaxed: yet the functions of in

ternal

life

continued for twenty-four hours. Here was

an evidence of the

two

relation

principles of general

pupils,

was wounded by
to

my

exists

between the

Mr. Juville, one of nn

same bomb while assisting

life.

the

another general officer on the

both brought

which

field

of battle.

They were

ambulance, and I passed that night

and next day without quitting the wounded.

We

had

MEMOIRS, &e

168

amputation of the arm

arm.
at the shoulder, of the thigh, of the leg, and of the
Among those who required amputation of the arm, was

here forty

wounded

that required

one of the aids of the grand duke of Berg, Mr.

This wound was remarkable:

gur.

his fore-arm

De

the ball carried

Se-

away

above the articulation of the elbow, and

touched the corresponding side of the chest: but as this

projectile was in the midst of its course, it produced a
result different

from a

mination of

parabola.

its

ball

which had arrived

The

skin

was peeled

at the ter-

off

exten-

sively, and the latissimus dorsi muscle divided, while

the ribs remained unhurt, and the organs of the thorax

had not

He

for

moment been impeded

in their functions.

did not even lose his perception, but

was brought

to

the ambulance without dismounting from his horse. This

would

not have been the case

if

the ball had grazed after

having nearly finished its course: the skin would have

remained unbroken, while the ribs must have been infallibly fractured, and the lungs lacerated.* This wound

was cured

perfectly before the 35th day.

Colonel Vrigni was

wounded

in the

thorax by a ball

that penetrated the belly of the right pectoral muscle obliquely, to the extent of three inches,

of the sternum, which

was

it

fractured

and met a portion

but as the fracture

not very considerable, the sternum, by

its

resis-

tance and elasticity, gave this projectile a retrograde motion,

which caused

ing.

It

this

it

to return through the

lodged in the clothes of

wound was

tedious,

this officer.

same open-

The

cure of

on account of the exfoliation of

the sternum.

See memoir on amputation for

course of the

ball.

my

opinion on the

CAMPAIGN IN POLAND, &C.

169

(now general) Jeannin had his lower jaw

by a ball which disorganized the soft parts of

Colonel
shattered

cheek

the left

in such a

not be recognized.

manner, that

his features could

Although the wound was severe, I

had hopes of curing him without leaving a very great deformity.

After having removed some of the disorgan-

ized flaps and extracted the loose fragments of the jaw, I

made about twelve

position,

and brought the parts in apby means of a proper bandage he was conveystitches

ed with others immediately

By my

Thorn.

to

advice,

he, with his companions, remained five days without be-

wound uniwithout much dis-

ing dressed. In this time a great part of his

ted,

and he was soon cured entirely,

Had he remained a few hours without

figuration.

assis-

tance, death would probably have ensued in a short time,

or a fistulous

wound and

a frightful deformity must have

been the consequence.

A soldier

of the line had an enormous

point of the shoulder,

deprived
at the

vice of

under

it

which disorganized the arm, and

scapulohumeral

articulation, contrary to the ad-

my colleagues, who were afraid he

my hands. The operation was soon

with the others, to

recovered

when

the hospital at

my

several others

performed
sent off

saw him two months afterwards in

Marienwerder. The success of this case
I

who were

me to

save the lives of

The spasm of
when the causes of

in equal danger.

removed.

was obliged a second time

ing in the cranium

Vol. il

die

great astonishment had entirely

and of all the organs ceases

irritation are

would

man who was

this

should encourage surgeons. It led

the heart

of the

entirely of support. I undertook to amputate

without loss of blood, and

wound

to

make a

counter open-

ball penetrated the projection of

MEMOIRS, &C

170
the left parietal

bone of a

passed obliquely along

soldier, (in the

same

and stopped

internal surface,

its

battle;)

The insymptoms which

about one centimetre from the occipital suture.

troduction of a small elastick probe, the

attended, and a slight ecchymosis that appeared on the

skin near this place, induced

a crucial incision.

me

to lay

small fissure

bare the bone by

was then apparent;

and as he had symptoms of compression which continued

to increase, I applied the

ver the

fissure.

crown of a trepan

Immediately under

flattened ball, partially surrounded

it,

so as to co-

I found a piece of

The

by the bone.

dura mater was separated from the arch of the cranium

along the whole course described by the ball that had

lowed the concavity of this part of the bony

siderable portion of blood escaped

case.

fol-

con-

by both openings.

He was

sent the

was

days without any accident, and was then siezed

five

same day

to

Maricnwerder, where he

with the hospital fever, which carried him

off.

I amputated the legs of three of the guard, on a level

with the tuber ontof the

tibia

and through the thick

part of the condyles; although according to authors, the

fractures

which made amputation necessary

cases, required that

They recovered

it

in these

should be performed in the thigh.

slowly, but this inconvenience should

not be compared with that which results in general

from amputation of the thigh, and the difference in

vour of the wounded

is

After the battle of Heilsberg, the

self

fa

soon perceived.

enemy

finding him-

nearly surrounded by the French troops, abandoned

his position in the night,

Friedland.

and precipitately retreated

Next day we took

to

possession of Heilsberg,

where we found refreshments and provisions for the array. Hence we hastened to meet the enemy, by crossing the forests in a right line towards Eylau

By

forced

CAMPAIGN IN POLAND, &C.

171

marches, our advanced corps arrived on the plain of

Friedland, in time to prevent the
the river
to a

on the bridge near

general engagement.

enemy from

this city,

and

crossing

to bring

them

Indeed the battle commenced

as soon as the two armies met. As the columns debouched from the forests through which they had passed, they

formed

to increase the number of combattants on both

The engagement soon became general, and before

sides.

the imperial guards

all

sian

army was

sand dead on the

prisoners.

field,

and

we took

a great

number

Their wounded, the greater part of

and several standards

tillery,

was

came into action, the whole RusThey left more than six thou-

defeated.

fell

a village in the vicinity,

There

into our hands.

and

2*

great

of

their ar-

number

of

which we found a great deal of straw, and

many cattle, and Mr. Percy was enabled to operate on,
and dress the wounded with convenience. They were
large barns, in

sheltered from the weather,

broth, while time

was

and provided with good

thus allowed to procure carriages

for their removal.

was afterwards informed

formed on the

field of battle

rally successful.

were genesome wounds, and

was retarded by tetanus

The improvement

especially of the extremities,

which

that the operations per-

during

the sudden transition

this affair

of

from the heat of the day, to

the cold and moisture of the nights, produced in

some of

wounded.

the

After
sian

this battle,

army,

we

which decided the

fate

of the Rus-

pursued their remaining troops to the

Niemen. The imperial guard followed

valry that crossed the river at Tilsit.

the

enemy's ca-

The grand duke

overtook the rear guard of the Russians, but they forced

their passage,
for

burned the bridge, and earnestly begged

an armistice and a peace. The former was granted,

and

the

two armies approached the banks of the

river,

MEMOIRS, &C.

172

and an interview of the two emperours and the king of

Prussia took place. A pontoon was anchored in the middle of the river, and on

with

glass.

it

was erected a chamber

The monarchs

inclosed

repaired thither at the same

The

hour, each attended by his respective etat major.

two armies were drawn up in order of

banks:the scene was truly striking.

battle

on the two

Preliminaries of peace were entered on in this

conference, and the

first

two armies were immediately

in

Communications then took place be-

formed of the
tween the French and Russians.
fact.

The sovereigns

visited

each other. Alexander, Frederick William, and the queen

We remained

of Prussia, occupied the palace of Tilsit.

here seven or eigty days to complete the negociations for

peace, and to give rest to the army. During this time

Koningsburg surrendered to our troops, and abundantly

The imperial headall the wants of our army.

supplied

where

quarters set out for this city,

we

arrived on the

12th of July.

Among the

curiosities of this city are the writings of

Frederick the great, and of his ancestors

arms and armour of

brated warriors of the north.

point of a javelin

some curious
and celeThey showed us here the
;

several Teutonick knights,

which chevalier Erasmus had retained

in his cranium for fourteen years, without losing his faculties

an abscess then formed in the frontal region, and

made way, without

doubt, for the removal of this

reign body, and he recovered entirely.

fo-

This piece or

spear, after having fractured the frontal bone, probably

remained

in the frontal sinus,

where

long time without injuring the

it

might continue a

wound ed.

The same phenomenon might have taken

case of the

French

soldier,

who some time

place in the

after the

cam

paign of Poland had his head pierced by a fragment of

an iron ramrod which one of his comrades fired off by

CAMPAIGN

IN POLAND,

1<>;

campaign of Austria, under the article

" of wounds of the head," I shall give a case and a draw

accident. In the

He

ing of this species of wound.

had no bad symptoms,

but they should be apprehended from the situation of the

ramrod, that appeared

to

have penetrated the whole mass

of brain, and yet no part of this organ had been in

jured.

We also saw a small knife which a farmer, named An

dreas Guenheid, of Ancient Prussia, had swallowed in
1613.

The

violent

symptoms which ensued induced Dr

Gruger, a Polish surgeon, to perform gastrotomy upon

him

it

and he

was done on

May of

the 29th of

the above year,

lived afterwards ten years.

These

facts are

very

rare.

Authors give a great

num

ber of cases, in which foreign bodies of large volume

have been introduced into the stomach, and have been

discharged per anum, or have

made their way

out spon

taneously: but they do not speak of operations on this

viscus for the purpose of extracting foreign bodies that

have lodged

symptoms.

in

this

organ, and

produced

alarming

remember, while a pupil with Mr. Fri

zac, professour of the college of Toulouse, one

most dexterous surgeons of that

operate on a porter,

city,

by making an

that I

of"

the

saw him

incision in the epigas

trick region, parallel with the linea alba, through

which

he discovered the point of a knife blade, that had perfo

rated the coats of the stomach.

He

seized this point will

a pair of strong forceps, enlarged the opening with a

curved bistoury, and took out the fragment, which proved

to

be about two inches in length.

He

then put two

tures into the lips of the incision of the stomach,

su-

and an

interrupted' suture in the integuments. This porter re

covered: thread of different colours were used

tures,

and on the

united,

fifth

in the su-

day the wound of the stomach had

no doubt by adhering

to the peritoneum.

lean

MEMOIRS, &C.

174

bear witness that wounds of the stomach will heal quick

ly,

and even without suture.

I shall here give a short account of the case of a soldier

wound

belonging to the guard,

who

derable extent in the

extremity of the stomach, by a

left

received a

very sharp point of a sabre, which

of consi-

entered the tho-

first

rax, between the seventh and. eighth ribs, slightly

in-

jure* the lungs, cut the diaphragm, and perforated ihe

stomach
bio

The

end.

at i:s large

and escape of the

d,

fluids

which

swallowed, through the wound, and

wound and

of the

its

depth,

pain, vomiting

local

in short the direction

no doubt that the

left

of

the patient had

sto-

mach was opened. For several days he was very ill, yet
by means of cooling medicines, local and general venae
section, regimen, emollient

and entered

hospital,

He

still

had a hernia of the lungs, which appeared un-

was with

der the cicatrix, and

bandage adapted

With

to

'I

difficulty

round

real pleasure I sailed

where they

each of which

we

insects, such as bees, beetles, ants,

fish

up any of this species

ed from them that the

>borc

all

the western shore

fish

for yellow

am-

he fishermen sold us a number of rough pieces of

this substance, in

them

repressed by a

it.

of Frischhafen to Pillau,
ber.

cnemata, and a uniform po

wound healed, and he left fch<

among the veterans of the guard

on the right side, the

sition

by

&c.

We

did not see

we

of bitumen, but

amber was thrown on

learn-

the sea-

the agitation of the waves, in the form of a

quid foam, that soon

action of the

There

discovered divers

is

became hard, when exposed

li-

to the

air.

a diversity of opinion relative to the nature

of amber, and

its

component

parts: but

wc

der the variety of insects which

crete lumps,

and

the difference

mens, the resins and gums, it

is

when we

discovered

between

it

and the

probable, that

consi-

in the

it is

conbitu-

formed

CAMPAIGN
of the masses of honey and
quantities in the trunks of

IN POLAND.

175

wax that are collected

aged trees

in the

in great

immense

fo-

western countries of Europe, such as

we ob-

serve on the shores of the seas of old continents,

where

rests of the

there

is

generally an

immense number

of bees.

The

hand of Time, and the violence of tempests overturn

these trees, and their limbs,

filled

with these substances,

are partially buried in the earth by the

tents,

by remaining

fall,

and

their

con

in that situation a longer or shorter

time, become saturated with gaa and mineral acids, which

they absorb, and the properties of the honey are changed.

The

rains, torrents or rivers,

quid state to the

cany

these masses in a

li-

There they acquire a consistence by

sea.

the action of the air on the saline principles with

which

they become impregnated, and they are formed into distinct

masses of

shore,

different sizes that float, or are driven

and are there

collected.

substance are entangled in

it

The

on

insects seen in this

while

flows from the

it

earth, or floats near the sea -coast in a liquid state, and are

enveloped by
their natural

it

as

it

becomes concrete. Thus they

retain

shape and colour.

These pieces of rough amber are cut

at

Koningsburg,

make various kinds of trinkets. The Egyptian physicians warmly recommend the use of these trinkets for
women and children. They say that a necklace and

to

bracelets of yellow amber, (which besides are ornamenwill secure

tal,)

against

against hysteria, and children

protect the wearer from the effects

This opinion may be founded on observa-

of lightning.
tion

women

worms, and

perhaps the

fair

sex cannot choose ornaments thai

more elegant, and less expensive.

The white amber is the best and most valuable. This

are

more

substance

useful,

is

one of the principal

Koningsburg

to the east.

articles

of export from

176

MEMOIRS, &C.

On my arrival at this city,

small

number

For

sit.

this

of our

purpose

ciently spacious for

I prepared a hospital for the

wounded and

sick

who were

at Til-

procured a superb house,

600 men, situated

and healthful part of the

in the

suffi-

most elevated

city.

The arrival of new troops increased the number of

sick. The corps of fusileers, who were young conscripts,
and unaccustomed

The

phalalgia, attended
mia.

was a dysentery, with

many

in

We lost but few of them

good aliment,

violent ce-

cases with ataxia or adyna-

The use

getable acids, good beer, (plenty of

here,) cortex,

war, suffered most.

to the fatigues of

prevailing disease

of ipecacuanha, ve-

which we procured

strict attention to cleanliness,

and a kind of daily exercise that I obliged even the sick

to perform, prevented the fatal

consequences of

this dis-

I attended to the fever

wards and to the wounded,

and entrusted those with syphilis and psorick affections,
ease.

to

my

one of

We

assistants.

remained at Koningsburg

The number

until

the end of July.

this

time, gradually diminished, because our

of our sick during

soldiers

were well fed and lodged, and had not been subjected
duty so fatiguing as in the
parture,

we

sent our

last

campaign.

to

Before our de

wounded and sick by water to El

Bamburg, Custrin, and Berlin.

burg, Marienvverder,

Thence they were removed

to

Hanover, where

their re

co very was completed.

A peace between the belligerent powers was

soon con

eluded and proclaimed.

After having sent off

of a proper
overseers,
rector of

number of

our wounded, under the care

health-officers,

I set out for Berlin

my

fertile

WaYta, which we had

campaign.

sub-officers

with Mr. Pilchet, the

ambulance. With pleasure

ed the smiling and

first

all

we now

and
di

revisit

banks of the Vistula and the

a state of gloom during our

left in

CAMPAIGN

From

IN POLAND.

177

Berlin the imperial guard repaired to

Hanover

ambulances, and remained there during the fine

weather. I gave up my situation to Mr. Paulet, and re*

with

its

turned to Paris, pursuant to the orders of marshal Bessieres.

I passed through Wittemburg, Leipsick and Jena, and

tarried a

few days

their- universities.

two last cities, celebrated for

At Leipsick I beheld with venera-

in these

tion the amphitheatre, in

which the immortal Leibnitz

delivered his excellent lectures. Other eminent

adorn the university of

From
pitals, in

Leipsick I repaired to Jena, and visited the hos-

which there were

still

some

been wounded in the battle near this

I

men now

this city.

was much

gratified

soldiers

who had

city.

with the distinguished attention

with which I was received, by the professours of Jena,

on

my

time

arrival there.

among

They

pressed

me

to

remain some

them. While there, I received the degree of

doctor of physick from their university, after having de-

fended a thesis, and submitted to the usual examinations,

I arrived at Paris on the last of October,
diately

resumed

my

and imme-

duties at the hospital of the guard.

The emperour had repaired

to

Milan to be crowned king

of Italy. During this journey his majesty conferred on

me

the honourary

and

title

of " knight of th

iron

crown,"

I received the insignia of this order on the

January, 1808.

Vol.

ii.

first

of

MEMOIRS, &C.

178

MEMOIR
ON THE PLICA POLONICA
*****&*& <*<**& 4*

<y^My^xy

a
of tbe 25th March, 1808, dated at OsteIN rode,
which addressed
the secretary general of
letter

to

the medical society of emulation, I informed

inquiries

and observations made by

me on

him

that the

the plica, du-

ring the campaigns in Poland, and in Ancient Prussia,

had convinced me,

that this singular affection

real disease of the hair

and physicians

call

was not a
travellers

who have written on the ertdePoland. They consider the plica as a

crisis

of a general disease,

which

tricoma: so in the plague, the buboes are viewed

as a principal

symptom, and

often as the crisis of the dis-

Accordingly in the works of physicians, the de

ease.

scription of the plica

To show the

eases.

and

all

assert,

mick diseases of
symptom, and as the
they

and beard, as almost

is

to give the disease

per to examine

its

given in the table of general

dis-

errour into which they have fallen,

its

true character,

it

will be pro-

principal features.

All physicians agree, that tricoma commences

by a general

(like

numbness
and gradual or sudden loss of venereal desires, of sleep, and of appetite. Pains of the bones begin
and continue, especially in the cranium, in the legs and
constitutional syphilis,)

debility,

of the limbs,

joints

these pains increase during the night,

and pro

CAMPAIGN IN POLAND.

179

Auce a fever, with heat and dryness of the skin. These

ep^henomena are

of a longer or shorter duration,

are various in their progress.

Some

physicians have as*

sured me, that they have sometimes seen copious sweats

take place, or spontaneous purulent discharges from the
urethra, that have overcome the disease.

When

these fa-

vourable circumstances do not take place, the effects continue with

more

or less violence, according to the sex,

age, and constitution of the subject, the season, local

tuation,

&c,

for all these

of the disease, and in

The
that

its

crisis finally takes

the hair

becomes

progress.

place

the

operation

is

dangerous to cut

it is

same authors

painful, tumefied,

and entangled, forming separate

masses thai

si-

produce changes in the nature

twists, or
it

off;

tell

enormous

and

that this

attended with pain, haemorrhage, or

charges of bloody and viscous humours.

At

joints,

and

dis-

same

the

time exostoses frequently appear on the cranium,

and cubitus, with tumours on the

us,

interwoven,

tibiae,

ulcers or

pustules on different parts of the body, frequently on the

hands and head. The nature of these symptoms cannot

be mistaken, and according to the same authors, they

much resemble

those which arise from syphilis

their

progress and duration will be according to their treat-

ment, and

many

other circumstances that

conceived. Its termination

may

in the syphilis of our country.

be

fatal

Such

is

may

be easily

or fortunate, as

the sketch

ot'

the

general symptoms of tricoma, as detailed by authors.

As

to the particular

change of the hair and beard,

various, causing different species of plica.

would be

difficult to

give

all

the external signs

characterize this pretended affection, with

it is

In short,

more

it

which
interest

work on diseawas not in posses-

than Dr. Alibert has done in his elegant

ses of the skin.

He

confesses that he

sion of the information relative to this disease that

can

MEMOIRS, &C.

180

only be obtained, where

it

and hence he

exists,

able to speak decidedly as to

is

not

true character, causes, and

its

progress : but he carefully gives the opinions of different

authors.

information that I received from enlightened phy-

The

sicians of Posen, of

places, led

me

Warsaw,

of Pultuska, and

other

to believe that this general disease, called

tricoma, has-been brought from Asia into this country by

the Sarmatians, who, according to history, have descen-

ded from the Tartars and Scythians. The change of

mate and of

diet

cli-

must, of necessity, have altered the

symptoms of the disease they brought with them: it

doubtless was a syphilis like that I saw in the interiour
of Egypt, that appeared to have had
the earliest ages. Indeed
philis

had been known

it

its

rise or origin in

cannot be denied, that the sy-

in that ancient continent, as well

as the small pox, long before the discovery of America.

This

is

names

proved by a great number of authors, whose

As

I shall not mention.

acts on the skin,

the syphilis

sometimes

membranes, and bones of the cranium,

may in this case be altered by it.

the roots of the hair

It

cannot be combed without pain, interlocks, changes

colour,
in

and

France.

hair

may

falls

have often seen these results

off.

In Poland,

from the same disease, the

experience a greater degree of alteration, and

by means of

certain practices, the plica

pletely developed. It

is

is

more com-

encouraged and promoted as a

salutary crisis: with this

view they confine the hair un-

der a woolen bonnet, which has been used for

pose

this

hood

pletely formed,

is

not

removed

and they wear

time, according to the season

it

until the plica is

when
if it

com-

for a longer or shorter

it

has appeared, and

the degree of pain that the patient suffers.

they do not cut off the plica,

this pur-

In any case

have formed in winter,

CAMPAIGN
Good Friday

except on

or on Easter

advocates lor the plica refer

cede or attend

it

Day. Although the

symptoms

the

all

to this affection, they

ticks, diaphoreticks,

181

IN POLAND.

still

that pre

employ diure-

and antimonial, sulphurated, and

mercurial preparations.

As

a diaphoretick, fhey speak

highly of lycopodium (club moss.)

Dr. Lafontaine, of Warsaw, showed a great number

who

of persons

laboured under the plica: they were

principally Jt*ws,

time

afflicted

marked

may

and had been previously, or were at

with the symptoms above detailed

were venereal or

that these

be concluded, that the plica

is

that

I re-

Hence

scrofulous

it

nothing more than an

acquired or hereditary syphilis, or scrofula in disguise

for they are

common

diseases in this country, where, I

doubt not, they have prevailed time immemorial.

The

syphilis

tween a

is

disseminated by sexual

class of people

a wandering, disorderly

who
life:

are never located,

it

is

frequent.

is

The Jews and

are also very obnoxious to

the plica
or

is

among

seldom seen

it

it,

where

by the

this in

artisans of the cities

for the

same

reasons.

But

in the higher circles of society,

the agriculturists of the country

cidentally contract

be-

and lead

also propagated

inhabitants of the boroughs and villages,

tercourse

commerce

or

if

they ac-

they apply the proper remedies im

mediately, because they are not ignorant and prejudiced

like the vulgar.

A number of our soldiers contracted

the syphilis from

common people, but not one of them had a plica.

What then is the conclusion to be drawn from these

the

facts?

That

produced

in

this particular affection of the hair, although

some

individuals

by the nature of the above

from the neglect of the hair among

Jews, and other persons of similar habits; add
want of cleanliness the means that are used by

disease, arises chiefly

the Polish
to their

them

to bring their hair into a plait, or plica,

under the

MEMOIRS, &C

182

persuasion that this affection

a cure or preventive of

is

They are encouraged

other diseases.

all

to persevere in this

whom

errour by the physicians, the majority of

enter-

tain a similar opinion.

It

may

also

be possible that

animal hood,

this thick

acting with the remedies that arc indicated,

may promote

the crisis of a new disease, by increasing the heat ol the

head, and promoting the transpiration of

der these circumstances

this part.

productive of unpleasant consequences,

if it

ring a season of severe cold, or during the

another disease.

It

will

Un-

may

hair

the cutting off the

be

be done du-

paroxysm

of

be proper under such circumr

stances to exclude cold moist air from a sensible surface

that has

that

been suddenly stripped of a natural covering,

promoted a copious excretion.

The sudden

reper-

cussion of the discharge might prove highly injurious to

the brain

more

Poland, on account of the

especially in

extreme coldness and moisture of the climate. This

one of the principal reasons

is

for retaining the plica, in this

country, until Easter.

I believe that the plica might be cut off at any season

of the year without inconvenience, provided care be ta-

ken

to

cover the head with a

hair of lying in

women

cessation of all the

tion.

warm

fur cap.

The

tangled

should not be cut off until the

symptoms connected with

Does not experience teach us

that

it is

their situa-

improper

to

cut off the hair of children in the winter-season, provi-

ded they have a discharge of humours from any part of

their bodies, before the 20th

day of the disease?

It is not

then unimportant to ascertain the time and circumstances

that authorize us to cut off the plica or hair that

is

twisted

or tangled, from any cause.

But except the influence

which diseases of the head may exert on the hair, J am
convinced that the plica

and almost

is

a local and

factitious affection,

entirely independent of the diseases

from

CAMPAIGN IN POLAND.
which

it

is

supposed

hereafter to

be

we

to arise, as

183

shall

prove by

facts

detailed.

I have always remarked, in every case of plica, though

I

saw

it

in all

stages and varieties, that the extremities

its

Of the hair remained uninjured, and

colour, elasticity,

and size;

roots

its

it

retained the natural

were

in

every respect

similar to the other extremities,

and perfectly sound. If

the substance or body of the hair had been diseased, the
two ends would necessarily have partaken of the disease:
but I never found

Not one of

be the case.

this to

the Polish physicians

who had

cut off the

hair in cases of plica, ever

saw a discharge of blood, or

sanguineous humour from

its

hesitate to

deny the

divided portions.

possibility

the filaments that unite the bulb of the hair to

ing

membrane

ficult to

more

and

are so fine

delicate, that

difficult to

its

it is

decide correctly on their nature: and

circulate in

I do not

of such an occurrence,
invest-

very
it is

difstill

become acquainted with the

them

though

we

fluids which
advance the opinion witlj

confidence, that the red globules of blood never do circu

them, because the

late in

thrown thus
enables

me

far.

to assert that

is

and

that if the person

cannot be

cases of plica

off the hair in this disease,

who undergoes

that he feels pain, or

it is

many

no pain and unpleasant sensa-

produced by cutting

tion

seen,)

finest injections

My experience in

seems

to

the operation says

be uneasy, (as I have

caused by the jarring and the distension that

the investing

membrane

of the bulb or rootof the hair

experiences from the instrument used, more especially

from

dull

scissors.

brane of this bulb

The

produces the hair, and

that

can partake of the

skin.

Under such

med like the

envelope, or investing

may be
is

mem-

considered as the organ that

the only part of this production

irritation or

inflammation of the

circumstances, far from being

cutis, the hair dries

infla-

away, shrinks, becomes

MEMOIRS, &C.

184
white,

is

detached from

its

and

capsule,

I cut

falls off.

number
Warsaw, and no inconveniences reTwice I directed these persons who were
of cases of plica in the civil hos-

off the hair in a

Saint Jesus at

pital

sulted

from

it.

the subjects of the experiments, to take the necessary

precautions to prevent any unpleasant symptoms. These

observations prove that this affection

the consequence

is

means

of filthiness, neglect of the hair, and the

inhabitants of Poland use to produce plica

that the

have never

plica, a

circumstance that

corroborates our opinion, because the

Jews take more

The plica that is

seen the beard affected

by the

care of their beards than of their hair.

seen in the hair of the pubis, and other parts of the body,

may
lis,

in

be the consequence of an inveterate chronick syphi

which has charged the bulbs of the hair on these parts

such a manner as to prevent the circulation of the

fluids that are

necessary to soften and nourish

resembles the wool of the negro.

may

It

until

it,

also acquire

from the same causes the

different shades of colour.

no case does

which

this affection,

constitute a disease of the hair:

uncommon change

the temporary effect

it is

destroys

its

in the

growth of

excretory glands, and causes

Although the roughness of the

nails

to a metastasis of the plica, caused

it

to

fall off.

has been attributed

by cutting the

had never seen such consequences from

most

nails

produ

first

hair, totally

prematurely: yet, the Polish physicians assured

have seen the

In

but of short duration,

is

of the principal disease (the syphilis) which

ces an

it

hair

me they

this operation.

become disorganized, and assume the

irregular shape, in consequence of the repercussion

of a gonorrhoea or a chancrous ulcer that attacked their

roots.

saw a

who was
after

striking case of the

former in a

soldier,

attacked by a general erisypelas immediately

checking the discharge of a gonorrhoea

ulcerated, the epidermis

fell off,

and the

The

nails of his

cutis

hands

CAMPAIGN IN POLAND.
were disorganized, and covered with

and

feet

ties

of a yellow colour.

tangled,

The

]85

and he soon

plica

irregulari-

His hair for a time was much

became

entirely bald.*

which we sometimes

see in animals,

after

is

pro-

duced by neglect, by the peculiar arrangement of their

hair,
thin,

and

abandonment of it to nature. Long,

hair, soon becomes entangled like the long

the total

and spare

hair of animals.

The

Poland

bitants of

is

among the inhaThe horses of this

length of the hair

remarkable.

country, although of small size, have very long manes

and

tails,

which are generally found entangled, or

ed with a kind of
If

we admit

and

and

skin,

changed by some cutaneous

we

rus,

tagious

shall consider

character,

it

affect-

that this singular affection

disease of the hair

ly

plica,

is

not a distinct

that they are not entire-

disease, or a kind of vi-

unnecessary to speak of

which

its

con-

certainly can never exist.

We

are also of opinion that this affection never could produce

a crisis in any other disease. It

is

an inconvenient,

filthy,

and oppressive burthen, and may eventually impair the

The condition of the

much improved, and their disorders

integrity of the animal functions.

people would be

prevented, by cutting off the hair, by care and cleanliness.

The

Polish soldiers

never have the

now
hair,

exist,

plica.

who

submit to

this discipline

Finally, the cases of plica

might soon be done away by cutting

which

off the

with proper precautions as above recommended,

and by applying on the parts

We

that

have been shorn an

*
often find that a metastasis of the gonorrhoea to
the eyes, destroys the eye-lashes and brows. This is an unpleasant occurrence, and proves injurious to vision: it may
be prevented by a new inoculation in the urethra, with matter of the gonorrhoea.
f These animals are in the mud and snow two-thirds of
the year, and in the dust and dirt during the other third.

Vol. it

Aa

MEMOIRS, &C.

186

warm

unctuous aromatick pomatum, by keeping the head

by attending
that

may

from becoming plaited and entangled.

it

inhabitants of Poland should be informed of the

Under

true character of their diseases.

their

any extraneous symptoms

appear, and by keeping the hair straight, and

preventing

The

principally to

chained

down

institutions

their

minds with

which they have

the bondage, in
hitherto lived,

the sanction of

and empiricism have

prejudices, interest

early

fear.

But the laws and

lately received will destroy

which two -thirds of the Polanders have

and

will banish their ignorant prejudices,

check the cupidity of empiricks, and introduce among

this people that emulation, which, while it is the safeguard of a people, leads them on to the attainment of

moral and physical perfection.

We have nothing to fear from

titious,

a disease

and therefore not contagious.

have given

in order that

its
it

true character,

may be

which

is

It is sufficient

and explained

properly arranged

its

fac-

that

causes,

among the

dis-

eases of the skin.

In order more

fully to

impress on the reader the opinion

that I have just advanced, I shall take the liberty of inserting here the conclusion of a report
class of the institute

the

same time

seru,

on

my work,

made by

the

first

and on that sent

at

academy, by Dr. Rousille Chama physician of the army.

to the

" If the memoirs of doctors Chamseru and Larrey, of

which we have just given an account, be compared,
it will be observed that they mutually corroborate the
opinions advanced on the pliea,

its

character and treat-

ment. This concurrence of two respectable physicians

whom we have long known to be entitled to our confidence, affords a triumph to truth

CAMPAIGN IN POLAND.

187

* They saw and

described the same disease without

holding any communication or intercourse with each
other,

and agreed

in the

same opinion and practice: a

by their joint testimony, but

practice not only confirmed

by

that

tals oi

their brethren in

of*

Poland, and of

arms,

many

who

visited the hospi-

enlightened physicians of

that country.

" Established in their doctrine, they have effected a

lutary revolution in Poland,

verance

and

we

by

do not hesitate to say, that

will concur in thanks, to

sa-

and perse-

their firmness

all

Europe

which they are

entitled for annihilating a disease hitherto considered as an alarming

endemick, and

for

banishing the frightful spectres of ig-

norance and empiricism that have been conjured up by

servile prejudice. They have described it simply as it
appears, and pointed out the means by which

They have
when the will

it

may

be

extirpated.

secured the health of the Poles at

a period

of a conquerour breaks the chains

of their servitude, and raises

them

to the condition of

freemen.

"

On

account of this signal benefit,

medicine and surgery are

we may

in a great

assert, that

degree associated

with the glory of our victorious armies ; and our physicians can boast of having co operated in the extension of
the beneficent intentions of our sovereign.

" Under

this impression,

we

propose that the class

should give a distinguished reception to these memoirs,

and

that they be printed with the collection of

memoirs

received from foreign philosophers."*

The

class

approved the report, and adopted

its

recom

mendation.

knew nothing

of the

memoir

of doctor

Chamseru

MEMOIRS, &C.

188

CAMPAIGN

FIRST

IN SPAIN

<C ** ++*> *V *> *&

~\ /JTY stay at Paris was short. The campaign in Spain

-*- was about to open, and I received an order irm
the marshal, duke of Istria. to iollow a column of the im**-

guard that vas destined

perial

under the
Berg. I
pupil,

my

command

set out

form part of the army

to

of prince Joachim, grand duke of

on the 11th of February, 1808, with

my

Mr. Frizac, one of the best informed surgeons of

ambulance.

As

rected

wished

my

to revisit the place of

my

nativity, I di

course towards Toulouse, where I arrived on

the 17th of the same month.

On

the succeeding day, I

received an invitation from the professours and students

of the medical school to undertake the demonstration of

the system of Dr. Gall,

which was then a subject of ge-

neral interest.

Although I

new

felt

a repugnance to say any thing on this

doctrine in a city

where

the

opinions must rise in opposition to

the wish of

my

it

prevailing religious
;

yet I submitted to

brethren, and in four hours completed an

anatomical and physiological demonstration of the en-

kephalon, according
doctor, but with

some

to

the principles of the

variations.

German

FIRST CAMPAIGN IN SPAIN.

A few days
me

fered on

afterwards, the

the honourable

189

academy of

title

sciences con-

of corresponding asso-

ciate.

Being

in haste to join the

Bayonne,

I set out

guard that had repaired

on the 27th, and arrived

at

to

Tarbes.

I again visited the mineral springs and baths of Bagneres, and the va'ley of

the

summer

offers a

No

Campagn.

more

country during

delicious repast to the eye in

picturesque views, and in the variegated objects of natural history.

The work

of

Mr. Raymond gives a

full

ac-

count of the topography of these places.

At Tarbes

was received

in the

most

flattering

man-

ner by the members of the electoral college, aid by the

prefect,

This

baron Duchazel.

every street by rivulets

city

is

watered through

of fresh water, and

is

the place of

deposit for the neighbouring country.

Hence
Pan

in

I repaired

to

my route. The

used as a

state -prison, is

a pyramidal shape;

it

through the mountains.

is

built on an inaccessible rock, of

commands

We tarried

the principal pass

a short time at Pau,

where Henry IV was born. Although

to visit the castle

this building is

Bayonne, taking Lourdes and

strong castle of Lourdes, which

verging

fast to

a state of ruin,

it

excites

sentiments of admiration and awe.

A part of this city

incloses

it,

and

Being

it is

the other half

by

mountains,

affords a prospect of the

it

the Gave.

kind.

From Pau

notice.

Bayonne,

Pyrenees,

may

to

separated from

built at the foot of the

Bayonne are no

most picturesque
places

worthy of

situated at the extremity of the chain of

be considered as one of the most impor

tant mercantile cities of the empire,

on account of

its di-

rect and easy communication with Spain.

The two departments of Upper and Lower Pyrenees

that we passed through, were formerly the provinces of
Bigore and

Beam, and

once constituted a large part of

memoihs,

190
the

&,e.

of Navarre. Their inhabitants then differ-

kingdom

ed from those of the other inhabitants in the south of

France.

The

costume, which

is still

retained in

some

vil-

lages at a distance from the high road, bears a strong re

semblance

to that of the Celtiberians,

who

for a great

length of time dwelt in the defiles and valleys of the

Upper and Lower Pyrenees. The costume of

consists of a

berret

called
to

bonnet made of
;

men

the

fine stuff of various colours,

of a round short ample vest, with pieces

extend from the wrists to the shoulders; a large gir-

with a buckle, &c.

dle to fasten before

The women wear

a plain cambrick bonnet, and a

forms a point

small scarlet mantle called capulet, that

over the head, and

falls

ed to a laced bodice before.

of various colours, &c. &c.
cient provinces,

the

course

of

They

over the shoulders.

have a short vest which extends

to the waist,

They wear
All the

also

is fix

short petticoats

women

which extend from east

the mountains, from

and

of these an-

to

west along

Bagneres Adour,

Tarbes, Lourdes and Pan, to Bayonne inclusive, dress

in this

manner. The men are of moderate

made,

athletick

and

robust.

Their port

is

stature, well-

dignified, their

eyes sparkling, and their appearance fine and bold.

women,

although generally below the ordinary stature,

are well formed, have agreeable

fine

The

and regular

features,

black eyes, good teeth, and blooming cheeks.

the inhabitants of

ated in the valleys

But

some hamlets disadvantageously situand ravines between the mountains,

are afflicted with a tumefaction of the thyroid gland, that

constitutes the disease called goitre.

the consequence of the

common

It

use they

appears to be

make

of snow-

water, and to arise in a great degree from an unwhole-

some gas
mer.

that

emanates from the bottoms of the deep

between the mountains during the heat of sumThese exhalations are more copious where the

valleys

FIRST CAMPAIGN IN SPAIN.

mountains are covered by thick
the valleys

boggy and

is

191

and the

forests,

soil

Improper aliment

moist.

contributes to the production of this disease, which

ten followed

by

of

also
is of-

cretinism or fatuity, as I before witness

ed in the valley of Maurienne. The goitre may perhaps

be considered as incurable, more particularly

vanced

stage.

forming

state,

situations,

charcoal,

may

mitted to
in

by removing

water that

are subject to this disease

cany heavy burthens on

places

ad-

its

its

the patient from low, moist

filtering all the

many

in

be prevented or obviated in

is

used, through

and by respiring none but the purest

men who
tomary

by

It

where

it

Wo

air.

should not be per

their heads, as

is

cus

prevails.

This tumour generally appears about the age of pu

berty: care should be taken at this time to keep

ordinary secretions in their natural

and salivary evacuations.

ticularly the catamenial

curial frictions, either local or general,

nagement, might

fulfil

To the

be added, resolvent aperients

the

Mer

under proper ma-

this indication,

resolution of the tumour.

all

and more par-

state,

and promote the

foregoing

remedy should
which may

internally, to

occasionally be added, muriatick acid in small doses, and

cupping, and

vesicatories

means, varied accorded

With

to the tumour.

to circumstances, I

these

have in ma-

ny

instances

its

second stage. If the chief magistrate of a department

would

removed

carefully

this disease, after

it

had arrived

watch over the people, and follow the

at

di

rections of enlightened physicians, he might prevent or

remove

this

endemick

disease.

In order to

effect this,

every prefect should be assisted by a committee of health,

to act

under

his direction,

and oblige every individual to

submit to publick and private regulations

for the preser-

vation of health.

The
a

two ancient provinces speak

wry agreeable language, compounded of Spanishinhabitants of these

MEMOIRS, &C.

192

Arabick, and French,

Italian,

and manners mild and

each other,

much

are

the

little

They are much

social.

Courage

bold.

commencement

ber of their young

amazons,and went

attached to

of the affairs of government,

Their character

offended by flattery.

and

petulant,

At

know

Their morals are pure,

is

common

is

and
gay,

to both sexes.

French revolution, a num-

of the

women

accoutred themselves like

forth to battle with their husbands, to

repulse the Spaniards

who had

entered the defiles of

their native mountains.

These mountaineers generally breath a pure atmosphere, enjoy the advantage of the best water and food
in

abundance.

they

live,

The

continual state of activity in which

and the particular education which they receive,

according

to the

contribute to

customs and manners of their forefathers,

render their intellectual and physical pow*

ers of a superiour order.

In the autumn the wood-pigeons are very numerous

here.

As

soon'as the spring appears, the flocks of sheep

are driven to the mountains,

the weather

is

I arrived at

where they

are kept while

moderate.

Bayonne on the 5th of March, and

recei-

ved an order from prince Joachim to take the direction of

the medical staff of his

army,

in the capacity of inspec-

tor general,

and

Bayonne

Burgos, and thence to Madrid.

to

from

to visit the hospitals of the line

About two or three leagues from Bayonne we entered

a deep narrow valley which winds among the mountains
and is fertilized by numerous streams and rivulets. The
sides of the
fertile

mountains which overlook

and well cultivated up

cayens,

who

are remarkably

The

summits.

Bis-

inhabit this valley and the neighbouring

mountains, cultivate the

nious,

to their

it

soil in

and well adapted to

customs and usage*

They

a manner which

their eountry,

and

its

is

inge-

ancient

also use small carriages

with

FIRST CAMPAIGN IN SPAIN.

two wheels, in
sily drawn by
These are

193

the shape of the ancient cars, that are ea-

oxen over

heifers or

their

mountains.

wounded and bag-

useful in transporting the

gage of an army.

The

inhabitants of these regions bore but

blance to those
dress

is

frightful

sing'e

we

had

little

resem-

Their language and

soon bade adieu to these

lately left.

We

entirely different.

mountains, whose passes are so narrow, that a

company

of soldiers might aiTest the progress of a

whole army.
Tolosa was the

first

principal city that

entering the territories of Spain.

we

visited

separated from this city by a space of fifteen leagues,

found ourselves in a

new world

every country in Europe

have passed through

that

it

bears

its

Spain

from

in the

phy-

inhabitants. Travellers

who
me

for

and

different provinces, assure

much resemblance,

parts of the coast of Africa.

On

in several respects, to

entering Tolosa, I

was

which the inha-

struck with the similarity of appearance

bitants bore to the people of

is

we

differs

in its buildings,

siognomy and character of its

on

Although Bayonne

Alexandria

in

Egypt.

In this city, as in the generality of the cities of Spain,

the windows, of their houses are built with grates and

projecting balconies that intercept the rays of the sun,

and prevent those who are

in the streets

from looking

in-

to the apartments, while the inhabitants can see what

The same mode

The narrowness of the

transacting on the outside.

is

common

in

Egypt,

is

of building
streets, the

irregularity of the houses, their internal arrangement

and

want of chimnies, also confirm the similarity of which

we

have just spoken. The people also resemble some of

the eastern nations in their character, manners, and dress.

Hereafter I

shall

speak of these more

giving an account of my

be considered as a

Vol.

ii.

fair

stay in

Old

in detail,

Castillo,

when

which may

specimen of the rest of Spain.

&C

MEMOIRS,

194

From

Tolosa, where I rejoined the guards,

Ebro

rapidly to Vittoria, and crossed the

I employed the short time of

my

at

we

passed

Miranda.

stay in these cities to

visit the hospitals, where our advanced troops had left a

number of sick. By my direction several new and use-

arrangements were adopted in these establishments,

ful

which I

shall notice in the sequel.

From Miranda we

rough and rocky

travelled over a

road to Old Castille, where

spacious and well kept. It
cellent state of cultivation

is

we

found the publick road?

delightful to behold the ex-

and the

of the coun-

fertility

try on the road to Burgos. You do not see this city until
you enter it, because it is situated on the declivity of a
hill, which hides it from the view of a person coming

from France.

It is

one of the most ancient in Spain, and

the curiosity of a stranger

is

thedral, Carthusian convent,

attracted

by

its

castle, ca-

and the tomb of Rodrigo,

surnamed the Cid.

The

castle, formerly the residence of the kings of

Castille,

built

is

on the summit of a

the city and the avenues leading to

hill

It

it.

Old

commands
was in a ruinit

ous condition at this time, but the French have since repaired and put
it

had

lost its

brance

its

it

once

Notwithstanding

in a state of defence.

ancient grandeur,

it

recalled to

illustrious inhabitants

it

was

rememalso the

birth-place of queen Blanche.

The

cathedral

is

one of the

now extant. The style

of

its

finest

gothick monuments

architecture, the elevation of

arches, and the boldness of the cupola, excite admira

its

tion.

All

The

its

internal

ornaments are of immense value.

Carthusian convent, situated in a charming val-

ley, a short half league

the

tombs of the two

from the

last

city,

is

remarkable

princes of Castille.

They

made of alabaster, of most exquisite workmanship

few monuments can compare with them in elegance.

for

are
;

195

FIRST CAMPAIGN IN SPAIN,

On my

arrival at Burgos,

and

hospitals,

to

make

my first care

days in

to visit the

such arrangements as were neces

sary for the convenience of the sick:

ral

was

we

remained seve

while the troops of prince Joachim

this place

advanced towards Madrid Here we

heard that a

first

revolution had taken place in Aranjuez, and of the accession of the prince of Asturias to the throne of Spain.

The
I

magistrates, on this occasion, ordered a bull-fight,

which the inhabitants

at

now

for the first time

I attended to

and
In

with transports of joy.

this curious spectacle.

minutely through

various stages,

all its

here attempt to describe

shall
all

it

officiated

witnessed

it

in a

few words

the principal cities of Spain there

is

an amphithe-

atre or circular area, appropriated to this kind of exhibition.

The

spectators are arranged in balconies, projecting

from the windows over

ted round

its

it,

or placed on stages construc-

A double barrier separates

circumference.

the area from the place which the spectators occupy.

men who

tauradors, or
lead

him

The

are prepared to fight the bull,

into the amphitheatre

some of them are on

horseback, covered with coats of mail, and armed with

long sharp lances.

he

on

is irritated

As

all

appear before him

soon as the animal

sides

in

by

the horse

a red dress.

He

is

and

introduced,

foot

men, who

soon becomes

furi-

them with the greatest impetuosity, and

catch them on his horns. In this contest 1 saw

ous, plunges at
tries to

two of the men dismounted, their horses were embowelled,

and the men owed

One

their safety to their agility

and address.

of the pedestrian tauradors was also severely woun-

ded, and

left

for

dead on the ground:

horrible accidents the Spaniards

at the sight

made

of these

the welkin ring

with their acclamations and applauses.

The

taui*adors

concluded the scene by plunging a sword into the heart

of the animal.

I* this

blow be properly

generally the case, the animal

falls,

directed, as

is

and instantly expires

MEMOIRS, &C.

196

A new occasion

is

then afforded for the shouts and plau-

dits of the spectators:

when

the taurador

is

very adroit,

he plunges his dagger into the posteriour part of the

mal's neck, to
instantly

the spinal

marrow, and

rlo

arrows: he then becomes out-

down

rageous, and attempts to break

Sometimes bull-dogs are

if

ani-

him

not possess great vigour and fierceness,

his skin with

they pierce

taken

to kill

but this a very dangerous undertaking.

the bull

It

wound

tlv^y

let

the

barriers.

out upon him, and he

be not destroyed on the

first

is

soon

rencontre by

the horns of the animal.

When

manner on the

this

number of

a certain

have been killed

bulls

field of battle,

in

the conquerours receive

a stated reward, and the reiterated plaudits of the publick,

and the most affectionate testimonials of

more

especially from the lair sex. It

that sports like these

tranquillity

much

is

satisfaction,

much to be wished,

were proscribed,

for the lovers

disapprove, while humanity

of

condemns

them.

Having received orders from the director general of

the war department and prince Joachim, to superintend
the surgical staff of the army of Spain, I obtained permission from the duke of Istria to follow the division of
the imperial guard attached to his person, as far as

Ma-

drid, there to await his orders.

We set

out for this capitol on the

of April, and

first

passed by Lerma, Aranda, Boussequilles,

ra,

Summa

and Buytrago. I inspected the permanent and

ry hospitals established in these

the troops while on their march.

and barren.

As

a succession of

soon as

hills that

of mountains called
hills I

we

left

cities for

The

Sier-

milita-

the reception of

route

was rough

we

encountered

Burgos

gradually rose towards the chain

Summa

Sierra; while crossing these

remarked a great number of

silken

bags hanging

from the summits of the pines which cover the heights.

FIRST CAMPAIGN IN SPAIN.

These bags are

the cocoons, of a species of caterpillar,

which feeds on the

pine.

At

ter they unite into a family,

the

commencement

month

of

of win-

and budd an asylum, where

They appear

they undergo their metamorphosis.

terflies in the

197

The

May.

quality

as but-

and quantity

of these cocoons might render them an object of commercial importance.

We reached Summa

Sierra, the

most elevated point of

the mountains that bear this name.

projections that

its

thermometer

was

still

climbed up one of

covered with snow; here the

several degrees.

fell

From Summa

Sierra,

we

arrived in a few hours at

Buytrago, a small but ancient town, which separates

New from

Old

Casfcijle.

It

is

situated in the entrance of

a defile of the mountains, and protected by a castle that

the

Romans and

M jors fortified

in

Before

succession.

our arrival, this castle was exclusively appropriated to

reception and

th

shearing of the numerous flocks of

were kept three -fourths of the year on

the neighbouring mountains. I had an opportunity of

Merino sheep

that

witnessing the process of shearing on the finest of these

flocks that entered the castle just as

we

Spaniards are very adioit in performing

As we advanced from

The

arrived.

this operation.

Buytrago, the mountains gra-

dually declined, and formed a circular plain of three

or

four leagues in diameter. This plain, in the centre of

which stands the

would be dry and

capitol,

count of a substratum of

silicious rock,

sterile,

were

it

on

ac-

not co

vered with manure, and cultivated with great care. In

this plain there is not a tree to be seen ; for the Spaniards
are unwilling that

any should be planted,

shelter to birds that injure the crops.

son

we seldom

find trees here in

any

as they afford

same

rea-

fertile fields,

ami

For

the

only in the immediate vicinity of their houses, and in the

gardens.

MEMOIRS, &e

198

When

I arrived at

Madrid,

I received

my

instructions

from the commissary general, with a copy of the order

from

minister at war. I visited

his excellency the

and

inspected the hospitals of the capital, and such situations

as

for the erection of others, should they

were suited

requisite.
tal for

had wards prepared

in the large city

the reception of sick of the guard

This hospital

is

situate

and the

on the north east of the

the extremity of the prado,

and

is

well

city, at

four

a regular form, well lighted and

stories in height, of

ventilated, sufficient to contain

3000

sick.

The wards

communicate with each other by corridors, or

run quite round the

that

hospiline.

It is

built.

be

edifice. It also

galleries,

contains an amphi-

theatre, with every convenience for the instruction of

students of physick.

But there are two important objects of which

tal is

much

in

this hospi-

want. These are, houses of office and reser-

voirs for the fluids that run

from the wards. The nurse^

are obliged, frequently during the day, to throw the sor-

des into a kind of canal which communicates with the

bottom of the hospital, and proves very unwholesome

and injurious

to the sick.

would render

this

of

its

I proposed such alterations as

establishment one of the most perfect

kind.

In order

to

staff of the

systematize the operations of the medieal

army, I formed a board of health, which was

my

composed of

colleagues, the apothecary general

Laubert. and the chief surgeon and physician Bardol

and Talabeie
tions for the

hospitals,

we drew up

and they were approved by the commissary

general and

commander

sessions three times a

made

a system of rules and regula-

government of the permanent and military

in chief.

week.

This board held their

A general arrangement was

of the health officers,

in distinct classes, and the

ambulances completely organized. For the benefit of the

FIRST CAMPAIGN IN SPAIN.

numerous surgeons who were

at

Madrid,

199

we established
The

a school of medicine and military surgery.

members

several

of the board gave lectures on the different de

partments of the science.

Every week I added a lesson on

demonstrations.

clinical

surgery to

improved the short intervals that

professional duties allowed

me

my
my

to enjoy, in visiting the

botanical garden, and the cabinet of natural history.

This garden

and

Here

is

Buono

contiguous to the park of

without exaggeration, one of the

is,

saw a number

finest in

Retiro.

Europe.

of rare plants from every part of

the world: with pleasure I recognized the mimosa Niloiica, the

cedar of Lebanon, &c. &c.

entered the

immense park

From

this

garden I

of Retiro, that contains nu-

merous pools of fresh water,

filled

with wild aquatick

fowl: here also are delightful groves and thickets, the

The

haunts of fallow deer and other game.

temperate and agreeable

saw

may

air is also

further observe that

here a hybrid animal, the offspring of the stag

and

the heifer, partaking evidently of the appearance and nature of both these animals. This
the fact that
al

came under my

was a second proof

of

notice, of a successful sexu

union between the stag and the heifer.

The

palace of Retiro

years, but

still

contains

is

sinking under the weight of

some magnificent pictures.

It

once the residence of the kings of Spain, being the

healthful situation near

Madrid, the most advantageously

situated in a military point of view, and

city. It

nity.

was

most

commanding the

has a number of most delightful walks

in its vici-

Between Buono Retiro and the botaniek garden, is

monument of gray granite, presenting the three

a superb

ancient orders of architecture. It

of the

academy and museum

is

intended for the hall

of arts and natural history

Further on, behind the botaniek garden,

is

the obscrvato-

MEMOIRS, &C.

200
i

v, that contains

one of the largest telescopes of the pre-

sent day.

The new

palace of the king, situated on the south of

the city, on a calcareous plain,

deur and
in

fine architecture

remarkable for

is

but

gran-

its

dangerous to reside

it is

during the spring (the season of the colick) and very

it

inconvenient during the heats of

rous cold of winter.

quarters were

while his

On

The

summer and

prince generalissimo

the rigofell

sick

here.

entering this castle I observed a gallery

with

filled

armour of curious and rare appearance.

The

cabinet of natural history

the richest in

without doubt one of

is

Europe, more particularly as respects

saw the skeleton of

made an exact drawing of

its

mineralogical collections. I

the fa-

mous mammoth.

it

sent

it,

with a description,

and

to professour Cuvier.

I observed, that the large concavity in the bones of the

the pelvis

was

not a natural consequence of the form of

the animal, nor a peculiarity that

refer

it

would authorize

us to

to a distinct class.*

I also sent several other preparations of natural history

to the

same academician.

Among them was

sheep, with the skin preserved and

I

saw

this

animal alive:

ruvianas auribus

erectis,

it

its

may be

because

it

a Peruvian

skeleton mounted.
called camelus Pe-

closely resembles th

camel, except in height, length of ears, and fineness of

wool. It

is

deposited in the

museum

of natural history at

Paris.

The

successive arrival of troops and consequent aug-

mentation of the number of the sick, obliged us to multiply

oor hospitals.

The commissary

general requested

me

to

extend tiny inspections to the distance of 12 leagues. I then

This concavity

is

the consequence of mutilation.

*Ilt8T

CAMPAIGN IN

201

SPAIN.

repaired to Alkala, a small city, celebrated for

hence I went

versity:

to

uni-

its

Aranjuez, one of the pleasure-

Tie park which is large, is well

and intersected by a branch of the Tagus that

houses of the king.

laid

out,

irri-

Nothing can be

gates the several plantations.

the casa del Labrador, that

this park,

is

than

finer

situated in the midst of

and surrounded by smiling groves and delight-

fu parterres.

In the spring and summer seasons

is

very healthful

this pleasure

house

but at the beginning of autumn, inter-

mittent fevers of various grades prevail here, and some-

times assume a malignant character.

ranjuez

the eastern declivity of a

The

ous rock.

But the

not particularly liable to disease. It

is

on
on a foundation of calcare-

hill,

leaves that

A-

city ot

fall

early in

is

built

autumn from the

trees of the park, are the cause of occasional disease,

when

the effluvia that arises from

tants.

The

spring

is

them acts on the inhabiand the foot-stalks of

at first sudden,

the leaves, even while green, are detached by the slightest north
is

wind, which

also hastened

*he Tagus. I
stances

when

about the

is

very cold during the nights. Thif

by the continual moisture

I visited this royal

latter

that rises

from

particular attention to these circum-

,-aid

mansion a second time,

end of July. The

leaves, as they

fell,

ac-

cumulated in the winding canals that intersect the park

in various directions, wiiere they soon

trefactive process,

undergo the pu-

from the excessive heat of the sun.

Hence noxious exhalations are carried by the south winds

that blow during the day, into the city, where they produce fevers. The castle, and the houses contiguous to
the park, are then forsaken, and the royal family, during
this season,

remove

magnificent palace

been given,

Vo L.

II,

to the Escurial. I also visited this

;

but as a description of

I shall pass

it

by.

it

has often

MEMOIRS, &C.

202

The

departure of the r

>yal

family to

Bayonne excited
to nmt

and gave us reason

th murmurs of the poop e,

an insurrection. Several unpleasant occurrences had

ready taken place in the

cities

through which I passed.

I therefore determined to carry

and I returned

al-

my inspection no further,

of Madrid on the second

to the gates

of

May, the day of the revolt, at eleven o'clock, a. m. It

was a most alarming and dangerous crisis: the report of
musketry and cannon was heard on all sides. I did not
hesitate to enter the city, where I had left my nephew
under the care of

my

host, the

was anxious

moreover

ment and

security of the hospitals.

marquis of Belgida;

to attend to the surgical arrange-

I rode through our

troops and the insui gents, without attending to the dan-

me, and arrived at my quarters with

my pupil, Mr. Frizac, and Mr. Fabar, surgeon of artillery, whom I met at the entrance of the city.
Having found my nephew safe under the protection of
the marquis of Belgida, I remounted my horse, and, fol
lowed by my two companions, repaired to the hospital,
gers that surrounded

now menaced by

a horde that had escaped the swords of

We passed

our battalions.

several groupes of the insur-

gents that I should not have recognized but for the muskets they discharged at us.

time to secure
convalescents

its

gates,

who

some of our

health officers

and

to

arm

all

could handle arms.

veral Spanish nurses

lence on

We arrived at the

who had

hospital in

the surgeons and

We

arrested

se-

already committed vio

and on two or three of the

Dr. Houneau, in particular, was severely
sick,

wounded by them.
This
try

efficient support,

and a few discharges of muske-

through the windows and over the gate, obliged the

insurgents to retreat from a position

Which they had

hiken under the walls of the hospital.

Our troops marched

iust

FIRST CAMPAIGN IN SPAIN.

to every part of the city, put an

and

tion,

it

203

end to the conten-

soon became tranquil.

We received the wounded of both nations into the hosimmediately, and gave them every necessary

pital

Before night,

tance.

we had

which number seventy belonged

Among

assis-

admitted more than 300, of

to the imperial guard.

were several wounds of the head,

the latter,

with a division of the cranium, the consequence of sab re

wounds. In one of these the

right parietal projection

was

cut off obliquely, with the integuments, the dura mater,

and a

superficial portion of the

the brain.

The bony

branous flap re-applied, and

favourable symptoms.
ring
the

cortical

substance of

was detached,

piece

it

the

united without

We were

mem-

any un-

also successful in cu-

wounds that penetrated the thorax, and others of

abdomen through which the intestines were protru

ded unhurt. Several amputations were

the extremities,

humeral

and two

articulation.

also

performed on

at the shoulder-joint, or scapulo-

The

subject of one of these latter

operations recovered completely, and the other

fell

a vic-

tim to

the colick of Madrid, which attacked him during

a' cool

night.

A severe but equitable proclamation was issued by the

prince generalissimo, which

Madrid

into submission,

awed

the inhabitants of

and restored order and trap

quillity.

great elevation of temperature in the atmosphere,

with storms and rain, checked the rapid progress of our

men towards a cure. A gangrenous

appeared among the wounded of the
the

wards on

,side

affection suddenly
line,

who

occupied

the ground floor, on the south south-east

of the hospital.

Almost

all

who had been wounded

MEMOIRS, &C.

204

in the large articulations, or

had fractures of the thigh,

were carried off by a complication of this disease

I was so fortunate as to arrest its progress among the

who were placed on

had appeared among them.

soldiers oi the guard,

ry, although

it

the third sto-

combined with bitter diaphoretick

mixed with ether, and antisepticks applied

Mineral acids,
drinks, cortex
externally,

removed

this

gangrenous affection

in the

ma-

wounded: but I found it necessary to amtwo cases, where these remedies did not arrest

jority of our

putate in

the progress

of"

The minute

the traumatick gangrene.

care with

which

I attended to the pro-

gress and character of this gangrene, and the unexpected success that followed amputation in several cases of

a similar kind, induced

following memoir.

me to make

it

the subject of the

FIRST CAMPAIGN IN SPAIN.

205

MEMOIR
ON TRAUMATICK GANGRENE, OR GAN
GRENE PRODUCED BY WOUNDS

X7C7"HEN the particular species, progress, and

*

causes

of a disease are not well defined, the different

therapeutick plans are often confounded and mistaken

for

each other. For a remedy

may

be advantageously

exhibited in one species of a disease, which would prove

ineffectual or

even pernicious in another, though

pertain to the

same genus of

diseases

cess, or the unfavourable results of

the

it

want of

apsue

an injudicious pre-

scription, often induce a physician to pause,

and

to re-

main satisfied with palliative means or the patient is

abandoned to the resources of nature, that are generally
;

insufficient: the disease

and science remains

advances, terminates in death,

stationary.

In

this

manner may we

account for the gradual advances of medicine, and

many

other sciences, towards perfection.

Physicians

who

have written on gangrene, or sphace-

lus of the extremities, advise us,

distinctions,

never

to

without making proper

amputate a sphacelated limb,

until

become defined by a reddish circle,

of demarkation between the dead and

the mortification has

forming a true line

living parts. This demarkation will not take place ex

MEMOIRS, &C.

206

cept in cases of spontaneous gangrene from an internal

cause; or

if

should happen, which

grene from wounds, (where

to wait for
tick

progress

it,) its

is

is

rare indeed in gan-

would be very imprudent

trauma-

it

quite different; for

gangrene almost always continues to advance, a ge-

neral infection of the system

is

and the

the consequence,

patient dies.

Before

now

that

we

enter into a detail of the species of gangrene

we

occupies ^ur attention,

shall briefly point

out the nature of gangrene in general,

its

causes, and

its

varieties.

When

a part of the living

body

is

cut off from the ge-

neral circulation, deprived of sensibility, and of

characteristicks of life,

gangrene.

it is

Then gangrene

fect or imperfect

all

as

be dead, or

all

It is

by a sense of weight, by
and cessation of

known by

and

the absence of

mo-

insensibility, loss of

arterial action;

faction almost immediately ensues,

foetid,

in a state of

authors admit, a per-

the vital functions of a part at

once, produces gangrene.

tion,

is,

death of a part of the animal body

whatever destroys

heat,

said to

the

all

spontaneous putre-

and

is

known by

nauseous odour, by blackness of the part, and a

decomposition of its whole substance.

the a teries

and the nerves are the

The muscular

last to yield to the

fibre,

mor

tilication.

We shall attempt to explain this phenomenon, of which

authors have not spoken.

The
ing to
cal,

progress and character of gangrene varies accord

its

causes.

When

and immediately

they are external, and mechani

injure the vitality of the parts,

it is

always preceded by an inflammatory obstruction, eri

thismus and rupture of more or less of the capillary system: the parts are tumefied by their vital action, which
is

not yet extinct.

The

epidermis

is

separated, and forms

lRST CAMPAIGN IN SPAIN

piilyetena?, filled

207

with a serum that should have been dis

charged from the part by transpiration.

The cutis grows

becomes black, and putrefies; the cellular substance
decomposed, with all the membranes; a redundant

soft,
is

quantity of fluids

is found in the parts

these have escaped
from the vessels and the adipose substance hence this
;

species of mortification

called moist

is

more

the centre of this sphacelus,

destruction of the limb

not been

uncommonly

all

and the

in

the

find muscles, arteries,

also

is

the fact in the

which decomposes and melts

the adipose substance, while the muscular fibre,

arterial tubes

of dissolution.

What

we

Such

life.

hospital sore or sphacelus,

down

when

especially

not complete, or the injury has

is

violent,

and nerves possessed of

gangrene. Yet

remain of a red colour,

in the

midst

All practitioners can confirm these

facts.

phenomenon? These

parts,

the cause of this

is

without doubt, retain their

life

longer than others,

al-

though deprived of their mobility, because they contain

a larger portion of calorick

The

and oxygen.

nerves have also the power of resisting the action

of deleterious substances, by reason of the fluid that passes

through them, which, doubtless, by

its

electrick or gal-

vanick properties, enables them to retain their

this fact,

deductions

may be made of the

first

life.

From

importance

in the practice of physick.

Such are the principal phenomena

fo us

by gangrene

the consequence of

that are presented

wounds, which I

have designated under the name of traumatick gangrene.

Hereafter I shall explain
but

first it

is

that produced

its

development and progress,

proper to notice spontaneous gangrene,

by an

01

internal cause, or the abstraction of

heat from a part,

This spontaneous gangrene generally appears

parts furthest

removed from

the heart, or in

are debilitated, or have their vital

in those

such as

power diminished,

as

MEMOIRS, &

208

and the fingers while trau

matick gangrene can take place in any wounded part.

the feet, the nose, the ears,

In the former, a deleterious cause acts on the parts

tant

from the centre of

life

dis-

in the latter, the injured parts

have suffered a certain degree of disorganization. In

either case, the part dies: but as the vessels in dry gangrene have experienced no change, they are not obstructed as in traumatick gangrene
former, the subjects of
cold, or

more

especially, if in the

have been exposed

it

have been debilitated

by some

to intense

disease.

Here

the part affected turns black, and instead of puffing up,

shrinks, dries, and some-

as in traumatick gangrene,

it

times hardens like horni

This

which

from the former

differs

discharge of fluids

in

is

dry gangrene,

the

having no effusion or

Thus we explain why

the latter,

in

the vessels remain entire, and

why

tion of continuity takes place.

Dry gangrene is more

in the

former, a solu-

dily defined, because the parts are supplied

vessels that

communicate with the centre of

enabled by their

powers longer

vital

ofmorbifick infection.

rea-

with large

life,

and arc

to resist the action

well defined inflammatory line

appears, separates the sound from the gangrenous parts,

and prevents the propagation of the gangrenous

ple

towards the former,

in

produced by inflammation
in

princi-

consequence of the obstruction

in the

mouths of the

vessels,

the cellular substance, and lymphatick system. In this

ease then, no inconvenience can ensue,

if

we

choose to

when amputation is indicated until the mortification

defined. In my memoir on " congelation or gangrene

wait
be

from
It

is

frost," I

have explained

quite different

propagates

itself rapidly,

its

production and effects.*

from traumatick gangrene, which

and

in succession

See the campaign

in Poland.

through the

FIRST CAMPAIGN IN SPUN.

parts,

from one limb

fects the

organs of

to another,

life,

izes on

s<

and destroys

209
the trunk, in-

the patient.*

easily conceive, notwithstanding the vessels

when

substance are disorganized

the gangrene

pears, that a sufficient degree of action

We

and

may

can

cellular
first

ap-

remain

still

them to absorb the

same time to partake of

in the deep-seated parts, to enable

gangrenous principle, and

at the

the erethismus, or latent inflammation that

Thus

is

going on.

I explain the progress of the disease,

and point

out the impropriety of trusting to the powers of nature to arrest

it,

and to throw

it

off.

But

in addition to

the local and gradually-extending inflammation, a metas-

of the gangrenous principles to the brain

tasis

is

induced

either through the cellular substance or vascular system,

and the most alarming symptoms ensue.

tual faculties are disturbed,

The

intellec-

and the animal functions im-

paired. Paleness of the face, anxiety, delirium, and all

the

symptoms of ataxia make

On
the

opening the dead body,

and if
must soon expire.

their appearance

infection continue, the patient

this

have found the arteries of

brain replete with black fluid carbonated blood,

and the heart

filled

with liquid blood of the same appear-

ance.

In dry or spontaneous gangrene, the absorption

effected with greater

difficulty, the

tent for an indefinite time,

this

sphacelus

parts

by the power

and

it

is

disease remains

is
la-

not unusual to see

or necrosis separated from

the

living

of nature alone, without a change in

the general functions.

On

this subject, says

Boucher "if mortification threaten

on a part above which a section of the flesh cannot

be made, it is evident that no other resource then remains
but immediate amputation, although this is uncertain." See
to seize

Memoirs of the Academy,

Vol. ii.

Vol.

Dd

II. 4t.

MEMOIRS, &C.

210

From

this

must appear that an

between traumatick and spon
you please, between the moist

view of the subject,

essential difference exists

taneous gangrene, or,

if

it

gangrene from an external cause, and the dry gangrene

that generally

The

depends on an internal cause.

is

more

for in either case, the patient

must

prognosis in these two species of disease

or less unfavourable

by a process of nature, or by
an operation of art; and life must consequently be endangered. Yet, what is the indication in each of these
6pecies of gangrene? I refer to my campaign in Poland
for the treatment of dry gangrene, or that produced by
lose the sphacelated limb

frost,

and

we

shall

now

attend exclusively to the

means

of preventing or arresting the fatal consequences of trau-

matick gangrene.

A ball,

or the bursting of a

bomb

extensive disorganization of a limb,

without producing

may do

such vio-

and nerves, that death of the part must

be the consequence. We have witnessed many such
lence to

cases. I

its

vessels

have also remarked that violent percussion of

a bone, (although not attended with fracture) and the

shock which the osseous membranes, supplied with
nerves appertaining to organick

life

produce gangrene, more especially

undergo, gcnerally

when

the articulating extremities of bones,

the ball strikes

and lodges

in their

substance.

We are yet unacquainted with the extent of

the disor

derthat commonly follows considerable injury of the pe

riosteum, aponeuroses, (the white parts) and articulating
surfaces of a joint, because
distribution

we

are yet ignorant of the

and extent of the nerves of organick

which we are induced

to believe,

thy, physiological experiments,

tions, are not

very limited.

life,

from diseased sympa

and anatomical dissec

Bichat, Scarpa, Chaussier.

FIRST CAMPAIGN IN SPAIN.

211

and Ribes, are the anatomists who have thrown most

light

on their connection with the animal economy

at

and on the peculiar phenomena of organick life.*

According to this opinion, we believe that the change of

large,

membranes, or aponeuroses of the ligaments, celluand skin, which appear to receive their vitality from a continuation of the nerves of the great sympathetick, must be followed by a change and disturbance

the

lar substance

of the organick functions in the injured limb, viz. in the

process of nutrition, in those of the synovial and adipose

apparatus, and in the respiratory function of the skin.

When there is

a suspension of power in these functions,

a reflux of the nutritious

juices, obstruction, atony,

and

dryness, erysipelas, and tumefaction of the skin take

place.

Disorganization of the epidermis, phlyctenae, and

effusion of

serum are the consequences of a rupture of the

capillary vessels,

and the accumulation of a gas which

should be discharged externally

by

transpiration.

The

absorbent vessels being deprived of action, the oily and

lymphatick

fluids that are effused,

remain quiescent in

and disorder and obstruct the

membrane, which soon undergoes a change, and

the adipose cells,

into a state of putrefaction.

The

cellular
falls in-

local irritation or torpor,

* In dissecting the fretus of the cow, I have easily traced

the nervous branches given off by the great sympathetick
running together with the umbilical arteries, as far as the
placenta. Other smaller branches accompanying the crural
and axillary arteries, form congeries that are discernible
by the eye, and appear to unite in different places into
small white masses that are doubtless so many ganglions. It
is probable that filaments much more delicate than these,
follow all the arterial branches to their termination. This
doctrine enables us to account for the pain that a patient feels, when a ligature is applied on an artery, more
especially if it be in a state of disease, and for the appearance of certain symptoms that sometimes attend the application of these ligatures.

MEMOIRS, &C.

212
extends

and

its effects

whole system of organick life,

of various complications and grades

to the

febrile affections

The

are the consequence.

principal vessels of the affect-

ed limb speedily partake of the disease, and

their actions

are destroyed, the blood ceases to circulate in them,

more

becomes

particularly in the capillary system,

tends throngh

car-

This carbonization exand produces the

membranes,
the

bonated, and loses

its

all

black colour, which

is

calorick.

one of the characteri sticks of gan-

grene. Putrefaction takes place, and advances with a rapidity proportionate to the quantity of adipose

membrane,

the high temperature, moisture, and insalubrious state of

This

the atmosphere.

local affection is

plicated With an ataxick fever,

at the

same time,

as

was

sometimes com-

and adynamia takes place

the case in Egypt,

soldiers were attacked with the yellow fever.

progress of traumatick gangrene

few hours
mity

extended

it

to the trunk,

its

was

when our
There the

so rapid, that in a

ravages over the whole extre-

and the wounded often died

in six

hours.*
It will easily

grene,

be conceived that in

would be dangerous

it

this species of gan-

to wait until

it

had become

defined by this reddish circle, or line above-mentioned,

because putrefaction advances without any opposition, not

only by contagion, but by the absorption or transudation

from the part

first

affected

We

should not then hesitate

may say, to perform

immediate amputation, when once the necessity for it is

whatever authors or practitioners

well established.

We need not

succeed

which

not defined

is

fear that

gangrene will

the stump, as in spontaneous mortification,

in^ >rodqc*d

by a

for traumatick

local cause, is

gangrene, after be-

propagated or extended

by absorption and a disorder of the membranes, which

* See

memoir on yellow fever, campaign

in Egypt.

is

FIRST CAMPAIGN IN SPAIN.

gradually propagated through

nu

vessels

213

that are

conti-

'lis.

In

fact,

amputation performed in a proper part, arrests

the progress of this species of gangrene, and prevents

fatal

its

consequences. Admitting then that the lower halt of

were

the leg

in a state

o c sphacelus,

consequence of a

in

severe contusion by a ball, and that the vessels, nerves,

and ligamentous membranes were injured

to such a

gree, that gangrene had already attacked the

substance on the superiour part of the limb,

amputated

most advantageous

in the

it

de

cellular

might be

part, if the skin

remains sound, without any apprehensions of an attack

from gangrene

whole leg

is

in the

stump: but when the skin of the

sphacelated,

we

should lose no time in per-

The same

forming the operation on the thigh.

apply to the superiour extremities.

ly

limb that

rule will
is

mere-

rendered torpid, should not be treated or viewed as

one affected with legitimate sphacelus.

In the former,

the heart, sensibility, and power of motion remain,

though the skin

may

Besides, in this case,

cutient tonicks

The

nally

when

vessels obstructed.

the di ease

and cordials should

is

first

doubtful, reper

be given

inter-

recommended by the generality

commonly more injurious than beneficial,

and accelerate

gangrene, without removing the tor-

part.

my memoir on
Amputation

have spoken of

this last

affection in

amputation.
first

removes the contagious matter when

performed above the parts

that is

its

al-

scarifications

of authors are

por of the

be black, and

in a state of real

gangrene

above the parts which are disorganized. The nerves

and vessels are

set at liberty

when

divided by a sharp in-

strument, and they are thus relieved from fluids that are
in a

and

state of stagnation.
far

Their action

is

re-established,

from performing the part of syphons by absorb-

ing heterogeneous principles, they arc enabled to expel

MEMOIRS, &C.

214

these principles, and the fluids which they contained, and

subsequently to receive the invigorating principle of

life.

All the membranes are relieved from obstruction, and

resume their vital powers. The effect of amputation

should be assisted by the internal exhibition of chinchona, generous wine, tonicks, &c.

The

be adduced

facts that shall

will, I think,

this dissertation

prove incontestably the

truth of the doctrine I have supported

amputate
provided

in
it

conclusion of

at the

gangrene without waiting

that we
until

have often been a witness

who

rigidly

should

be limited,

be caused by a mechanical injury, and the

of the person so injured be in danger from

it

life

it.

to the death of

persons

adhered to a contrary doctrine, and I have

long since been induced to abandon a rule which I had

always believed pernicious, and according to the precept

of Celsus, I chose rather to adopt an uncertain remedy,

than to abandon
est

my

patient to certain death.

cnim cmceps auxilium experiri

quam

" Satius

nullum." (cel$.

CORN.)
I

first

soldier

made

the experiment at Toulon, in 1796, on a

who had

a gangrenous ulcer of the foot from a

violent contusion.

The whole limb was

soon attacked

with sphacelus which continued to advance. I determined

to

ed

remove

my

his leg.

The

expectations

than forty five days,

This case was

success of the operation surpass-

stump

the
this

cicatrized,

man was

sufficient to

and

encourage me.

During the siege of Alexandria

in

Egypt,

second case of a similar character presented in

tice.

in less

completely cured.

in 1801, a

my

prac-

FIRST CAMPAIGN IN SPAIN.

A dragoon of

the 18th regiment

ball in the articulation of the left

and arm

fell

gangrene

into

when

was wounded by a

arm, and

life

of the

sphacelus

man was

in

I resolved to extirpate the limb at the

scapulo humeral articulation.

The

disease continued to

advance perceptibly, and he already

the brain, with

his fore-arm

The

in succession.

Approached the shoulder, and the

jeopardy,

215

symptoms of

checked the approach of death

completely cured

felt

an affection of

ataxia: but the operation

:

he recovered, and was

at the conclusion of the siege of

Alex-

andria.

After the capture of Ulm, Mr. Ivan, surgeon to his

majesty the emperour, amputated the thigh of a soldier
in

my

hospital,

and under

my own

eye

at

Elchingen,

whose leg had been disorganized by a ball, and afterwards fell into sphacelus. The gangrene was not defined,
and evidently continued

to advance, but infection

was

prevented by the operation, and he had completely rcco

vered,

The

when we

returned from Austerlitz.

fourth case occurred in an officer of the

same

regi-

ment who was wounded in the ankle joint by a ball. He

was brought to the same hospital to be dressed, on the
third day after the accident ; his foot was in a state of
gangrene, and

his leg

milar destruction.

tumefied and threatened with

si

The cellular texture of the remaining

was of a dark yellow colour and al

portion of the limb

ready infected with the gangrenous principle

but the

operation arrested the progress of the disease, and suppu-

was established in the stump. Some gangrenous eswere produced, but they sloughed off. The wound
became clean, and the cicatrix w as completed on the

ration

chars

92A day.

He

had been walking on a wooden leg for

some time, when he contracted the

hospital fever, then

MEMOIRS, &C.

216

epidemick at Ulm, where he waited

to

my

great regret he

for his

regiment, and

a victim to this disease, after

fell

having escaped the dangers of his wound and

its

conse-

quences.

After the battles of Austerlitz and Jena, several of my

colleagues and surgeons of the first class also undertook

example

to amputate sphacelated limbs according to the

I had set them, though the gangrene

wounded

rather than abandon the

inevitable.

They were

been. I regret that I

me

am

the subject of

that I

many

not able to report

lost

have detailed here

sufficient to fix the

my

seemed

in general as successful as I

Spain, where they were

I was in
young Bane

not defined,

to a fate that

which one of these surgeons

similar cures

appears to

was

sent

had

cases of

me

while

but the case of

length,

full

at

opinion of surgeons on

memoir.

CASE.

Anthony Barre, 18 years of age, a

regiment

and

ot imperial guards, a

delicate constitution,

revolt of

Madrid,

May

man

fusileer in the first

of the

common

was wounded by a

2, 1808.

The

bullet in the

ball, after

penetrated deep into the angle of the elbow on

side,

was

lost in

and inward, so

the parts. It

made

its

tiguous to the cubitus.

it

radial

way downward

met the point of the

On account

having

its

that, after perforating the skin

pronator teres muscle,

size

and the

radius, con-

of the resistance

it

met

here, the ball passed in an oblique direction, glanced

the interosseous

membrane, and continued

its

on

course be-

tween the two bones under the flexor muscles of the

hand, following the course of the interosseous vessels, as

FIRST CAMPAIGN IN SPAIN.

iar as the articulation of the wrist,

where

21?
stopped.

it

He

when wounded, he felt a violent shock

him to let his arm fall: he also felt ^ pa n

informed us, that

which obliged

numbness and

ful

wounded

limb.

total loss

He was

same evening, where

of voluntary motion in the

conveyed

I received

to the hospital the

and dressed him imme-

In vain I sought to discover the situation

diately.

foreign body.

The wound was

and dipped

spiit roller,

oi the

then dilated, covered with

water, and the fore-arm

;n salt

was bound up with compresses moistened with the same

fluid. He was kept on a proper regimen and used acidu-

He

and antispasmodick drinks.

lated

was

night;

restless,

slept

and much agitated; a

none that

livid paleness

of the countenance, and haggard appearance of the eyes

seemed

On

to indicate

something unpropitious.

the 3d, in the morning, his

slightly tumefied,

arm was immoveable,

and threatened with torpor. Apprehen

ding danger from the subsequent symptoms, I directed

whole extremity to be covered with compresses

dipped in hot camphorated or ammoniated wine. I order-

the

ed him

to take

an anodyne antispasmodick draught

night, and to use an infusion of

drink.

He

camomile flowers,

passed a restless night, and on the morning of

the 4th the hand and fore-arm had

and heat

lost

the r sensibility

the dark colour of the skin and the tumefaction

of the hand

We

at

as his

left

no doubt of the accession of gangrene.

applied camphorated brandy, heated nearly to the

boiling point, over the whole limb, except on the

wound,

which was covered with a plaster of digestive salve.

Camphor and chincona were also added to the foregoing
remedies. But in opposition to
sited

him

all

our care,

when

at half past four o'clock, p. m. the sphacelus

complete, the whole hand was dead, and

its

converted into phlyctenae, as was also a large

fore-arm.

Vol.

I vi-

The elbow -joint, and

ii

was

epidermis
|>art

of the

the lower third of the

MEMOIRS, &C.

218

arm were inflamed and much

Scarifications

swollen.

on

nd fore arm, the use of antisepticks internally

th^ hand

and externally, could not arrest the progress of the gan

grene, and on the 5th it had ascended as high as the
mot elevated part erf the wound. To me, the scarificafavour the progress oi the sphacelus,

tions appeared to

had several times previously remarked

as I

considered them as injurious.

when

I visited

On

the

hence I

morning of the

6th,

him, the sphacelus had extended round

the whole articulation, and gangrenous radii seemed to

The

pass off towards the middle of the arm.

much

and

debilitated,

his pulse small

was

patient

and intermittent:

he laboured under mental aberration or delirium,

his

eyes were dull and wild, and his countenance exhibited

Seeing him thus in the most im-

the paleness of death.

minent danger,
ing, but

my

wished

colleagues

to a

amputate the arm that even-

were apprehensive of the conse-

quences, as the gangrene

to adopt this last

to

remedy

was not

defined

rather than

death that seemed inevitable.

the operation,

but I resolved

abandon the patient

Before I

called a consultation

commenced

of the best informed

The

physicians and surgeons to consider his case.

sultation could not

be had

this short period the

until four o'clock p. m.

con-

and in

gangrene had ascended several mil-

limetres,

and invaded almost the whole of the arm

proposed

to operate, although

were by no means
guments

n.

flattering, relying as I

th's formal

was opposed by a

in consultation,

my memoir, on
Roman sur-

the gentlemen

except one.* Notwithstanding

and general opposition,

I believed

to s>aci\fiee motives of personal interest

did on the ar-

and on the opinion of the

My proposition

who were

prospects of success

and principles detailed before in

my experience,
ge

my

Mr. Talabere, chief surgeon

to

it

my

duty

and convenience

marshal Money's corps

to save the
practice,

FIRST CAMPAIGN IN SPAIN.

219

by means

of an unusual

life

of a citizen,

if

had the most slender expectation of

effecting

the ataxick symp-

There was not a moment

toms grew more and more alarming, and the mortificato lose:

it.

tion
this

advanced with uncommon rapidity;

young man must inevitably have died.

in

two hours

In a few moments the dressings were prepared

extirpation of the arm,

ble,

for the

which was now barely practicainto a ward where his com-

and the patient removed

panions could not see him. At the period of the operation, his vital powers were almost extinct, yet I persisted
observed
in going through with it. One of the assistants
that the operation

was performed

in the

space

t)f

seven-

teen seconds, exclusive of the time employed in applying

the ligatures

scribed in

I operated in the

my

manner

that I

campaign

with care, so as not to include the nerves

them,

have de-

in Egypt. I tied the arteries

accompanying

much more important

The fleshy parts of the two

in the ligature, a precept

generally admitted.

than

is

flaps

were of a brownish

colour,

and almost dry the cel;

diseased. I approxilular substance of the arm-pit was

contact, and.
mated the flaps without bringing them into

of fine linen,
covered the whole wound with a split roller
pledSeveral
wine.
steeped in very warm camphorated
immediately
of lint, sprinkled with camphor, were
gets

compresapplied, and retained in their situation by long

shoulthe
to
up
continued
and
wine,
ses dipped in hot
long
a
by
supported
der, and the whole dressing was

and broad bandage.

He was conveyed

bed, in a ward appropriated

but little pain during
suffered
he
to the imperial guard:
in a great mea
the operation, because the shoulder had
followed, as he lost
its sensibility; no syncope
to his

sure lost

the contrary, the opsbut a small quantity of blood; on

MEMOIRS, &C.

iO

seemed

ration

was

delirium

to

have restored

less,

and

his strength, at least, the-

the pulse

immediately improved.

him a portion of chicken-broth, prepared by my

cook for t';ose who were most severely wounded, he
I sent

drank

this

and some good

the animal heat

and

natural,

was

and he

five o'clock

tranquil,

became more
two hours, and passed the

restored, his pulse

slept

mainder of the night

At

He became

claret

full

re-

in tranquillity.

next morning,

amelioration in his condition.

found a perceptible

The

dressings which I in-

spected h .d imbibed a yellowish serum. I prescribed for

him a stomachick potion composed of

loxa,

and "Hoffman's anodyne mineral

claret,

chinchona

liquor, in suitable

proportions, a spoonful to be taken every quarter of an

hour

The amputated
opened

in the amphitheatre

tion, in presence of a great

sicians

who

was

limb, which

entirely black,

was

immediately after the opera

number of surgeons and phyThe skin, the cellular sub-

had assisted me.

membranes and ligaments were black, and

of sphacelus
the muscles were soft, and in-

stance, the

a state

in

jected with black carbonated blood.

by

The

aperture

made

the ball, was filled with a black, foetid, ichorous serum,

the ball had stopped under the annular ligament of the

flexors of the fingers: the contiguous articulary ligaments

were disorganized, and

the articulation broken up. The

had been flattened by the resistance it had met with

ball

At

the second dressing,

I covered the

wound

shoulder with a piece of flannel, dipped in very

camphorated wine, mixed with bark.

vals good broth, seasoned with
after this a glass of

his

body

gar,

to

to

took

warm

at inter-

cinnamon and cloves, and

claret.

be washed with very

and then

flannel.

good

He

of the

I ordered the surface of

warm

cthereated vine-

be covered instantly with pieces of warm

Towards

the evening I directed an

enema

to be-

FIRST CAMPAIGN IN

made with

given,

camphorated.

He

a decoction of chinchona, strongly

took a draught as on the former even-

and I had him removed

ing,

221

SPAII?.

bed that had been

to a

migated with oxygenated muriatick acid

fu-

gas.

The seventh was a more favourable day. His pulse

was more expanded, the heat of the body more general
and

and the paleness of the countenance

natural,

daverous: he had several black, bilious, and

ations

by

stool, that

seemed

to relieve him.

not copious, but he discharged

it

less ca-

foetid

evacu-

His mine was

without pain.

The same

remedies, &c. were continued.

During the night of the 8th, a paroxysm of fever came

was followed, about four o'clock in the morning,

by a slight haemorrhage. I was called to his assistance,
removed the dressings, and soon discovered the vessel
that had bled, which was a branch of the circumflex.
The ligature had been torn from it by an involuntary
on, and

motion made by the patient

of

dreaming

in his sleep, in

that the Spaniards

consequence

were pursuing him. I

applied a ligature on this small artery, dressed the

with a pledget of

lint,

and covered

it

wound

with digestive.

I or

dered him to be removed to a fresh bed, and prescribed

the remedies of the preceding evening, having first taken

care to give

him some good

broth, and a

little

excellent

wine
This new accident had again reduced him
debility

and inquietude

were gradually

re-established,

three days, his evident

most

flattering

to a state of

but the functions of his organs

and

in less than

two or

improvement inspired us with the

hopes and expectations.

dressed the

wound every 'day myself with the above-mentioned

cles.
Suppuration was established on the seventh
and

arti-

day,

his strength sensibly returning.

The gentlemen who had been concerned

tation,

in the consul-

could scarcely believe that a change so extraordi

MEMOIRS, &C.

222

nary, had taken place in him. It also attracted the attention of

On

all

the health officers of the army.

the 9th clay after the operation, a second haemor-

rhage took place from a vessel deeper seated than the

On raising up the dressings, it immediately ceased

first.

not being able to discover whence

it

issued, I dressed the

again, and ordered the usual remedies to be con-

wound

tinued with such changes as circumstances might require.

He was

much

again

debilitated, but

he soon regained the

strength he had previously acquired, and continued to

improve

come

till

clean,

and the

cept a part of

and of a

fied,

in the

The wound had

the 13th of the month.

its

flesh

was

lowest internal surface, that was tume

On the

livid colour.

13th, about four o'clock

morning, the haemorrhage returned, but immedi-

ately disappeared

when

This appeared

be the effect of the contact of cool

to

the dressings

were removed.

repetition of these accidents at this

me much

gave

vessel

the ligatures of the arteries that

now come away, except

and

I felt certain that the blood

that

had been previously

critical period^

had been

tied.

flowed from no artery

As

the haemorrhage

powder of bark, and

I ordered the stomachiek draught to be repeated

same

No

and a half of opium

in

at night

sweetened

accident occurred, and Barre continued in the

state as

on the preceding evening

broth, light soups,

On

had

The wound was now

dressed with colophonia, mixed with

I prescribed a grain

first tied,

that on the axillary artillery,

ceased, I determined to wait.

wine.

air.

uneasiness; I sought in vain for the open

had

now

be-

of a good red colour, ex-

and good

the 21st day, at the

he took rich

claret.

same hour, a

fourth haemor

rhage occurred, after a paroxysm of fever of a similar

but

type with the

first;

my

found

arrival, I

my

this last

was more

acute,

and

at

patient in a syncope, that threa-

FIRST CAMPAIGN IN SPAIN.

tened to prove fatal

without loss of time I removed the

dressings, while Mr. Frizac,

vol.

He

ammonia.

my

pupil, supplied

him with

revived, and I discovered the part

from which the blood issued:

at the

223

this

was

tumour

a fungous

lower and internal part of the wound before-men-

my

it,

and

after a slight resistance, discovered a large abscess,

from

tioned

plunged

finger into the middle of

which was discharged a considerable quantity of purulent matter,

mixed with flocculi of black cellular subcommunicated by a fistula of consi

stance. This abscess

derable size with the substance that lay below the pccto

major muscle. I

ralis

this cyst

on

its

and separated the walls of

di ated

external side, and discovered the orifice of

the artery that had bled, and with a crooked needle, I applied a ligature

on

the fistula, sponged

examined the whole extent of

it.

it

clean,

and removed

all

the sloughs

of the dead cellular substance, filled up the opening with

pledgets of soft
in

powder:

lint,

I applied

one

who was

of his recoveiy

camphor and bark

a suitable dressing, and prescribed

He

a cordial draught.
like

sprinkled w'.th

appeared, during the operation,

and I had no hope

in articulo mortis,

we were

even on the point of throw-

ing the sheet over his face, supposing that he

But

was

in opposition to the opinion of the assistants,

dead.
I

still

ordered stimulants to be applied externally., and administered internally.

The warm

ethereal frictions appeared

to be advantageous, and finally, after these means had

been continued ten or twelve minutes, he revived.

were encouraged

to continue our labours,

night, 1 again entertained hopes- of seeing

He was

very weak, but

dually returned,

better

him

recover.

his strength gra-

suppuration and the other secretions

were restored, and

food.

much

We

and before

in a

few days he could take

This was fortunately the

last

light

accident of the kind

that occurred to disturb the tardy restoration of nature.

MEMOIRS, &C.

224

The
sel

purulent abscess, in the middle of which the ves

d<

wn

to contract

mu-

was soon formed, and

ad-

had opened, soon became clean; the

to their proper level,

The

tual adhesions.

cicatrix

sunk

flaps

and approximated

vanced rapidly from the centre to the circumference.

The

symptoms of adynamia that succeeded

were successfully Combatted with the chinchona loxa, preceded by gentle erne
ticks. The strength of our patient improved daily, but
occasional

each of these

critical periods,

was recovering completely, he was suddenly

just as he

attacked by the colick of Madrid, after exposing himself to the effects of

overcharging

chenies and

his

sallad.

a cold frosty night, and imprudently

stomach by the immoderate use of

His wound was at

nately for him, almost healed over. I

alarmed

for his safety, but

this time, fortu-

was now much

he speedily recovered, though

he had two or three severe paroxysms of the colick, that

made him

roll

over the

His convalescence was

of sending

him

off to

floor,

and scream most dreadfully.

tedious, yet I

had the

satisfaction

France on the 30th of July, the

wound was

ninetieth day after the

received, and the

eighty fourth after the operation. I afterwards heard that

lie

arrived safe, and continued well.*

The

foregoing case, with those previously reported,

appear to

me

sufficient to

remove

feered with traumatick

fined,

and

it

doubt of the pro-

all

priety of performing amputation of a

limb when

gangrene, although

This

be not de-

therefore goes far to decide the question that

has arisen on the propriety of adopting

it

it is af-

man

is

now

this practice.

with hi6 family at Ca6telnaudary.

fclRST

CAMPAIGN IN

225

SPAIN.

MEMOIR
ON THE COLICK OF MADRID.

^S, >&

T> EFORE
-*-*

& </ y *v *&

I arrived in Spain, I learned that several

diseases prevailed there,

which the greater part of

the inhabitants and physicians of this country denied to

be caused by the climate ; one of these was the colick of

Madrid, which
Dr. Thierry,

justly attracted our attention.

who

travelled through this country, has

given us a series of very interesting observations, and the

satisfactory results of his inquiries, relative to the climate

of Madrid,
useful to

and the causes of this

me

as a travelling

confirm his observations, while

quences of

we

If

disease.

His work was

companion, and served to

it

pointed out the conse-

this distressing colick.

accept the opinion of this

member of

of Paris, either in whole, or in part,

opposition to that of the royal

the faculty

we must

stand in

academy of medicine of

Madrid* Most assuredly the writings of this celebrated

demand the veneration and confidence of physi-

society

cians

but

if

accident or experience should lead to the

discovery of errours in the opinions of the most exalted

Memorias de

la real

academia medica de Madrid. Dis-

sertacion sobre el colico, del doctor Luzuriaga.

Vol.

ii.

226

MEMOIRS,

authorities,

must they, through respect for

be concealed,

On
is

to the detriment of science

am

the contrary, I

light

important to

into the labyrinth of science,

cultivators,

On

uth.

its

this

their authors,

and humanity}

of the opinion that every ray of

which can be thrown

very of

&C

and may lead

to the disco-

ground have I opposed, with un-

expected success, the opinion generally adopted in the

army, that amputation of a limb should never be per

formed until the consecutive symptoms have ceased. I
think that this question has been decided in my " memoir on amputations."

now

I shall

drid, as

it

appeared

was

assisted in

the climate,
ease,

by

some account of the

and

my

colick of

Ma-

in the hospitals, or in different parts

where our

of the city
I

give

sick

were quartered.

my researches

into the causes

associates doctors

into the nature of the

and character of this

dis-

Herminier and Ribes,

physicians to his majesty the emperour.

Upon our arrival at Madrid, early in April, a great

number, both of the army and of the imperial guard, entered our hospitals with

all

the

symptoms of

the colick

of Madrid.

Doctor Thierry,

who

attended closely to this disease

for several

years, has given us, as I before remarked, a

satisfactory

account of

it.*

And we found the same symp

toms prevailing among our sick, with such variations as

were produced by the age and constitution of the patient,
and by the occasional causes of the disease

itself.

With-

out refering to the description of this disease as given

by

the doctor, and as'found in Spanish authors, I shall faithfully report from my journal its phenomena as they
came

under

my own

observation.

With

the greatest possible

precision, I shall attempt to point out

#

its

causes,

and the

Physical and Medical Observations on Spain

FIRST CAMPAIGN IN SPAIN.

227

which were produced by the action of these

effects

and then

causes,

shall frankly give the success that followed the

adoption of certain curative means, and the precautions

that appeared necessary, to fortify the

human system

against this formidable disease.

The

disease

in the right

commences by

constipation and dull pain

hypochondriack region, with borborygmus,

and pain of the abdomen. The sick feel a sensation of

weight in the region of the stomach, accompanied by
and nausea: the eyes become languid, the

eructations

skin of the countenance and vessels of the conjunctiva

assume a yellow colour: the base of the tongue is covered

fails, and sleep is

with a yellow mucous fur; the appetite

imperfect.

At

our soldiers paid no attention to these symp-

first

toms of incipient disease, and, not suspecting

ger, exposed themselves to the operation of
lived as usual.

A repetition

its

their dan-

causes, and

of such lessons as experience

was necessary to induce them to apply early for

medical assistance, to arrest the alarming symptoms that
soon made their appearance. On this account, and in consequence of the state of the weather, the disease was most
inculcates,

severe during the

The

foregoing

first

months of our stay

symptoms

in Spain.

generally continued without

increasing in violence, during the

first

two or three

days, and were then followed by acute pains

tines.

The

rolled

over the

shrieks.

colick

was sometimes
floor,

in the intes-

so acute, that the sick

and uttered the most dreadful

In some cases, the pain came on without any

-particular premonitory

symptom.

are acute, the efforts to vomit

When the

colick pains

become more

frequent,

and vomiting ensues, by which the contents of the stomach are first discharged, and aftei wards, a quantity of
thick, bitter bile. Every emesis is preceded by an intense pain about the umbilical region,

whence

it

ascends

MEMOIRS, &C.

2&8

up towards the stomach and thorax. The patient is agitated, sheds tears, sighs heavily, and suffer* great anguish until the vomiting ceases.

painful stiffness of the

limhs then succeeds, with pandiculation, and irregular

rigours that are sometimes terminated

although this

is

by no means

by a

perspiration,

The bowels

general.

be-

constipated, and the walls of the

come more and more

abdomen are slightly

when touched, and fall

backwards towards the spine. The urine is diminished
in quantity, and of a yellowish red colour. The anmal
painful

powers are lessened, and the patient

sadness: he

is

of pain in which he

a natural

and

feels anxiety

deprived of sleep, from the continual state

is.

But the pulse remains nearly

in

and even during the paroxysms of vomit-

state,

ing scarcely shows any symptoms of nervous disorder.

If these evacuations afford a temporary relief to the patient, the

He

pain returns again with increased severity.

then utters the most acute and discordant cries, like the
roaring of animals, followed by deep groans, or a sullen
silence.

The

constipation

becomes more obstinate

proportion to the continuance of the vomiting.

seen

many persons

had no

labouring under this disease

in

have

who have

stools for seven, eight, nine, or ten days.

These symptoms continue gradually

especially

when

nature alone, or

and

the disease

when

is

to increase,

more

trusted to the resources of

baths, antispasmodicks, anodynes,

mild laxatives are

employed

to the

exclusion of

other remedies,

In the month of M'iy, I saw several soldiers die of

this
tal,

at

disease a
in

few days

after they entered

consequence of neglecting

an early period of the disease.

ease

to

the hospi-

apply for assistance

In such cases, the

was complicated with symptoms

dis-

of a bilious remit-

tent, or rheumatick fever, accoiding to the

temperament

of the patient, or the action of additional causes.

When

FIRST CAMPAIGN IN SPAIN.

the bilious remittent attacks,

cept in irritable
inflated

which

and sanguineous

and becomes

is

229

not frequent, ex

habits, the

painful, the urine

abdomen

is

diminished or

suppressed, the patient experiences a sensation like a

burning heat through the whole abdominal region.

ver increases, the skin

is

Fe-

dry and hot, the colick pains

diminish, but the vomiting continues, and towards the

conclusion, bloody fluids are discharged from the sto-

mach, the
vital

alvine evacuations take place involuntarily, the

powers

decline,

and the patient

But when the rheumatick fever

of the colick diminishes; the pain

extremities,
tion: the

which tumefy and

dies.

attacks, the intensity

is

translated to the

lose their

powers of mo-

rheumatism then continues the usual time, and

almost always terminates favourably.

In some eases, the colick was followed by a putrid

On

nervous, or malignant fever, more or less acute.

opening the bodies of those

disease,

The

we

with a black liquid blood

their

mucous coat was

stomach distended and

the intestines

were

in

some

biiious matter:

from inflammation, and the

free
tilled

had been swallowed before

we

and mesentery were injected

and contained a black

inflated,

of the colon,

died of this complicated

could perceive no marks of inflammation.

vessels of the epiploon

measure

who

with gas and such

fluids as

death. In the sigmoid curve

found the fceces hard, and formed into

balls, the liver tumefied,

dark green colour:

in

and gall-bladder with

short,

bile

of a

every symptom indicated

the exhaustion of the vital powers, and the effects of ady-

namia.

Such are the

principal

phenomena observed by

inspecting the dead bodies of three soldiers,

ter several relapses of the colick,

complicated

with

adynamia or

which
ataxia.

who

finally

We

fourth in presence of Dr. Herminier. This

us on

died

af-

became

opened a

man was

an

23Q

MEMOIRS, &C.
and had previously suffered

ostler at the imperial stables,

violent attacks of this coiick,

which reduced him

He was

extreme emaciation.

state of

with symptoms of adynamia, and carried

On

seventh day.
the
tlii*

found

the vessels filled with black

was

The

blood, and

with a quantity of

filled

li-

not inflamed,

mucous coat sound. The duodenum and a

their

of the ilium

matter.

we

as in the three foregoing cases

intestines distended, but

quid blood, the

and

off before the

inspecting the dead body,

phenomena the same

epiploon was yellow,

to a

suddenly attacked

part

foetid bilious

cavities of the heart contained black liquid

fibre

its

was

soft:

the lungs presented nothing

remarkable.

In a (ew cases the coiick disappeared spontaneously,

and without the interference of

case, or

when

the

art.

means of which

successful, the pains descend,

When

this

is

the

have spoken prove

and seem

to

disappear in

the inguinal regions, instead of ascending from the umbi-

towards the oesophagus, a symptom that Hippo-

licus

crates observed to be favourable.*

The vomiting

then

becomes more
the bowels are free but

ceases gradually, the secretion of urine

abundant, and of a paler colour:

painful

tenesmus

is felt,

and black hard

balls of fcecal

matter covered with a yellow mucous substance, are

dis-

charged. After these evacuations, the patient enjoys a delightful

calm

restored,
first

the pains cease, tranquillity

and he may now be considered

and sleep are

as safe. If these

operations of nature be assisted, he speedily reco-

vers.

In

many

abdomen,
and sometimes an erysipelatous affection

cases, a miliary eruption of the

loins or thighs,

of the parts or of the extremities, suddenly removes the

coiick

and

through

its

all its

symptoms. In other cases,

after passing

different stages, intermittent fevers of various

De humoribus.

Sect. 2d. Vol.

FIRST CAMPAIGN IN SPAIN.

types ensue. I have
paroxysms suspended

several times

the colick,

231

remarked

that these

which returned during

the intermission.

The

duration of this colick

is

severed

in nine or ten

days

It

seldom

if it

be per

irregular.

withstands a well-directed plan of treatment,

but the sudden impression

of cold, or the least irregularity of regimen causes a re

lapse which

may be

reiterated twice, thrice, or

four

times. After the second or third relapse, the patient

much

debilitated,

and

falls

pochondria, or nostalg'a.

remain

ticular,

stiff

and

nusis of this disease

sick suffer

into a state of

The

iimbs, and the legs in par

The

feeble for a long time.

prog^

generally favourable, although the

is

much, and are slowly convalescent unless the

:

disease be complicated with a febrile affection, but

patients die with

I shall

is

marasmus, hy-

now

few

it.

proceed with

my

inquiry into the true

causes of this disease.

produced by metallick substances, as the physi.

Madrid believe ? It will be easy to show that such

Is it

cians of

causes cannot be concerned in the production of a disease,

presenting, at least

inflammation which

ter's colick, or in that

1st.

The

third stage,

in

no symptoms

commonly observed

ot

in the pain

caused by corrosive substances.

solid or liquid aliment that

was not prepared

sils for

its

till

is

our soldiers used

copper or glazed vessels: their uten

cooking were made entirely of

tin.

The glazed

earthen vessels in which they sometimes kept their drink,

could not be acted on, as

activity
to

contained no acid, and the

and changes of a military

remain

furthest.

it

did not permit

it

more than twenty-four hours

at

Besides, the soldiers generally put a quantity

ol'

in these vessels

life

water in the wine and vinegar which they use while at

their meals.

They kept

their drink in tin cans,

ly used pitchers, except to carry water.

and rare-

MEMOIRS, &C.

232

From

the experiments that I have

made

the degree of decomposition produced

to ascertain

by applying

rent acids on the glazing of these pitchers, I

am

diffe-

led to

drink lemonade or oxirat which

has been kept in them for a considerable time, without

may

believe that persons

drank intentionally of these

Huids after they had been in glazed pitchers, and experienced no unpleasant symptoms ; and I then gave them
to a number of dogs, and they were not affected in the

much

inconvenience.

This proves that the portion of the oxide of

lead, which is separated from this glazing is very small.
least degree.

who

arc well aware

wash these pitch
ers with vinegar before using them, or boil in them this or
some other acid fluid and the sellers of this ware always

The common people

of Madrid,

of the dangerous effects of this metal,

recommend
used. Yet,

by

that this precaution be taken before they are

it is

possible that the colick

this metallick

the

symptoms

when

but

this

be produced
is

the case,

from those that characterize the co-

Madrid. Again, the generals, the superiour

lick of

and many

cers,

substance

differ

may

other people in the army, I

am

offi-

certain,

never used these glazed vessels, and they were as obnoxious to the disease as the soldiers,

and suffered in a great

er proportion, although provided with every convenience.

Finally,

why

is

this colick

same glazed ware

the

is

confined to Madrid,

used

in

when

almost every part of

Spain? The French physicians, who, as well as myself,

lived for a long time, at different seasons of the year, in

the cities of Burgos, Miranda, and Vittoria, never saw

this species of colick in these places.

2d ly.

I satisfied

kitchen -apparatus of
of

all

ing

classes, that

all

myself by an examination of the

many

owing to

of the inhabitants of

Madrid

the prudent custom of cover-

their copper vessels with tin,

no injury need be

apprehended from verdigris, or oxid of copper.

FIRST CAMPAIGN IN SPAIN.

France

3dly. In

merchants,

mix

who

it

is

233

no uncommon thing

by a

are actuated

spirit

for wine-

of cupidity, to

foreign ingredients with their wines (as litharge* or

oxide of lead) to sweeten and give them a more agreeable taste: but in Spain, or at least in Madrid, the mer-

chants have no need to resort to the same expedients, as

wines are much milder than those of Fiance, and

their

become acid. Mr. Laubert, the apothecary general of the army, analyzed several kinds of
wine purchased indiscriminately at several of the inns of
do not so

easily

Madrid, and he could detect no metallick substances in

them, but he obtained a considerable quantity of narcosubstances in

tick

made from some of

extracts

these

wines.

To

a cat of about three months old,

we

gave about a

scruple of this narcotick extract in a piece of meat, and

the

same quantity

few hours

The former

to a large dog.

in a lethargick state,

died in a

and the dog continued in

a profound sleep for twenty four hours. Several unfortunate circumstances that followed the immediate use of

wine, induced

this

An

us to extend our inquiries further.

account of these cases shall form the subject of ano-

ther memoir.

The wine

does not take up metallick sub-

stances from the vessels in

which

it

is

kept, and

it is

generally carried in leather bags that cannot impart to

any unwholesome

quality

yet

it

may

still

colick. Finally,

can the chocolate, which

in this country,

and

duce

who

it

much used

is

prepared in vessels of copper, pro-

this disease? I think not: for

able to procure
drid

is

it

predispose to

our soldiers were not

and besides, the inhabitants of Ma-

continually use

it

would be injured

but on the

contrary, they consider chocolate as a wholesome

arti-

and experience confirms their opinion. It was

then necessary for us to ascertain whether the chocolate
could take up the verdigris, or oxide of copper from the
cle of diet,

Vol.

i*

Gg

MEMOIRS, &C.

234-

vessels

m which

it

was

preparer?,

and the examination of

these vessels and experiment proved that

It

now remained

for us to inquire

water of Madrid contained

were supposed

to

could not.

it

whether the potable

ing through the leaden tubes that convey

fountains.

It

was

These

tallick substances

be taken up by the water white passalso suspected that the

or aguadores carried

The former

it

it

from

the

water porters,

about in copper vessels badly

ras assured that the conduits

was easily refuted, for I

were nearly all made of

few of lead

Could the water of Ma-

tinned.

bri^k, and but very

drid (which

supposition

very well

is

known

to

be

soft

and limpid)

dissolve the lead while passing through these conduit's?

It

On

cannot.

particles

the contrary,

which

it

deposits the few earthy

it

holds in solution, on the sides of these

tubes, and thus forms a lamellated covering

ternal surface, as I

duct the water

at Paris.

Thus

from Arcueil
the water

m contact with the lead.

produced coTick,
cities

where

is

to the

is

suburb

Again,

if

St.

Germain,

the water of aqueducts

would

prevail in

all

used in their construction.

spects the copper vessels, although they

tinned, they cannot impart

copper to the water, because

them

their in

soon prevented from coming

this disease

lead

on

have often seen in the pipes that con-

so short a time,

may be

great

As

re-

badly

any portion of the oxide of

it is permitted to remain in

and the

sides of these vessels arc

covered with an earthy or calcareous deposition,

that on the sides of the leaden aqueduct. Besides,

like

many

of th~ aguadores carry water in casks, or in gray pitchers

that are not glazed.

The

foregoing facts

and

inquiries prove incontestibly

that Hie disease called" colickof

Madrid," which attacked

oi" soldiers, does not necessarily

ftPtalli

obnoxious

depend on the action of

ohstances, and that the inhabitants are less

to

it

only because they are seasoned to the

cli

FIRST CAMPAIGN IK SPAIN.

235

mate. Moreover, the coHck produced by these substan

ces

easily distinguished

is

from the endemick colk-k of

Madrid, which I have called

bilious or

rheumaticky

bears a great resemblance to the rachialgia

and symptoms.
the

In the colick that

is

it

cause

in its

caused by metals,

symptoms of irritation being rapidly followed by those

The

of inflammation, are by no means equivocal.

commences

in the region of the stomach,

is

intermission, gradually extends towards the pelvis,

the umbilicus

is

The

forcibly retracted.

first

times an obstinate constipation, but

The

Jong.

an4

vomit are more frequent, and do not

efforts to

is

discharged

is

cially

is

and

if

the patient be aban-

to the unassisted resources of nature,

when

The

sanguineous.

not so painful to the touch, but becomes in-

flated before the third day,

doned

Madrid: the pulse

febrile, there is a suppression of urine, or the

small quantity that

abd imen

some-

is

does not continue

it

relieve the patient, as in the colick of

becomes

There

and

effects of

the pain in this disease are, vomiting, diarrhoea,

tenesmus, which take place together.

pain

acute without

more

espe-

a considerable quantity of metallick substan-

ces have been swallowed, the inflammation continues to

advance, and runs

When

with great
cous

course in a longer or shorter time.

its

the disease

mild, resolution

is

difficulty

if

membrane of the

it

be

may

be effected

violent, portions of the

intestines are disorganized

poison, and thrown off and discharged

by

stool.

mu-

by the
It

the

inflammation be very acute, and the poison active, a general death of the animal
table.

and organick system

is

inevi-

In the colick of Madrid, the progress and termina-

tion of the disease

is

quite (iifferent.

The

characteristick

signs of the latter* are, the approximation, contraction,

* Doctor Libron, who experienced a most severe attack

of the Madrid colick, gives a correct account of the symp-

236
and pain of the abdominal walls: obstinate, and longcontinued constipation, a hardening of the foeces, and
their formation into scybala (a

symptom

that sometimes

takes place in the painters' colick, but continues for a

short time only) a natural state of the pulse, yellowness

of the countenance, eyes, and tongue, with an intermission in the pains of the colick,

and progress of the

dis-

ease. I have observed that these pains increase during

the cool weather of the night, and moderate during the

sick have none of these tremours,
paralysis of the superiour extreand
convulsive motions,

The

heat of the day.

mities that take place in the saturnine colick.

two diseases may attack

same time, and advance together
e one may be complicated with the other. This was
<bably the case formerly at Madrid, when metallick
Still

it

is

possible that these

he same person

at the

tances were more common causes of disease.*

While I remained in Madrid, I saw but two cases of
sn ': a complication of disease, and the colick was of
,

>rt
'

duration, f
lis

disease

^ind and

which

may

then be considered as endemick in

environs, and throughout the plain on

this capital stands,

far as the

and

its

and

to the north north -w-st, as

mountains of Guaolarrama and

to the east

and south

as far as the

Summa

Sierra,

Tagus, and

to the

this disease in his inaugural thesis. He contends

also that it does not depend on a metallick cause. See collection of theses, 1809.

toms of

The art

imperfect

of manufacturing earthen

ware was then in ap

state.

There were two of our hospital overseers who suddendrank about a litre of strong lemonade, prepared the preceding evening in a new glazed earthen vessel. They had
f

ly

attended to the sick, during a cold night, without being

dressed as usual, and I am of opinion the cold was the principal cause of their disease.

23?

FIRST CAMPAIGN IN SPAIN.

At

distance of seven or eight leagues in other directions.

Aranjuez,

it is

scarcely

known;

say they have never seen

peared

but

it

it ;

at

Toledo the physicians

at Alkala

it

has seldom ap

appears in the country between Madrid

and Aranda, by the way of Buy trago, no doubt, because

this route

is

so highly elevated

among

the mountains.

I divide the causes of this disease into predisposing,

and exciting or

essential.

The former
weaken

immediately on

act

the organs of digestion, and

or irritate

them

such are unwholesome drinks and aliment, that injure

both by their quality or quantity. For, delicate persons,
such as are of a bilious temperament,
rich

and

oily articles of diet, or

into a state of putrefaction, are

disease.

The

flesh of the veal

disposed to putrefy during the

tery fruits are also

who make

use of

meats that speedily

most obnoxious

and lamb

summer

unwholesome; these

is

fall

to this

particularly

season.

The wasoon un

articles

dergo an acid or putrid fermentation in the stomach, and

of necessity disturb the functions of this organ

cous
that

membrane
is

is

mu

its

disordered by the presence of the gas

generated, and by the gastrick, pancreatiek, and

bilious iluids.

The

small intestines are irritated, and be-

come contracted by spasm, an

antiperistaltick motion

takes place in them: this irritation

is

propagated by sym

pathy to the hepatick apparatus, which

increased quantity of
their usual channels

bile.

by

The

now

supplies

fluids are diverted

this inverted peristaltick

an

from

motion

they are accumulated in these intestines, and poured into

the stomach,

whence they are

in addition to the foregoing, a

the muscular
tines,

it is

assist in

ejected

new

by vomiting.

If,

exciting cause act on

and nervous coats of the stomach and

intcs

clear that these effects must be increased,

and

may be
transition from a warm

cheeking cutaneous transpiration, which

completely destroyed by a sudden

to a cold atmosphere.

The

heterogeneous constituents

9!'

memoirs, &c:

238
this transpiration

(in

being translated to the internal organs,

a manner that I cannot exactly define,) attack the

moving

fibre of the

stomach, intestines, and abdominal

parietes in particular.

also to be produced
spiration,

and

by a repercussion of cutaneous tran-

acts in a similar

Finally, this irritation

wh

le

nervous system

arm

is

ol

manner.

extended to and disturbs the

animal

by the communica-

life,

between the nerves of the eighth

tion that exists

tnis province of the

that the

principle appears

The rheumatick

body:

to prove

this also goes

stomach partakes of animal

Do

life.

pair,

not her

bivorous animals ruminate at pleasure, and have there

men who

not been

These

also possessed this faculty?

principles being laid

down, we

be able to

shall

follow the progress, and point out the causes of the disease with

more

certainty.

When these effects, which may

be considered as the predisposing, have been produced,

the patient feels an anxiety
slight but painful

and weight

at

the stomach, a

compression in that part of the abdo-

men, below the umbilicus, attended with acrid and

bitter

eructations.

AH

the Spanish

wines being sweet and mild, are

still

and give out a quantity of

susceptible of fermentation,

carbonick acid gas that disturbs the intestinal canal.

For when they are taken pure, and

in large

quantities,

they are seldom well digested, and particularly

Many

son be unaccustomed to their use.*

as I have remarked, produce the

taken in the quantity that

rope

because the

other excretions

is

loss

is

same

usual

in

if

other

effects,

the perai

tides

even when

other parts of Eu-

of the body by transpiration and

greater

in

Spain, and the stomach

thus debilitated and rendered unable to perform

* Cider produces the same effects, especially

during the first warm weather of the spring.

its

is

func-

when used

FIRST CAMPAIGN IN SPAIN.

239

due degree of vigour; hence indigestion and

lions with a

concomitants follow.

My

experience has taught

me

its

that

a small quantity of food and wine should be taken in hot

the rich sweet wines in particular should be
used with caution. In such climates also immoderate ve-

climates

nery

is

aware
tal

to

be particularly avoided. Physiologists are well

that inordinate irritation or excitation of the geni-

system produces a sympathetick disorder of the

sto

mach.

The

peninsula of Spain being separated from the con-

by the Pyrenees, and washed on the remainder of

circumference by two seas, rises gradually from its

tinent
its

base

shape of an irregular flattened

to its centre, in the

cone, on the summit of which

that

situated the capital, so

is

you gradually ascend to it from either side. The sumis the most elevated part of the penin

mit of this plain

sula, if

we

except Sierra Guadarrama, of which I shall

speak hereafter. According

tions that

to the

barometrical observa-

have been made and repeated by

me

with the

Spanish barometer, Madrid stands at an elevation of

and two
At Madrid, duringthe

four hundred toises above the level of the sea,

hundred above the

first fifteen

level of Paris.

very dry and serene days

in the

beginning of

July, the mercury in the barometer never rose above 27

or 28 degrees

at least I

never could perceive a greater

variation during several weeks.

This elevation prevents

the atmosphere from being impregnated with moisture

and vapours from the two

seas, while the

mountains

the vicinity of the sea, and in the neighbourhood of

drid, arrest the vapours, so that

summer

in

New

Castille.

it

From

seldom rains

the city of

Madrid you

it is

east south-east side of a

The Mon^anares,

river that rises in

hill.

thc-

on the summit and

enjoy an extensive prospect:

built

in

a small

the mountains of (Guadarrama, runs

the base of the promontory on

its

in

Ma-

at

north, south, and east

MEMOIRS, &C.

24-0

About

six or seven leagues

Sierra

Guadarrama and

tos mountains,

from the

Summa

with

generally covered

New

mountains separate Old and

city

you may see

Carpen-

Sierra, or the

Castille.

These

snow.

They bound

the horizon of the city of Madrid, and appear like an

extensive curve on the east, north, and south, at a

tance of seven leagues.

ground on which
atre,

it

The

stands,

dis-

city, from the nature of the

is

arranged like an amphithe-

and intersected by large irregular

The

streets.

houses are built of brick or granite, four or five stories

in height

in fresco,

their interiour

and the

is

floors of

of white plaster, or painted

brick or marble to increase

their coolness ;-these floors, during the winter, are co-

vered with Persian carpets, which are removed in the

spring.

The

sides of the streets are

granite,

and

their

Every publick place

nite.

The

city has

gardens
its

paved with slabs of

middle with silex or fragments of grais

ornamented with a

fountain.

an arid appearance, because there are no

in its interiour,

and

saw but three gardens

in

vicinity the Buono Retiro, and the botanick garden

on the south -cast, and the Casa del

The

west.
into

it,

we

soil

here

is

thin

Campo on

the south-

and sandy, and on digging

find thick strata of silex

running in different

directions.

From

this short topographical

description,

supposed that the heat at Madrid

is

the vernal and autumnal equinoxes.

(he 40th degree of north latitude,
vicinity, or in the

or retain moisture

it

might be

excessive between

The

city is about

and has no

trees in

surrounding country, to afford

:

add to

this that the

it

its

shade

granite and

sili

and increase the in

Yet the north winds that usually

eious soil reflect the rays of the sun,

tensity of the heat.

blow, moderate the heat, and render

mercury
of

May

it

tolerable.

The

Reaumur's thermometer, during the months

and June, from ten a. m. to twelve o'clock, bein

FIRST CAMPAIGN IN 8PAIN.

241

Iween the 23d and 25th degree, and during the month of
July, between the 25th and 30th degree, in a gradual
manner. When exposed to the light of the sun, the same
thermometer rose, during the

latter month to 35 and 40

two former months, the mercury fell during the night and until six o'clock in the morning, as low
as 15, 14, 13, 12, and 11 degrees. About the beginning

degrees. In the

of July it never fell below 18 degrees, though the cool

winds suddenly sprung up, as is usual at that season.
About the end of July and beginning of August, the
mercury rose to 31 degrees, and upwards.

When

our army, on

its

return during the

summer, was

crossing the arid and scorching Carpentos mountains, the

mercury

my thermometer always rose in the shade, at'

in

noon, to 32 and 33 degrees.

tressed

by

From

Our troops were much

dis-

this heat.

these thermometrical observations, the diffe-

rence between the temperature of the day and night

may

be perceived. This difference of temperature also obtains

in India,

and

which from
tion,

in several other countries of the

their position

have a climate similar

to that of

day the whole animal economy

the

pillary

new world,

and natural topographical

is

Madrid.*

situa-

During

relaxed, and the ca-

system of the skin in particular

a dilatation of

the exhalant pores takes place, with a partial fusion of

the adipose substance, the copious perspiration thrown
out

is

speedily evaporated or absorbed by the dry air,

which passes over and cools the whole surface of the

body.

The

brium with

heat of the
that of

its

body

is

surface,

thus reduced to an equili-

and the

internal are di-

* It appears that a colick, bearing a strong analogy to

that of Madrid, prevails in these southern countries, and
particularly in Surinam, during the spring. See the account of Capt. Stedman, Vol. I.

Vol.

it.

Hb

MEMOIRS, &C

242

minished in proportion

to the increase of

cretions: the organs are thus fatigued,

The liver in par

noxious to the action of morbid causes.

ticular,

being powerfully stimulated by a superabundant

afflux of adipose fluid,

must furnish an unusual and

proportionate quantity of bile,

unimpaired. If in
the

the external bd-

and rendered ob

if it

retain

this state of rarefaction

whole body be exposed

its

vital

and

to a current of cold

very sensible, must certainly be acted on

tion to

sensibility

its

power

dilatation,

dry

or in cool apartments during the night, the skin,

is

dis-

in

air,

which

propor-

and the intensity of the cause, the

pores are closed and contract, the capillary system under-

goes an extensive and confirmed constriction, and a species of metastasis or reflux of the perspirable

matter and

returning fluids of the vascular system ensues: and these

heterogeneous principles
cited,

change

eolick

is

its

fall

sensibility,

on some part previously ex

and produce

disease.

The

thus produced after the stomach and intestines

have been debilitated by intemperance, passions of the

mind, bad food and wine, external rheumatism or febrile
dysenferick affections, &c.

of the disease

commence,

Then

the legitimate

symptoms

sucri as pains in the affected

organs, &c. If the intestines be

its

seat, the inverted pc-

motion that ensues seems to carry the pain from

the umbilicus up towards the cardia and oesophagus. Voristaltick

miting soon ensues, with anxiety, constipation, delirium,

tears,

and

sighs.

The

patient

alarmed , and expects to

1

is

die. This shows that this disease attacks the nervous

tem of animal life in a particular manner.

sys-

If this first appearance of disorder be not removed-,

the disease advances, nervous shocks (if I may be
al

lowed
the

to

use the expression) are communicated through

of the eighth pair, and extend to the limbs

medium

hence rigidity and muscular spasms follow, the large

intestines are retracted, and their contents formed
in sevba-

FIRST CAMPAIGN IN SPAIN.

243

which are forced towards the transverse colon and

Ja,

the coecum.
stinate

The

The

and a

constipation

and

The

thus rendered

principal functions of organick

most unimpaired,
tion

is

redundant

life

in the prima? viae, because

secretion

it is

its

bile is

not evacuated

of urine continues to go on, but

assumes a deep yellow colour,

consequence of

al-

the pulse remains in a natural state

becomes emaciated very slowly, the

"by stool: the

this fluid

continue

viz. the secretions, the general nutri-

circulation

patient

more ob-

particular form given to the feces.

remora

for the bile, in

in the small intestines, is ab-

sorbed, and carried to the kidneys by the blood-vessels

By the same process, I doubt not, the

whole surface of the body is tinged with a yellow co-

or lymphatick*.

lour; but

if

beyond

the disease continue long

period, organick

life

will be affected.

its

usual

Paroxysms of an

intermittent, putrid, nervous, or malignant fever then

succeed.
disease,

The malignant
and the

combination with

During the

fever

is

a rare attendant on this

bilious remittent fever seldom occurs in

it.

first

months of our stay

in

Madrid, the co-

was much more frequent and acute than about the

end of June and month of July, because our soldiers
were encamped under bad tents, that neither protected
them from the heat of the day, or coolness of the night.
They were also so imprudent as to bathe in the Mancalick

nares immediately after going through their exercise.

Among the

troops quartered in the city,

many cases

of coliek, because they

we had

a great

were under arms

all

night without cloaks, and suffered from the action of the

cold air.* They also used the wines of Spain immoderately,

and they are known

The

Spaniard.,

to

be particularly injurious to

the French costume, and

were also attacked with the coliek.

who adopted

laid aside their cloaks,

MEMOIRS, &C.

2^4

who are

and they paid

them for the preservation of their health, and to put them on their guard
against sudden changes of temperature from warm to
those

no

not seasoned to the climate

attention to the instructions given

When

cold.

frequent,

dent

these deviations of temperature

and our

spirits,

soldiers abstained

we had

were

less

from wine and

The

but few cases of colick.

ar-

nights

of the 10th, 11th, 12th, 13th, 14th, 15th, and 16th of July

were cooler than

usual, in consequence of the preva-

wind in this month. This wind

blew with considerable violence during the night, and a
great number of our soldiers and our invalids, whose
wounds had nearly healed, were attacked at the same
time by the colick, from being exposed without colence of the north-east

vering, while asleep, to the action of these cold winds.

I

might here report several unfortunate cases,

were not known

to

all

our physicians and to

Spanish gentlemen of the

faculty.

am

if

many

they

of the

led to conclude,

that the spring, or rather the first season, (for the climate

of Upper Spain should be divided in two seasons only, the

summer and

winter)

is

most favourable

the period

to the

production of the colick, which attacks new comers in preference to those

who

are seasoned to the climate.

people and adults are more obnoxious to

advanced

in

it

Young

than those

age, and persons of a dry and bilious

more

than those of a sanguineous and phlegmatick tempera-

ment:

males more than females, and especially such as

are debilitated and convalescent. Persons

wore

in a full state of suppuration,

whose wounds
were seldom attacked

by it, while few escaped this dreadful disease if they

were exposed to its causes just as their wounds were
healing.

The

injury that the nerves of animal

and the pain which continued to

more

debilitated the intellectual

affect

life

sustained,

them, more and

powers, and

left

stiff-

FIRST CAMPAIGN IN SPAIN.

ncss in the organs of loco-motion.

convalescence
if

was

sons,

still

speedily re-establishing the health of such per-

send them to a more mild and moist climate,

is to

where

this account, the

and slow, more especially,

in the same climate. The best

painful

the sick continued

means of

On

the temperature

Having made

is

more

equable.

ourselves acquainted with the true causes

of this disease, and attentively followed

shall

SJ4>

find no difficulty in

may

present themselves in

first

attacks,

we

its

progress,

we

meeting the indications that

its

different stages.

When

it

should endeavour to allay the irritation

of the stomach and

its

dependencies, to re-establish

and the alvine evacuations. Diaphoretick,

antispasmodick, and anodyne drinks should now be
transpiration,

used.

Camphorated enemata of

cassia, theriacal

and an-

tispasmodick draughts at night, bolusses of camphor, and

musk, camphorated
regimen,

rest,

oily

embrocations over the abdomen;

and a moderate degree of heat and mois-

which may be produced by evaporating water in

the patient's apartment, are the means calculated to fulfil
the first indication. Thus have I often arrested the dis
ture,

ease in

its

forming

state.

In the second stage of the disease, the vomiting continues with

its

concomitant symptoms.

When a bilious plethora exists, emeticks should be used

without fear, and for

this

purpose a proper combination

of ipecacuanha and antimoniated

tartrite of

potash may-

be used, and repeated according to circumstances. This

preparation possesses a double advantage. It remove?
the

mucous and

bilious contents of the prima; viae,

produces a change in the

irritability

and

and

sensibility ol

the stomach and small intestines, and gradually re-esta

blishes their peristal tick motion.

vomited

When

the patient ha

sufficiently, the alvine discharges are to be en

oouraged by

bitter diaphoretick

antimoniated drinks,.

MEMOIRS, &C

14J6

and by camphorated enemata, without omitting the us

of the opiates and antispasmodicks at night. If notwithstanding the continued use of the above means, the vo

miting should continue, the tincture of opium should be

added

camphorated

to the

oily

embrocations

to

which

should be gradually substituted camphorated ticture of

cantharides, and bolusses of camphor, opium, and

given

musk

at night.

Finally, the alvine evacuations are established,

third stage of the disease
injections are

still

to be continued, as well as the opiate

The

patient should be

bitter catharticks, united

with an infusion of

draughts and the same drinks.

purged with

and the

commences. The camphorated

bark.

Sometimes
this case

this

colick assumes a chronick form. In

a vesicatory on the abdomen changes the seat

When

of irritation, and removes the disease.

by

followed

paroxysms of an intermittent kind, the bark

vantageously used in conjunction

with

bitters.

is

ad-

When

complicated with other diseases, the remedies should be

varied according to circumstances.

Venisection, mercurial
rious formulas; carbonated

frictions, or

mercury

hydrogen, and the

in its va-

warm

bath

and narcoticks,

which are recommended by the Spanish

physicians, and

by them used in the commencement

by no means proper. Venisection

this disease, are

highly dangerous in
the debility in which
their falling into
sides, in
it.

warm
it

of
is

climates, in consequence of

leaves the sick, and the danger of

an adynamick state after

such countries there

is

its

use.

Be-

no inflammation to require

Mercurial frictions produce insomnia and cephalalgia.

Warm bathing increases

the bilious diathesis, and

ens the patients: they feel a temporary

continue in the bath, but

acts

more

forcibly

when

relief,

they leave

on the skin which

is

it,

weak

while they
the cool air

softened and ex

FIRST CAMPAIGN IN SPAIN.

jfiaiidcd,and irritates

cfanum,

body

when

to a greater degree.

it

Opium

or Ian

given too early, renders the organs of the

and disposes

torpid,

24*

Evaand diaphoreticks, have

proved highly advantageous, and we have found them al-

combined with

cuants,

ways

efficacious,

at a proper time.
in

to indirect inflammation.

bitters

when exhibited in a proper manner and

They were successful among our men

every case.

The grand duke

of

Berg was cured of a most

ing colick by these means.

soldiers of

same

every

Many
description who
from

disease, recovered

When

distress-

general officers and

laboured under the

their use.

paroxysms of colick have entirely disappeared, and there remains no bilious saburra, the patient
should be put on the use of bark, in conjunction with

common

the

bitters or

good

claret.

They may be taken

in the

morning on an empty stomach. They give tone to this

viscus, and prevent the intermittent fever that generally
follows the colick.
Finally, if the convalescence
tracted, the only

means

from

this disease

be pro-

of re-establishing the health will

be to go into another climate, and to use mineral waters,

such as those of Bareges or Bagneres.

ed

plan to

this

many

persons

who

We recommend

languished in Spain

without a prospect of recovery.

In order to guard against this disease, and several others

that are

common

to

warm

climates, persons should not

arrive in these countries at the season

prevail

the temperature of the

night.

when these diseases

when

they should select those periods of the year

day

is

nearly equal to that of the

This equality of temperature

is

greater

during the autumn, or from the end of

middle of winter. While

at

in

Spain,

summer

to the

Madrid, great care should be

taken to avoid exposure to the cool

air

of the night

MEMOIRS, &C.

248

While
the skin

transpiration,
is

from

fear

kept up in
its

and the natural discharge from

you have nothing to

this climate,

endem'uk diseases; the emunctories are

competent to furnish these cutaneous excretions with advantage, and thus to prevent disease. Chronick issues

and old

gleets secured

a great

many

of our soldiers

and the inhabitants of Egypt from the plague that prevailed in that country, and also from the small pox and
miliary fever. Respectable travellers have also informed

me
in

that similar drains have prevented the yellow fever

America and Spain.

The
ly

pores of the skin should be kept open

washing with soap and water, and the

tion to cleanliness.

night

air,

They who

by

frequent-

strictest atten

are obliged to be in the

should be provided with

warm

dresses

cloaks

may

or large capes are well suited to this intention: they

be thrown open during the day to admit the air, and pro
tect the

wearer from the sun, and

at night

ford an effectual protection against cold.

of the Greek and

proper

in

Roman

they will af

Hence

cloaks or mantles

is

the use

rendered

Spain, and in other countries where

it is still

retained.
It is injurious to health to

bathe in the rivers of this

country near their sources, because the water

is

too cold,

checks transpiration, and produces a particular sensation

in the skin,
tions.

changes

its irritability

and impairs

its

func

Venereal pleasures should be enjoyed with the

greatest moderation, both on account of the climate, and

may be latent or unknown

symptoms of syphilis, which in a cold or temperate climate would not remain dormant.
Animal food should be used very sparingly, with but

the probability that there

little

pure Spanish wine. Pulse, and light articles of

should constitute the principal part of the diet

diet,

spiritu-

ous liquors should be avoided altogether, and coffee taken

FIRST CAMPAIGN IN SPAIN.

as soon as possible after dinner.

iced lemonade
gestion

is

far

few

glasses of ice ot

taken in the evening

advanced, or completed. It

them

able to take

The

may be

fasting, or too

soldiers should

249

make

when

di-

not advise-

is

soon after dinner.

their

soup and eat farinace-

ous vegetables, such as potatoes, carrots, or chick-peas,

which

are very

common

They

in Spain.

should never

drink pure wine. Condiments with their food, in modelrate quantities, will prove beneficial

such as the canella,

pimento, garlick and onions, which are wholesome in

Warm

climates.

The

fruits

of Spain, except the grape,

are generally bad, and almost always disturb the organs

of digestion.

The most pleasant and wholesome

can take

is

drink that a soldier

a mixture of vinegar and water

the posca of the

Romans lemonade
:

is

;this was

equally proper.

Finally, he should pay the strictest attention to keeping

up

the transpiration,

by protecting himself with a good

cloak during the night, by taking care never to

moist earth, and by taking moderate exercise.

Vol.

ii

lie

on the

MEMOIRS, &C.

250

MEMOIR
ON A PARTICULAR MALIGNANT FEVER

*&K*KrKyKXK&/V

WHILE we

rehiained in Spain, our

much from

chased in the inns of the

fact

might have

men

suffered

the use of adulterated wines pur-

As

city.

the publication of this

army, and

excited distrust in the

inter-

fered with the security of the inhabitants of Madrid,

without explaining

my motives

count Belliard, I requested

him

to the

go vernour- general

to issue

an order, forbid-

ding the soldiers, under pain of punishment, from entering the taverns, or the porters of the hospitals from

al-

lowing wine to pass through their gates, without an

express order from the chief health-officers.
tribution of

plied

the dis

good Wine, with which our stores were sup-

from particular

and proved

As

cellars,

was

regularly continued,

sufficient for the soldiers, this

order was,

in a

short time, followed by the best results.

Before I proceed to speak of the extraordinary disease

produced by the wine, which I have called the soporose

ataxia, I

may

observe that at Madrid, as well as in

large cities, wine

is

adulterated

but as I have already said in

the wines of Spain contain

by

alt

different processes

my memoir

on the colick,

much of a gweet gummy

sub-

FIRST CAMPAIGN IN SPAIN.

stance,

and are not

using litharge, as

is

easily turned sour;

done

251

and instead of

France, they add the water

in

of different narcotick substances of a stimulating nature,

in order that each kind of wine may possess its natural
strength and taste. I never could acquire a knowledge

of

all

I have been so informed

The

know

the substances thus used, but I

mento and the lauro-cerasus

among

that pi-

the

number, and

by Spaniards of

credibility .

are

inhabitants of Spain are accustomed to these kinds

of wine, and are seldom disordered by their use

besides,

they drink them mixed with water, and, while smoking

their cigars, they
lates the

swallow the tobacco smoke

stomach and the

charged. But our

who

used them were

use.

The

who

ill,

same time
veyed

much

these wines pure,

and

disordered; almost

all

and some even died from

their

were

four

who

fusileers of the guards,

stimu-

and promotes

victims to this cause,

fell

it

the flu'ds are soon dis-

men who drank

without precaution, were

first

intestinal tube,

by which

the alvine evacuations,

died so suddenly about the

in their quarters, that

they could not be con-

Indeed, Dr. Cain, the surgeon of

to the hospital.

the corps,

was

According

to his report, before death they laboured un-

called but a short time before they died.

symptoms which

commonly produced by
symptoms were also observed by me in other soldiers who were afterwards sent
to the hospitals with the same disease. The first who
was admitted was an artillerist, who fell down in a state
der

all

the

are

the narcotick poisons. Similar

of insensibility as he entered his quarters, after having

drank about half a

stantly

litre

conveyed to the

mediately.

On

and lethargy;

immoveable, and dim;

tion laborious

where

the 14th of June he

state of insensibility

and

was insaw him im-

of wine at an inn; he
hospital,

his

jaws

still

his

remained

in

eyes were open,

fixed, lips blue, respira-

slightly sonorous, pulse nearly natural.

MEMOIRS, &C.

252

and extremities cold the sphincters of the bladder an<J

rectum were relaxed, and his limbs flexible, although in
;

a state of paralysis.
I

first

him

directed

to

be

and cupped over the

scarified

hypochondriack regions, and ordered the whole surface

of his body to be washed with a solution of alkali

cool-

ing antimoniated and ethereated drinks, acidulated with

sulphurick acid, to be administered; stimulating enemata

were

also used.

These means produced no

dition :

on the contrary,

sensible

change

in his con-

twelve

after the expiration of

hours deglutition ceased, and his teeth were obstinately

closed. I stopped his nostrils to separate his jaws, but

he was immediately seized with violent convulsions;

eyes rolled in their orbits, his face
piration irregular

was

his

discoloured, res-

and hurried, and the pulse excited and

convulsive. It would have been dangerous to try this ex-

periment longer, and

ordered that

when

his drinks

catories to his

it

ebony lever

should not be rehis

jaws

were given; I applied two large

vesi-

peated. I used a small

arms and

legs,

open

to

and continued the mucilagi

pous, ethereated, and acidulated drinks, and the stimu

lating enemata.

He

remained in

this condition until

the pulse seemed to recover; his eyes

next day, when

were opened and

closed occasionally, and sometimes followed

of the surrounding objects ; his respiration

trie

was

motion

less labo-

and the involuntary discharges ceased: his limbs

performed a degree of motion, and he gradually reco-

rious,

vered the use of his external senses and

intellectual

fa-

culties.

The
tress;

first

words he spoke were

and he

still felt

in every part of his body, with

tjf

the head,

indicative of his dis-

a disagreeable and painful

stiffness

an insupportable weight

and continual vertigo.

FIRST CAMPAIGN IN SPAIN.

The

skin of his face

accelerated
colour.

was

258

quite discoloured, his pulse

and very small, and

The same means had

tongue of a blueish

his

still

been continued to

this

time.

The sudden

restoration of the functions of animal

had produced a

was

state of

life

apparent improvement: but

it

soon followed by a great prostration of the powers

of internal or organick

life:

the pulse

became vermicular,

the respiration laborious: convulsive palpitations com-

menced about

the precordia, his tongue appeared of a

black colour, his teeth were covered with sordes,and the

skin and extremities
urine that

was

became cold. The small quantity of

was retained in the bladder, in

secreted

consequence of a paralysis of this organ.

The foeces were also retained in the intestines

domen was tumefied, and the patient seemed to

state of great anxiety

the ab-

be

in

and danger. I immediately order-

ed the best loxa bark in generous ethereated wine to

be given him, and embrocations of camphorated vinegar to be

made over

the whole surface of the body, to be

followed by a similar application of camphorated tine

turc of cantharides. Vesicatories

the hypochondria
septick

were

also applied

and thighs, and stimulating and

enemata administered.

Opiate and

draughts were also given internally.

On

on

anti-

ethereal

16th of

the

June, the prostration was extreme, the pulse almost im-

warmth and sensibility of the skin

The vesicatories had produced no
effect: his respiration was hurried and laborious, and the
abdomen tense and sonorous, when struck, as in tympanites. Though the functions of animal life were much
perceptible, and the
entirely destroyed.

debilitated, they

stiil

continued to be performed until the

night of the 17th of June,

On
faction

when

he expired.

the following evening I opened his body.

had commenced:

the

whole body was

Putre-

inflated:

MEMOIRS, &C.

'251

the face tumefied,

more

especially about the eye- lids, the

tongue thick and brown, the membranes and vessels of

the brain filled with black coagulated blood, while

its

medullary substance was of a firm consistence, and gray

colour.

The

lungs

blood and

brown

were discoloured, collapsed and

air.

The

frothy humour.

pericardium

The

from

free

trachea contained a small quantity of

There was but

little

four cavities of the heart

serum

in the

were

filled

with lymphatick concretions of a citron colour, which

were covered on
agul ted blood

their exteriour with a layer of black co-

the pedicles of these concretions extend-

ed into the trunks of the arteries and large veins.

I ob-

served no signs of inflammation about the heart and

the

teries:

abdomen was

the interstices

inflated,

and the gas that

ar-

filled

between the viscera and the abdominal

parietes, escaped through the first incision.

was decayed, and

The

of a yellow colour: the liver

epiploon

filled

with

black blood, the spleen small, and the stomach and intes-

with gas. The stomach also contained some

The mucous membrane of the intestines was of a

tines filled
fluid.

dark gray, or yellow colour; besides

this, there

was nq

other sign of inflammation.

The

foregoing case, with

kind, occurred
institute

among our

many

soldiers,

others of a similar

and induced me

to

proper inquiries and experiments, to discover

their causes.

I directed several bottles

of wine to be

brought from the different inns, and requested Mr.

Lam

bcrt, our apothecary general, to analyze them. In the extracts of these wines, after they

had been evaporated, he

found a large quantity of a narcotick substance.

made

scruple,

The

this

he

a cat of about four or five months old swallow a

cat

and the same quantity was given

died

to a large dog.

a few hours afterwards in a lethargick

FIRST CAMPAIGN IN SPAIN.

and the dog continued

state,

On

ty-four hours.

in a

255

profound sleep for twen

opening the body of the

cat, the

same

appearances were discovered as above noticed in the bo

dy of the

To

soldier.

we made

complete our experiments,

spaniel swallow half a

a full-grown

drachm of monk's-hood, (aconitum

in a chamber. He became

Napellus) and shut him up

drowsy

in

a few minutes

gnashed his

cried,

after,

wakened with

teeth, tossed himself about,

tacked with convulsions, and

fell

surprize,

was

at

into a lethargick sleep

by subsultus of the extremities:

next morning we found him dead and rigid, his limbs
extended, his jaws firmly closed, and his abdomen in-

frequently

interrupted

flated.

On

opening the body of this animal,

sels of the brain injected

The

substance of the brain

er consistence than natural.

dark gray colour,

ties

free

of the heart were

concrete

state.

Of

was
The

found the ves

coloured, and of a firm

lungs collapsed, and of a

from blood or

filled

we

with black coagulated blood.

air.

The

left

cavi

with black blood, almost

this the right cavities

in

contained but

were distended, and of a greenish

red colour externally. The mucous membrane of the
stomach was friable, of a brown colour, and fell off in la-

The

little.

mellae.

urine,

intestines

The

bladder was

which emitted a

few days

filled

foetid

after this,

with brown-coloured

odour.

a soldier of the guard

brought to the hospital with the

was

same symptoms, name-

a suspension of the functions of animal life, while

organick life, although impaired, still performed its func-

ly,

tions.

All the means which had been used in the case of the
artillerist

were now resorted

to without success. I

imme

MEMOIRS, &C.

256

opened one of the jugular veins, and procured

the discharge of a small quantity of coagulated black
diately

The symptoms

blood.

of soporose ataxia continued to in-

and he died on the second day after entering the

hospital, and thirty six hours after having taken the wine

crease,

with one of his comrades at an inn.

The advanced
the

body of

this

which

state of putrefaction in

man

we

found

four hours after his death, toge-

ther with the excessive heat of the weather, deterred us

from opening him.

A third was

brought from his quarters twelve hours

symptoms.

after the appearance of similar

He

lay in a

profound stupour, with cold limbs, locked jaws, regular

small pulse, and free respiration.
alvine,

He

had involuntary

and urinary discharges. After remaining twelve

or fifteen hours in this state, convulsions took place,

with

febrile

symptoms.

The abdomen

enlarged, and

black spots soon appeared in the lumbar and dorsal re-

The functions

gions.

of animal

life

were suspended, and

he died within forty eight hours. Putrefaction was not so

and

rapid as in the foregoing case,

we

The same appearances were observed

A grenadier was
the

brought

same symptoms,

sleep

in

opened the body.

as in the first case*

to the hospital

but his abdomen was not inflated.

ately used acidulated

frictions

with nearly

a state of stupour and profound

We immedi-

and ethereal drinks, dry

and applied a

great

number of cups

to the

abdomen,

rax, and posteriour part of the neck: sinapisms

plied to the feet:

we were

alkaline"

over the whole surface ot the body, scarified

and stimulating

injections administered:

in this case so successful as to re-establish

functions of animal

life,

but in proportion as these

restored, those of organick

life

tho-

were ap-

sensibly declined.

the

were

A fever

FIRST CAMPAIGN IN SPAIN.

gradually

came

became

on, respiration

senterick flux ensued, and he

pains in the
distress

abdomen and

seemed

felt

umbilical region.

him

general

him, he frequently

uttered plaintive cries, and shed tears.

felt

laborious, a dy-

very unpleasant dull

to take possession of

questions that were put to

257

Yet he answered

he informed us that he

himself intoxicated, after drinking but a half bottle of

wine

at an inn.

To

added the

the acidulated drinks, I

use of camphor and ethereated loxa bark, with direcVesicatories were

abdomen was embrocated

tions to increase the dose gradually.

applied to his legs, and his

with hot camphorated vinegar.

By these means, and the most sedulous attention,
grenadier was restored to

life.

But

this

his convalescence

was tedious, and his legs and hands remained a long time
weak and tremulous.

One

of our chasseurs,

who had been

severely wound-

whom had
an arm amputated and were recovering^ died from the
above disease, after having drunk some wine that one of
ed

in the shoulder,

and a

sub-officer, both of

the overseers of the hospital bought for

them

All the means that were used were

opening their bodies,

we

came

who had

inflated to

an

an inn.

On

observed nearly the same ap-

pearances as in the preceding cases.

chasseur,

at

insufficient.

The abdomen

of the

taken most liberally of the wine, be-

uncommon

degree, and black spots

of various sizes appeared on different parts of his body as

soon as he died.

My

favourite pupil, Augustus Frizac, died of a simi-

lar disease, but in

his case

was occasioned by a dose

it

of opium which he took to procure sleep, and to relieve the

mental inquietude

for the loss of

comrades.

Vol.

it.

K%

some of

his

MfcMoms, &c.

258

The

state of torpour in

the rigours, coldness of

which

stomach was

his

left,

the extremities, and anguish

that he experienced, induced

him

to

swallow two or

three small glasses of brandy, purchased at the nearest

inn; with this different narcotick substances had been

Instead of re-

custom in Egypt.

distilled, as is also the

lieving him, this increased the severity of the disease.

The

functions of animal

those of organick

life

life

were soon destroyed, but

continued for fifteen hours.

The

profound lethargy in which I found him, was accompa

symptoms that I have just described

saw him two hours after he had taken the bran
dy, I was led to suspect the previous existence of a sopo
nied with the

When

rose fever, the consequence of a narcotick poison.

found great

mal

life

in a partial

attention

aware of

We

difficulty in resuscitating the faculties of ani

upon him

manner, though

we
r

lavished every

that his case required.

his danger,

and anticipated a

He was

fatal

result.

well

He

expired in the third paroxysm of acute fever, which

returned during the day. In his case, the ethereated bark
in large doses,

with vesicatories to the extremities, and

every requisite means were used.

I shall be pardoned for paying a just tribute to the

memory of this uncommon young man. Perhaps the memorial of his excellence and virtues may encourage

How

others to imitate him.

three years

combined

so

few of the age of twenty

talent with every endow

much

ment that could render him useful and amiable Nature

had given him a most finished exteriour. He was con!

versant in most ancient and

modern languages. His ex

knowledge of physick and naturaT history had already acquired for him the title of adjunct professour in

tensive

the school of Toulouse,

and of corresponding member

ot

academy of Madrid. His attention to the sick

was incessant, and to them his purse was always open.

the royal

FIRST CAMPAIGN IN SPAIN.

259

His uncommon modesty and gentleness of character

rendered him particularly dear to his acquaintance.

With

hesitation do I

advance an opinion as to the

dus operandi of the causes of thfe disease: but

it

appears

evident that they act directly on the nerves of animal

and change
gen of

their galvanick tluid:

the blood, and

at liberty, cause
brain and

its

by

dependencies

The

me

this

powers of general

life

An

immediate

organ takes place, and

are extinguished.

absorption of the poisonous principles of narco-

tick substances,

to

A direct affection of the

the result.

is

suspension of the functions of

finally, the

life,

they absorb the oxy-

setting the carbon of this fluid

to coagulate.

it

mo

when thrown

to take place in

two

it

modes. First through

membranes

the arteries of the internal

whence

into the stomach, appears

different

of this viscus,

passes rapidly through the sanguiferous sys-

tem, and, secondly, through the nervous extremities of

the par vagum, or pneumo-gastrick nerves, which con-

vey

it

I coincide in opinion

directly to the brain.

with

academy of Turin, who has

a manuscript memoir, that the nerves are the

professour Rossi, of the

shown

in

conductors of

all

which are highly

admitted,

lows the

we

deleterious
volatile.*

cannot

bite of a

certain reptiles

tell

mad

or poisonous principles,
If this explanation

why

be not

death so suddenly

fol-

animal, or the deep sting of

and vipers of

warm

climates.

We know

also that sudden death has often been produced in perwho, while in good health, had absorbed pestilen

sons

produced rabies canina, by introducing a portion

crural, or popliteal nerve of a mad cat inposteriour
of the
dog. This porto an incision made in the neck of a healthy
warm was intro
tion of nerve was dissected out, and while
duced into the neck of the dog. Bulletin of the medical
*

He

society.

No. 35, 1810.

MEMOIRS, &C.

260

miasmata, or mephitis. This opinion I have long entertained, and from my observations while in Egypt,

tial

where I saw a great number while sick with the plague,

and after death, I am induced to agree with Pinel and
various authors, that tl# glandular system
fected, but that this disease acted on,

was not

and was

af-

chiefly

seated in the nervous system.*

In whatever manner narcoticks, which generally contain a volatile, acrid styptick principle of a peculiar smell,

do

and subsequently

act, they first destroy animal,

ganick

They

life.

first

or-

disturb the functions of the for-

mer, producing vertigo, tremours, pandiculation, convulsive motions, excess of joy or despair, painful contractions about the epigastrick

and hypochondriack regions,

anxiety, and irregular rigours of the extremities in particular, and often of the whole body. To these succeed
torpour, loss of perception, paralysis of the limbs and or-

gans of sense and lethargy.

If the dose of poison be

powerful, the person dies in this condition, and without

any remarkable change

When the poison

is

in the

parts of organick Ufe.

not very active,

if

by the exhibition

of proper antidotes, the dormant powers of animal

be resuscitated and the organs of internal

life

life

be stimu-

lated while labouring under the irritation of the poison,

a fever is the consequence. The febrile paroxysms thus

produced by stimulating and changing the condition of
the nerves, vary in degree and violence,

and are some

times followed by adynamia, or internal gangrene.

It is

very

difficult to

destructive substances.

by

counteract the effects of these

Acids have been recommended

authors, but were insufficient

detailed, except in

the

last.

in the cases alrready

The

sulphurick acid

was

giyen in an appropriate vehicle, as were also alkaline

*

See

my memoir on the plague,

Vol. J

FIRST CAMPAIGN IN SPAIN-

261

drinks and emeticks, while the most powerful topical

stimulants

were applied

externally.

Experiments should be

on living animals, to

instituted

discover the best means of counteracting the effects of

These

narcotick poisons.

cians the necessity of

a country previously

fatal cases

making such

unknown

may

inquiries

teach physi

on entering

to them, as are connected

with the preservation of heaith, and of such

in particular

as are not seasoned to the climate.

I regret that

was

not sooner advised of the use of the

water of supersaturated muriate of soda, recommended

by the celebrated Humboldt,

to counteract the effects of

the curare, which the savages of the

new

continent use

means should be

to poison their arrows. This

tried

when

persons have swallowed narcotick poisons.

Since

my

ral of the

return to Paris, I have observed that seve-

guards

under

considered as convalescents

partial paralysis of the

and loco-motion.

dumb,
I

who were

mild attacks of the soporose ataxia,

after

On

still

laboured

organs of vision, speech,

examining two of these who were

away.

I found the tongue withered

have always believed that the refined loyalty of the

Spaniards could never permit them to poison their wines

with the intention of destroying the French. Besides, the

the natives of Spain drink these same wines.
jards

did not encourage

among
is

syphilitiek

our troops, as 1 had at

a great

number

of these

first

supposed. That there

women

in Spain, is to

tributed to the miserable police of the cities.

rality

of those

norant of
this

than

its

who

true character,

and

it

I have

is

at

less inveterate in

been consulted by a

great

number of persons of both sexes

ease,

and I

The

be

The gene

are affected with this disease are ig-

in cold countries.

am

The Span
to come

women

relative to this dis

certain they had no correct opinion of

it.

best informed persons in this country believe that

MEMOIRS, &C.

262

this disease is generally hereditary,

vailed

among

them.

ginally derived

of treatment

It

and had always pre-

appears that the Spaniards

ori.

from the Arabs. It yields to the plan

it

common

in

France, but mercurial frictions

should be used with great caution.

With

the exception of the unfortunate cases just enu-

merated, the various diseases that occurred in our hospital

during the space of three months, were treated with

uncommon

This success, I think, may' in a great

success.

measure be referred
neral report sent

by

to the use of excellent bark.

me

to

" Sir

ge-

marshal Bessieres confirms

I shall insert an extract from

this.

The

Since the hospital of the

my

correspondence.

guards has been esta

blished in the great city hotel at Madrid, to the first of

July inclusive, six hundred sick persons,

were

also

some of

the household of the

among whom
emperour

and,

prince, have been admitted; of these but ten have died,

viz.

Three of different corps, with acute soporose

The

fourth, a grenadier,

tered the hospital

wound. The

fifth

ataxia.

was in a dying state as he enhis heart was found injured by a sabrewas stabbed in several places through

abdomen with a knife, and his viscera were wounded.

The sixth was wounded by a shot in the abdomen, which
injured the spinal marrow. The seventh of a complicated
the

malignant dysentery.

The

eighth,

my

pupil

with the soporose ataxia; and two others

wounded The

assistance of art

unavailing in these cases.

and the greatest care was

Two-thirds of these six hun-

dred laboured under acute internal diseases.

quite recovered, or are convalescent.

wounds

Mr. Frizac,
who were

The

They have
healing of

is retarded by caries, with loss of

them had undergone critical operations. I amputated the arm of young Barre, of Castlenaudary, Upper Garronne, at the shoulder joint. This

fsome of the
substance.

Many

of

FIRST CAMPAIGN IN SPAIN.

was rendered necessary by

operation

263

the traumatick

gangrene which had seized on the whole limb.

cond,

who was wounded

abdomen, with

in the

A se-

lesion of

of the stomach and escape of the epiploon, Was also cured,

with a third,

who was wounded

in the pelvis,

with an in

jury of the bladder and rectum, &c. &c. &c/'

remarked

mixed

that the loxa bark,

in

generous

wine, with the liquor of Hoffman, produced wonderful

effects in

when given

simple intermittents,

in

half dram

Four or five of these doses were generally suffiAn emetick of ipecac, and ant. tart, potash in due

doses.
cient.

proportions

was

generally premised. This treatment in

stantly arrested the progress of alarming intermittent fe

vers, of

species of

the

we

which

had many

cases.

We also used

this

bark and opium mith remarkable success in

adynamick

fever. I

began with half a dram, and

In-

creased the dose according to the actiteness of the disease.

This mode of exhibiting

ble to

any

The

it

appeared to be prefera-

other.

was preferable to the loxa in bilious

mucous gastrick fevers, given in decocand other bitters, such as the serpentaria

calisaya bark

intermittent, or
tion with ether,

virginiana, and chamomile.

The

red, or loxa bark,

gangrenous

affections,

was used with

when

gDod wine and sulphurick or aeetick

These three species of bark which
in

abundance

great success in

given in small doses, witfe

ether.

we

fortunately found

in the royal stores are the best.

It is to

be

were well supplied with them",

for no article can be substituted for them in these diV
eases. Mr. Vauquelin has analyzed and given us an ac

wished that our druggists

count of their constituent parts.

The grand duke of Berg was convalescent from a se

vere eolick, when he wa? attacked by an alarming inter

"264

MEMOIRS,

mittent fever.

We prevented

&-C.

consequences by the im-

its

mediate exbibition of the loxa bark, and he was soon able

to set out for France,

where he intended

mineral waters of Bareges.

general duke of Rovigo.

of the emperoUr,

made

He was

his entrance into

Madrid about

command

of the armies

bull-fight

was ordered and

exhibited to

celebrate his accession to the throne of Spain.

bulls

were

We

sacrificed

on

warm

Finally, king Joseph, brother

the end of July, and took the

in person.

to use the

succeeded by the

Fifteen

this occasion.

were indulging ourselves

in

the expectation of

completing the entire conquest of Spain,

when we

re-

ceived information of the surrender of Dupont's division

to the

enemy, of the insurrection of several provinces,

and the sudden march of a great number of the insurgents towards Madrid. In haste

and

we prepared

to retreat,

was effected on the night of the 31st July. Bewant of the means of transporting our sick, and

this

ing in

being also uncertain whether

ry supplies

we

should find the necessa-

them on the route between Madrid and

Burgos, wc were obliged to leave a part of our sick of
for

the line in the hospital of

Madrid but took care to secure to them every assistance that was necessary.
All the wounded of the guards were transported to
:

Burgos, and thence

to Vittoria, in the

to our ambulances.

We

left five

carriages attached

who were

not able to

bear the fatigue of the journey under the care of

Honnaud, one of our physicians.

Dr

At Burgos we met
series, to

the victorious army of marshal Bes

which the guards were then united, and pursu

ant to the orders of his excellency, I r mained

with
them. Our passage over the mountains of

Snmma

ra

was attended with

Sier-

great suffering, from the excessive

FIRST CAMPAIGN IN 9PAIN.

265

heat of the weather, and the various privations that

we

endured.

The king established his head quarters at Miranda,

and our army encamped on the right l>ank of the Ebro.

The

corps of marshal Bessieres, which formed the rear

guard, took a position between the fort of Ponte-Corvo

and Brievesca, where we halted some time. During this
period of leisure I was occupied in arranging the following
observations on the climate, soil,&c. of the

two

Castilles.

(Spain proper.)

known, forms the extreme southern

part of the European continent, and as I before observed,
terminates in a peninsula which is intersected by several
Spain,

it is

well

chains of mountains, of different degrees of elevation,

producing remarkable variations in the climate.

Along

the course of the mountains which extend from Ponte-

Corvo, on the right bank of the Ebro,

to the shores of the

two

summer

seas, the temperature d iring the

very elevated.

season

At Madrid, Reaumer's thermometer

is

rises

from 25 to 31 and 32 degrees, though the heat is by no

means insupportable. The air is rendered temperate by
the north winds which generally prevail in Old and
Now Castille. These winds, by passing over the snow
which remains a long time on the summits of the mountains, are so

reduced in temperature, that you cannot

stand in the shade while they blow, without feeling chil-

For the same reason, the winds are intensely cold

in the winter. The air of these two provinces is dry and
piercing, owing to their elevation. There is seldom a fall

ness.

of rain;

when it takes

place,

it-is

generally attended with

a storm.

The

soil

principally

Vol.

of this country rests on a

formed of vegetable

ii.

silicious rock,

exuviae.

and is

MEMOIRS, &C.

266

The

houses of all the towns and villages are built near-

ly in the
bel<

same

and have but one chimney, which

style,

Around

ngs to the kitchen.

men

collect

the fire of this the wo-

during the winter, without distinction of rank

or age.

The chambers

warmed

are

basins (brazeros)

in

winter by large copper

with coal made of green oak

filled

(siiex qucrcus) these are kindled before they are brought

into the room.

The

influence of climate

prevent the

Castillians

growth, which
country,

who

and unwholesome customs,

from

attaining that physical

we observe among

of the Castilles are seldom

inches in height

the inhabitants of this

The men

near the borders of Spain.

live

more than

The women

five feet

one or two

are generally very small

m more than four feet two or three inches in height

The constitution of both sexes is dry and vigorous.
The complection of the inhabitants generally, and of
those of the country in particular, is brown. The Castil
Iians are generally well-made and muscular. The woseld

men
feet,

are of an agreeable shape, and have fine hands and

Their mein

commanding and

is

noble, their eyes

black and sparkling, with an appearance of fierceness.

Their eye brows are also black and well arched,

their

noses aquiline, with expanded nostrils, the mouth small,

and the

lips

moderately thick ; their teeth are generally

inelegant. In both sexes the

spherical form,

cranium

is

and considerably arched

The physiognomy

of the

Castillians

very large, of a

at the vertex.

is

forbidding;

when under the influence of

alarming. They are quick and

they are very irascible, and

passion their aspect
petulant,

is

and transported

slightest occasion

to

an excess of passion on the

with the most extravagant

they cherish the most exalted

spirit

self love,

of independence.

FIRST CAMPAIGN IN SPAIN.

Th<w are

267

fond of quiet and repose, and sacrifice

many

advantages to obtain them. They bear adversity with

re-

signation.

In our second campaign

these Spaniards

who had

we saw

a great number of

passed the most rigorous pe-

riod of the winter in the mountains, and supported themselves

bread.

on a few cakes of chocolate and pieces of toasted

It is true that chocolate prepared with Water

forms at

times the principal part of the nourishment

all

of these people.

of bread

They

still less

generally eat but

but they

make much

meat, and

little

use of the chich-

pea (garvancas.)
Intoxication

is

rare

among them. During

they always stay near the brazertis, in

kept up day and night

The women

ry seldom absent from these stoves.

the winter,

which a

fire is

in particular are ve-

Though

there

is al-

ways a current of air in their rooms, owing to the imperfect workmanship of the doors and windows, yet they
breathe a portion of the carbonick gas discharged from
the stoves while the carbon is in a state of combustion.
I consider this as the principal cause of the scorbutick
affection

of the gums, and habitual tooth ache, of which

the Castillians, and particularly the fair sex complain.

On the other

hand, the purity of the atmosphere, the dry-

ness and warmth of the climate, by stimulating the pulmonary and capillary system, imparts vigour to the ani-

mal functions, and increases the calorick of

Hence among

the blood.

the females the catamenia appear at a ve-

ry early age.

The
years.

people of Castille seldom live beyond seventy

As

respects their moral character, they entertain

generous,
the most elevated sentiments of honour, are
intelligent,

humane,

be

flattered.

self-love

hospitable,

and even

polite, if their

MEMOIRS, &C.

268

The Spaniards
ticular, are

juJg

ent

in geneial,

and the Oartiflians in par-

endowed by nature with strong minds, sound

and uncommon aptitude n the acquisition of

the sciences and mechanick aits.

nion of their origin, and

selves

superiour to

the

They have

a high opi-

respect consider

in this

people

of othe

thf

m-

nations; but

these sentiments give them a national character, antl inspire

them with a iove of country, and with courage and

unde privation.

fortitude

I fully believe that

when

this

nation shall be completely treed trom the superstitious inst

lotions

and customs

and repressed

among
I

their

that

good

have hitherto led them astray

qualities, they

may

be ranked

the most respectable nations in the world

still

shudder while

I think of the atrocious tribunals

of the inquisition established in the principal cities ot this

country.

While going

campaign, I

visited

to Valladolid,

during the second

the subterraneous dungeons of one

of the most celebrated inquisitorial tribunals of Spain,

its numerous condemnawas seized with an involuntary
hall where the judges sit, and the

and read the black catalogue of

tions with horrour.

dread on entering the

room

that contains the instruments used

ordinary question

is

proposed.

the apparatus of 'his tribunal.

while he conducted

me

me

the extra-

also deposited

The grand

inquisitor,

through the gloomy vaults, gave

every information that

The army

when

Here are

I desired.

of the insurgents approached our lines, and

directed their

march on two

principal points, viz. Sara-

gossa and Bilbao, with the intention of advancing on

one side

toward;-. Catalonia,

Biscay, to cut
kin<?

from
to

marched

Mad

jff

to

id to

and on the other towards

our eoriimunicatit n with France.

The

meet a corps of the enemy which came

reinforce the garrison of Saragossa,

form a camp under

its walls.

He

and

sent orders to mar-

FIRST CAMPAIGN IN SPAIN.

shal Bessieres to join
Har.j.
far as

him

269

at the royal head quarters at

We

marched along the left bank of the Ebro

Logrono, and pushed on a reconnoitring party
Calahorrha without meeting the enemy,

far as

retired

as
as

who had

under the walls of Saragossa.

We made a retrograde movement, and took a position

on our former

Miranda.

line at

Oar

troops being again

menaced at Bilbao, we were obliged to march thither in all

haste, to drive out the enemy who had already taken possession of the fort; but he made no resistance. We re
turned to our former position, after leaving a garrison in

Head

this place.

were removed

quarters

to Vittoria. I

attended to the organization of the flying ambulances,

which were without many

tance. I ordered a

articles of the first

number of mules

to

impor-

be purchased, and

furnished with bats to carry dressings, surgical instru-

ments, and drugs, whenever the divisions might require

them.
tains

nient

The

and

small cars of Biscay, used to cross the

moun-

to pass through their defiles, afforded a conve-

mode

of transportation.

The contending armies remained

near each other

without evincing a wish on either side to come to an en-

gagement

but

we made

preparations to

siege of Saragossa, and

The enemy

fortified

commence

to open a second

himself in this city, and had ta-

ken advantageous positions on the road

to

Madrid, and

had thrown up redoubts and made intrenchments

defiles of the

At

this

the

campaign.

in the

mountains.

time the emperour was announced, and he ar

rived at Vittoria about the

first

of October, to which

place the guards and several military divisions had pre-

ceded him from Paris.

To

inspector general Percy,

arrived at the same time, I resigned

tor,

and resumed

my

former post

my

who

place of inspec-

in the imperial

guard

MEMOIRS, &C

270

I gave a detailed account of

this

campaign,

to

well satisfied with

my

my

operations &c. during

who

king Joseph,

expressed himself

conduct, and at the same time I

reported to the minister the measures I had adopted to

improve the

The
lessly

staff

of the hospitals and ambulances.

marshal, duke of Montebello, while riding care

with the emperour, was overturned, together with

on Mount Dragon, a rough mountain covered

his horse

with frozen snow. His horse

his

attempting to

rise, fell

on

thorax and abdomen, and injured him considerably.

On
ses

in

arriving at Vittoria, he
:

his

abdomen was

was covered with ecchymoand tender, he laboured

inflated

under acute pain of the bowels,

difficulty of respiration,

and suspension of voluntary motion. His pulse was small

and tense,

his face pale

and discoloured,

voice feeble, and extremities cold.

The

his

eyes heavy,

slightest touch of

abdomen produced acute pain and oppression. Every symptom proclaimed an incipient inflammation of the
the

internal organs.

Vencesection and tonick resolvent embrocations would

have proved

insufficient,

and experience had taught

me

that they are not adequate to arrest the disease that generally follows severe

organs.

contusions and concussion of these

made by the
Vigilante, who were

I recollected the surprising cure

Esquimaux on

the sailors of the

dashed with their boat against the rocks on the coast of

Newfoundland

a practice that I have since tried suc-

cessfully in several similar cases.

I resolved to

wrap the body of the marshal

of a large sheep, taken

animal was

still

warm

from

its

in the skin

back, while the

alive.*

* In order to deprive the animal of sensibility, it was

stunned by a blow on the neck, and two expert butchers
immediately flayed it.

FIRST CAMPAIGN IN SPAIN.

271

While the butchers were flaying the animal, I prepa

red and applied a very
rated

warm

of chamomile over

oil

all

embrocation of campho
the surface of the duke's

body, and immediately afterwards enveloped him

in the

reeking sheep skin, which was still covered with a copious

serous
its

fluid. I

adapted

Warm

edges.

it

flannels

tremities. I desired

him

and confined

closely to his body,

were then applied on

ex

his

to take freely of light tea, toge-

ther with lemon juice and sugar.

The marshal was immediately

relieved, but he coin

plained of a painful pricking, and the attraction that the

sheep skin seemed to exert on his body where they were

But these

in contact.

effects

were soon over, and he

fell

asleep in ten minutes, and remained so for two hours.

When

he awoke I removed his animal cloak, wiped

cloth,

body with a warm

and applied an embrocation of

warm camphorated

down

brandy. I applied some compresses dipped

on the

off

his

the sweat which trickled

parts

in this fluid

most severely injured prescribed cooling mu;

cilaginous drinks, ethereated milk of sweet almonds,

emollient camphorated enemata

At

and

eight o'elock next

morning, the swelling of his abdomen had subsided, and

was

painful, his pulse

less

was more

functions restored. His urine which at

pressed,

was

natural,

first

and

his

had been sup-

thick and bloody.

After premising several cups on the parts affected

ecchymosis, I had him put into a

warm

bath. This

v\ ith

was

repeated with aromatick embrocations: the same medicines

were continued with

able to set

suitable

out on horseback the

The whole army

variations,
fifth

and he was

day.

took up their line of march, and ad

vanced towards Burgos, where was the advanced guard

of the insurgents.

272

MEMOIRS, &C.

SECOND CAMPAIGN
IN SPAIN

fTlHE

advanced guard of the French army had an ob

stinate contest with the Spanish army, encamped

-*-

near Burgos, which terminated in their discomfiture.

The

field of battle

was covered with the dead and dying

wounded Spaniards and
in number about seventy.
Surgeon

We collected all the

Spaniards.

French together,

major Rousel, of the 4th

light infantry,

with the

cernment

that extensive experience begets,

on

wounded

all

battle.
to,

the

We

that required amputation, during the

dressed

all

and conveyed them

care at the

dis-

had operated

same time,

those

who had

not been attended

to the hospitals of

to separate the

Burgos, taking

Spaniards from the

French.

A few days after

way

this,

we

set out for

Madrid by

the

of Buytrago. I followed the advanced guard under

general Savary,

which was composed of the

the guard, and a part of

Lasalles*

flying artillery,

fusileers of

and general

division of light cavalry.

When we arrived
at the

its

at Boussequillas, a village situated

entrance of the defiles of

Summa

Sierra,

we

re-

ceived information that a corps of six thousand troops

was intrenched on

the heights of Spulveda,

and thai a

SECOND CAMPAIGN IN SPAIN.

more numerous corps occupied
tains. It

was judged

273

the defiles of the

advisable, first to attack their

moun-

camp

at

Spulveda, but here the wished-for success did not attend

us, though the enemy struck his tents and took to flight.

We had but thirty wounded

them onthe
and thence

spot and had

to

in this affair.

Burgos.

In the mean time, our army entered the

mountains, and met with no obstacle
the intrenchments of the

Summa

I dressed

them conveyed to Boussequillas,

Sierra

enemy

but then the

defiles of the

until

it

arrived at

before the village of

difficulties

appeared to be

insumountable. This rugged, narrow road, on the declivity of a mountain,

and the

sides of the

was defended by masked

batteries,

mountains on either hand of the defiles

covered with troops and cannon, and there was no

chance of turning on the rear of these formidable positions,

without losing

fatigue. Just at this

much time and undergoing much

time a heavy fog arose.

The emperour gave

the

word, and the

light horse of

the guard charged impetuously on the intrenchments

which commanded the road through a shower of bullets,

balls, and fragments of old iron: cleared the ditches, gained the redoubts, cutting

in pieces or putting to flight all

made themselves masters of the defile.

was bought by the blood of many in the

before them, and

But

this victory

foremost ranks. This

the

most

affair

brilliant that

wounded were

may be

considered as one of

occurred during the war.

instantly dressed

The

and operated on near

the rough road that winds round the mountain.

carriages of our ambulance then conveyed

The

them

to

Buytrago, and thence to Santo- Martino, near Madrid.

The Spanish forces who escaped our swords dispersed

among the mountains, and we arrived at Madrid without further molestation. But the inhabitants of this city

Vol.

h.

Mm

memoirs, &c.

j;a

gates, and. determined to dispute our et

had closed the

trance.

They made
held out for

and

several discharges of artillery at us,

two days but

;

at the close of the siege, a brisk

cannonade of several hours, and the possession of Buono

Retiro, which

commands

the city, induced

them

to ac

cept the proposed capitulation.

We very soon received information of the arrival

of an

English army in the province of Zamora, and that they

We

had pushed on

their

advanced guard

prepared for a

new

expedition, and orders were issued

be in readiness

to

march

appeared highly necessary

glish

on the route

to

to Valladolid.

word of command.

at the

to cut off the retreat

of the

It

En

Corunna, the nearest and most con

venient sea port for their embarkation.

we left Madrid on the 22d

marched towards the mountains of
Guadarrama, and crossed them on the 23d and 24th of
With

this

view, doubtless,

of December.

this

We

month. I observed that the mercury

meter

fell

in the

thermo-

nine degrees below zero at the foot of these

mountains.

The wind blew

rable quantity of

days.

directly

snow had

from the north.

fallen

A conside-

during the preceding

As we ascended the mountain,

the cold,

which was

already piercing, increased gradually and perceptibly, so

men and horses losing their equilibrium, fell in the

road, and many of them were misled on the steep decli
that

vities

Some

by

the thick whirlwinds of hoar-frost

and snow.

of them remained near the road, unable to

from the

effects

of the cold.

The

flying artillery

rise,

and

cavalry were obliged to stop about the middle of the

mountain on a

level that presented itself.

To have climb

n$ the other half of the Gaudarrama would have been im

SECOND CAMPAIGN IN

Wc

posBjbld.*

when

were obliged

wait

to

'2?'5

SPAIN.
till

the next day,

the temperature rose several degrees. In this emit was difficult to procure wood, and
were kindled, they were more injurious than
to the soldiers. For all who subjected their hands

barrassing situation,

when

fires

useful

or feet to the

warmth

of the

fire,

were suddenly

with gangrene from congelation, to a greater or

gangrene appeared

tent.

But

who

avoided the

this

lance, having

One

fire.

had

his right

in

affected
less

ex-

no case among those

of the soldiers of our ambu-

hand

affected with the cold

as he climbed the mountain, suddenly approached the

fire

of a bivouac, and chafed his hand near

manner,

ly swelled in a surprizing

When

into a hot oven.

hours

after, his

he rejoined

hand was

obliged to amputate

it

It instant-

it.

like

dough when put

his

ambulance some
and I was

entirely sphacelated,

at the joint

of the wrist. This fact

supports the opinion which I advanced relative to gan^

grene from congelation.

The

passage of these mountains

never suffered so

much from

ing these heights,

we

appeared to be very

On
with

to

difficult.

entered an immense plain, which

fertile.

the second day of our march, a sleet, attended

rain,

succeeded the rigorous cold.

With

wh

difficulty

we

pass-

Riosecco and Benevento by a Gross route.

The

we marched
ed

was very

cold and fatigue. After pass-

on

to

continued rains,

Medina

Campo,

and the boggy

our carriages stuck

difficult,

del

fast,

soil in

nee

which a part of

rendered our march

still

more

and when we halted we could procure neither

straw for the soldiers to

lie

on, nor

wood

to

dry their

clothes.

* See the fine picture of barcm Lejeune representing the

passage of this mountain.

MEMOIRS,

276

We arrived at Benevento a
army had

&C
day too

late

the English

just passed over the river near this city,

burned the bridge. Our advanced guard crossed

and

it

by

and soon attacked the rear guard of the English.

contest took place, and though our troops

fording,

A sanguinary
were

numbers, they rendered themselves

inferiour in

of battle, and of a part of the ene-

masters of the

field

my's baggage.

The corps

of marshal Soult obliged the

remainder of the rear guard

manner

to

to retreat in a precipitate

Corunna.

They who were wounded in the battle of Benevento,

to the number of seventy, were dressed by the surgeons
of the corps on the field of battle. Next morning I had
them

collected in a hospital of the city, devoted exclu-

sively to the guard.

Almost

all

the

wounds made by the

The

sabre were extensive and deep

surgeons had

tempted to unite them by the twisted suture, such as

is

with a view of preventing the retraction

used in hare

lip,

of the parts.

The

advantageously

at-

uniting bandage might have been used

in these cases, as

an auxiliary to the

6uture.

But

I did not think proper to

remove the dressings

here before the third day, because they were applied by

skilful

surgeons.

At

tion of three days,

wounds

the

first

we were

dressing, after the expirain

hopes of finding

all

cicatrized, in consequence of the re-union

suture; but in this

we were

disappointed.

The

the

by

needles

being without the support of the uniting bandage, had

produced a
the face,

local irritation of the thin

and

delicate skin of

and inflammation and rupture of the parts

through which the sutures passed were the consequence,

new

re-union of the

wounds was made by

the inter

rupted suture, with the addition of a bandage applied ac

cording to

art.

SECOND CAMPAIGN
In performing
the lips of the

anew

this operation

wound

277

IN SPAIN.
I

intended to bring

exact apposition, and to retain

in

them

so by means of the uniting bandage, which alone

can control the muscular power of the parts and overcome
their resistance.

With wounds
which other

The

my expectations.

surpassed

result

of the face I shall report several cases in

parts of the

body were

injured,

and some

remarkable appearances ensued.

Among

the latter

was a

had several sabre wounds

The skin, the

face of the

captain of

mamelukes who

head and

in his

left

arm.

olecranon, a part of the articulating sur

humerus, the contiguous ligaments, and some

branches of the recurrents were divided. Though the

wound was

severe, I had hopes of preserving the arm. I

did not wish to unite the parts

by the

first

intention, for

experience had taught me, that an exact union in wounds

of the articulations

is

more

injurious than useful, in con

sequence of the pressure that the uniting bandages pro

duce

in the part irregularly divided or torn.

follows with

its

train of

symptoms, and

its

Inflammation
consequences

are with difficulty prevented. Cataplasms, as I have ob

served in
tion

my

campaign

in

Egypt, increase the obstrue

and tumefaction of the

wine

is

parts.

Warm

camphorated

the best topical application that can be used.

The captain was often in

wound was under my care
:

a critical

but

ving the arm, which also retained

Ibrahim, one of

his

state

succeeded
its

while

his

in preset-

principal motions

mamelukes, was wounded by

pistol bullet,

which penetrated the knee-joint, and crushed

therotula. I

removed nearly

fragments of this bone,

and

all

the loose

the

and detached

wound was

simply

dressed he also had some alarming symptoms, but they

yielded to the treatment I recommended, and he reeo
;

vered entirely.

MEMOIRS, &C.

278

Gabriel Sauvages, a chasseur,

was

not so fortunate.

He

received a sabre-wound similar to the captain's, in

the

left

elbow, which divided the articulating portions

The surgeon had brought

deeply and extensively.

wound into

lips of the

the most exact apposition

the

inflam-

mation supervened, and, before the expiration of twentyfour hours, gangrene

waiting until
tate the

was

Without

the consequence.

should be defined, I resolved to ampu-

it

This operation was attended with the

arm.

wished-for success, and he

left

the hospital on the fortieth

day perfectly cured.

On

we

dissecting the arm,

found

much

disorder in the

which must have caused not only the

of the limb, but endangered the life of the patient.
articulations,

Whenever

ginglymoid articulation

wounding

extensively injured by a

loss

opened, and

is

cause, the

wound

should be examined with the greatest care, in order to de

cide whether

it

the limb, for

be not advisable (as

by omitting

I think) to

the operation,

we

amputate

expose the

patient to certain danger.

The danger

of these

wounds does not exclusively de-

pend on the admission of the external

the

wound

of the joint

would prove as
but this

is

is

air.

when the wound is

The symptoms that follow

injurious as

not the case.

not then be attributed to

that

large;

should

cause alone, but to the ex

this

tensive injury of the ligaments, the synovial

and the aponeuroses

when

If so,

small, the contact of the air

membrane,

surround the articulations.

It is

probable that this injury affects the nerves of nutritive

that run through these parts

which receive

their vitality

tem appropriated
fected

to the

from the nerves of the

sj's-

nourishment of the body, are

by sympathy, and hence

affections, local

gangrene with

life

thus the internal organs

result

its

adynamia,

af-

febrile

contagious effects, and

SECOND CAMPAIGN

death of the patient.

finally, the

number of
difficult to

270

IN SPAIN.

have cured a great

wounds of the articulations, but it is

manage such as we have just now described,
slight

and a prognosis

in

such cases

is

very

difficult.

Gardcl, a chasseur, had the inferiour half of

and the two corresponding portions of

upper

lip

his

his nose,

cheeks and

two maxillary bones were

cut through to the palate,

that the inferiour part of his nose, being inverted,

by a

The

divided by the stroke of a broad sword.

flap of the

tion of the

upper

lip

over that below.

septum narium, and the

so

hung

small por-

ala of the left nostril

remained undivided.

The reunion

of these parts had been attempted by the

twisted suture, but the parts had broken loose, and the
lips

of the

wounds separated; a portion of the septum

narium alone had formed a

and

this

was the only

adhesion to the nose,

slight

part of the cicatrix that afterwards

remained unsightly.
I

removed a

of the edges from

superficial portion

this

long and irregular wound, approximated and fixed the

lips

of the

wound

in the

interrupted sutures,

most exact manner, with eleven

and a retaining bandage.

turned the maxillary bones

to their situations,

I also re

and kept

them together by passing a gold wire around the contiguous teeth of the broken and sound parts. The consolidation of these bones, and the re-union of the soft parts

was soon completed, and he

left

the hospital in perfect

health in less than forty five days.

was

obliterated

brane, and
this

its

One

by the tumefaction of the

of the nostrils
pituitary

adhesions to the sides of the

young man returned

nostril.

mem-

When

to Paris, I destroyed this ad-

hesion bv a perpendicular incision, and kept the nostril

open by a tube of lead,

to

which was afterwards

tuted part of a gum-clastick tube.

substi

280

MEMOIRS, &C.

Philip Thevenir, a chasseur, also

the superiour eyelid of the

had the

same eye,

left

the os

eye-brow,

mate, and

a portion of the cheek, including the salivary canal, divided.

The lips of the wound were found retracted and dried

was obliged to pare them with the crooked scissors,
and to introduce seven sutures, to bring their edges into
:

exact apposition and to assist the bandage.

was completed

in a

ral appear.' nee

and there was no salivary

where

The

re -union

few days. The eye retained

its

fistula

natu-

formed

the duct of the parotid gland

had been divided.

Peter Leclerc, another chasseur,

was wounded by

which divided

sabre,

from right

to left,

was

As

same means

left

cheek, as

the separation of the part

inconsiderable, the reunion

ted bv the

nose entirely through, obliquely

with a great part of the

far as the masseter.

ease

his

in this

was soon comple

as in the foregoing case

Two

other chasseurs, Jerdet and Lejuste, had their no

ses divided from the root to the base, so that they were

by the septum and a small portion of the

Seven interrupted sutures, with a supporting ban-

attached only
alae.

dage, were sufficient to produce a re -union of the part*

and a

cicatrix so exact that

no deformity remained.

In the case of Riviere Brocard an

was

effected.

He was wounded by a

uncommon

cure

sabre which entered

ed the head at the most prominent part of the parietal

bone and divided the skin and the external fibres of the
crotaphitc muscle, as low down as the meatus auditriou^
of the car: a portion of the parietal bone, with the dura
mater, as large as a dollar, was cut off, and a thin layer ot
the brain.

placed

The

flap

but the pain

with the detached bone had been re

w hich

the patient suffered, the

symp

SECOND CAMPAIGN

IN SPAIN.

281

toms of inflammation which had already appeared, and

the spontaneous separation of the flap, induced

turn

and

it

to

down

me

to

order to extract the fragments of bone

in,

examine the opening of the cranium and the

inju-

ry of the brain. I cut out a small piece of the dura mater

that turned into the opening of the cranium,

made

a per-

pendicular incision in the bottom of the flap formed by

the integuments, bathed the

wound with warm wine,

applied the flap, and supported

ordered him to be
nial drinks,

He

let

it

re-

by a proper bandage. I

blood, prescribed diluting antimo

antispasmodicks, and low

diet.

afterwards laboured under symptoms which were

alarming: the wound suppurated but

little,

the

symptoms

gradually subsided, he recovered, and was discharged

from the hospital on the 69th day.

The

following case

is

not less important:

Francis

wounded by a

Bernard, a dragoon of the guards, was

sa-

bre in the right inguinal region, at the battle of Benevento. The walls of the abdomen were
momentary haemorrhage followed from
artery

divided, and a

the epigastrick

a large portion of the epiploon was protruded

through the wound. The swelling of this adipose membrane having arrested the haemorrhage, I chiefly directed

my

attention to the protruded part.

cold, insensible,

advisable to cut off

thought

it

beyond

the

As

and removed from

wound, and

abdominal cavity,

after

was now

livid,

connections, I

that part projecting

all

to return the

having tied

it

its

sound part into the

all

the small arteries

with the
that could be seen. I performed this operation
a proper
in
patient
the
placed
I
success I had anticipated.
bandage, prescribed
indicated, and he
the remedies and regimen that were
recovered in the space of six weeks.
position, after applying a suitable

Vol.

ii.

Nn

MEMOIRS, &<

282

Augustus, quarter-master

F.

of the

horse artillery

was wounded by a musket-ball in the same battle, which passed quite through the extensor muscles of the
guards,

head, from one side

other, and grazed the inferi

to the

our occipital prominences, and destroyed their aponeuro

tick coverings.

drew from

it

and dressed

He

soon

weight

both orifices of the wound,

dilated

a portion of his shirt, driven in

it

felt

by the

ball,

with emollients.
acute pain in the occiput, heaviness and

in the inferiour extremities,

and so great a

debili-

ty in the organs of sight and hearing, that he could

scarcely distinguish large objects, or hear acute sounds
testes diminished in size,

His

phy

the

and

and

fell

into a state of atro-

membrum virile also underwent similar changes

power of action: but his wound improved,
symptoms disappeared, and he was discharged

lost its

the local

froin the hospital within fifty days.

I shall conclude these cases with that of

Rene

Bigot,

a chasseur of a strong constitution, and passionately de

voted to the
also
all

fair sex.

wounded by a

was

the convex or salient portion of the occipital bone to

the dura mater, of

we

In the battle of Benevento, he

sabre that cut through the skin, and

which a small

part

was

also

wounded

could see ihe right lobe of the cerebellum through the

opening in the dura mater. The

slightest touch

on

this or-

gan produced vertigo, syncope, and convulsive motions;

when pressure was not applied he felt no pain. I removed
the portion of the occipital
flap,

and applied the

latter

the cranium, after having

bone

that

adhered to the

gently over the excavation of

made an

incision in the

bottom

of the flap, to favour the discharge of fluids from the

wound. That part of the

flap directly over the

opening

of the dura mater, did not adhere in consequence of the

constant serous discharge from the interiour of the crani

SECOND CAMPAIGN IN

um; from

this piace alone the fluid

every dressing, in small

was discharged,

at

bubbles, producing a slight

We attributed this

crackling noise.

283

SPAIN.

to the entrance

and

exit of the external air through this orifice.

After the

day

first

this

man

the sight of the right

lost

eye, and the hearing of the ear on the

same side. At the

same time he experienced acute pains along the dorsal vertebrae, and a kind of pricking, like the stinging of ants,
which gradually diminished

in the testicles,

were educed
the

left)

in less than fifteen

to the size of a

in size,

and

days (more particularly

Windsor-bean.

He

soon

lost all

inci nation for the pleasures he had so often enjoyed in

the

company of

He
lid,

fair.

without complaining. His

dition,

the

the

supported the juurney from Benevento to Vallado-

and

if

we

except the

powers of generation,

wound was

in

good con-

loss of sight, hearing,

and

that appeared to be forever

gone, his situation authorized us to expect his recovery,

when symptoms
and continued

of inflammation

made their appearance,

to increase in opposition to all the

which we adopted

to arrest

them

means

the pains of his head

and spine were now so violent that he uttered mournful

cries. He was always bent in his bed, and lay on his
right side
sions,
fell

the slightest motion threw

and when he rose

to take broths

him

into convul-

or medicines, he

into an alarming syncope.

I applied a large vesicatory to his head, prescribed

cooling drinks, and such means as were indicated, but

the disease

still

gained upon him, and became complica-

ted with tetanus: he died on the 7th of February, 1809,

thirty

On

nine days
opening

pearances

after

his

he received the wound.

body,

we

observed the following ap-

a great loss of substance in the occipital re-

gion, the opening of the dura mater (of

which we spoke}

opposite the right lobe of the cerebellum,

was

of a yellow

MEMOIRS, &C.

284

colour, without suppuration or effusion, the right lobe of

the cerebellum had retracted or sunk

oblongata and spinal

marrow were

down,

the medulla

of a dull white, of

a firmer consistence than natural, and reduced to one

fourth of their usual size; the nerves
also appeared to

From

be

which go from them

in a similar state

of atrophy.

we may conclude,

this pathological fact,

that one

of the principal consequences of inflammation of the en

kephalon,

is

a hardening of the substance of the brain

and nerves.

The cranium
now among the
Our

of the subject of the preceding case,

anatomical preparations in

pursuit of the English

was

my

so rapid, that

a part of them prisoners just as they arrived at

to

is

collection.

we

took

Corunna

embark.

The

imperial guard halted at Astorga, near the

moun

Astunas hence we returned to Benevento, and

thence to Valladolid, by Rio Secco: near the walls of
the latter, I saw the field on which marshal Bessieres

tains of

met a numerous army of insurgents, and fought the memorable battle that bears its name. On my arrival at
Valladolid, I

made

preparations for receiving our

woun

In addition to the duties of chief surgeon of the

guard, by an order of the day, I was invested, pro tern.

ded.

with those of inspector general of the hospitals of the

line in this city.

The

wounded English

superintcndance of the sick and

thus devolved

be the most arduous part of

privation, the cold

my

upon me, and proved

duties.

and moisture

to

The

which

to

fatigues, the

the prisoners

had been exposed, while crossing the mountains of Asturias, and the nostalgia that prevailed generally among
them, produced a hospital (adynamico-ataxick) fever,
which assumed a contagious character. Unless I had immediately ordered the English to be separated from our

SECOND CAMPAIGN
troops, the epidemick
hospitals

and houses

were removed

285

IN SPAIN.

would have extended

The

in Valladolid.

to all the

sick prisoners

a hospital at a distance from the

into

dwellings of the citizens, and they

from disease, were sent

on the outside of the

who were exempt

to spacious well aired barracks

city.

I superintended the treatment

of the former in person, and proposed such plans as were

calculated to preserve the health of the latter, and

pro-

cured for them, through the kindness of the marshal governour, cloaks, shoes, and

shirts, of

which they were

in

great want.

Baron Denzel, commissary general of prisoners, paid

them particular attention, and rendered them every assis
remember.

tance, as they no doubt well

I

may

make honourable mention

also

who

director general of their hospitals,

my

daily visits to the

sick,

of Mr. Gilbert,

attended

me

in

and acted towards them

with the same zeal and disinterestedness as formerly

in

Egypt.

During the

first

days after the arrival of the English

we

lost

a great

prisoners,

number

our own, because they were

nately into

all

at first

of their sick and of

received indiscrimi-

the hospitals; but the mortality of the dis-

when proper means

were adopted. Without doubt the change of winds and
ease soon abated, and disappeared

temperature contributed to arrest the progress of

epidemick.

The

excellent bark

this

and wine which the

Spanish agents supplied, aided greatly in the cure of

the

French and English

sick.

One

of the latter, a

dier of the 12th regiment infantry, about

when

convalescent from the hospital fever,

attacked by an anasarca, which

to the right half of his

was suddenly

was confined

body, while his

sol

36 years of age,

left

exclusively

side

remained

nearly in a natural condition. This singular affection re

MEMOIRS, &C.

286

means

sisted the

that

were used for a long time, but

by our physicians.

final

ly yielded to the plan adopted

I will

aUo

report an interesting cure in the case of a

young English drummer, about twelve or

prisoner, a

thirteen years of age, son to a corporal of the 12th regi-

ment

infantry.

This boy, which the father generally held on

his knee,

was

quite blind,

little

mobility. This loss of sight, his father informed

and the pupils of his eyes possessed but

came on him suddenly while crossing

the mountains of

during the rigorous cold of the

Asturias.

This cold produced a greater

effect

me,

late

winter.

on him, as the hair

of his head had just been cut close, and he had travelled

from Corunna

to Valladolid bare-foot, like the generality

of the prisoners. I soon discovered that this

boy was

af-

with gutta sercna, from the causes just enume-

fected
rated.

As

this

was a

case of recent blindness, I entertained

hopes of curing him. I sent him to one of our hospitals,

to

remove him from the diseased, and

convenient to me. I ordered

then put
plied

him on

moxa on

comes

at first

to

have him more

a saponaceous bath,

the use of diaphoretick bitters,

the course of the facial nerve,*

and ap-

where

out of the cranium, behind the angle of the

it

jaw:

I directed his head to be rubbed with a camphorated

woolen cap, and washed

eyes with warm camphorated wine.

alkaline liniment, covered with a

his

After the second application of the moxa, he saw the

light: after the

lours,

and

fourth, he distinguished objects

after the seventh, his vision

was quite

and corestored.

* The portio dura, or nervus communicans faciei of the

seventh pair. Tr.

SECOND CAMPAIGN IN
I took care to prevent the parts

28?

SPAIN.

burned by the moxa.

from inflaming or suppurating, by the immediate application of

this

ammonia. In order

to secure a continuance of

extraordinary improvement, I established a caustick

in his

arm. I procured a Spanish cloak

for the little fel-

low, had him dressed comfortably, and I

pleasure of seeing

him

health with his father,

set

finally

had the

out for France in perfect

who was

transported with joy at

his recovery.

This case, with many others already detailed

work, proves the

not

recommend

efficacy of

its

moxa in

paralysis,

in thi*

and

can

use in terms sufficiently strong.

Valladolid being appointed the place of rendezvous for

our troops and sick,

we were

obliged to increase the

number of hospitals. But notwithstanding this increase,

they were provided with everything necessary, and
were well attended. For these advantages, we were particularly indebted

to the care of the

marshal duke

of

Istria.

The

imperial guard being ordered to return to France,

I resigned

whom

my

place of inspector of the hospitals of the

Mr. Percy who was then

line, to

I corresponded regularly.

at

Madrid, and with

To

the duke of Istria

and the commissary general of the army I made a report

on the favourable condition of the hospitals.
I had now fulfilled a painful and difficult

come by

fatigue,

task.

Over-

and much debilitated by a catarrhal

fection which seized

me

during the campaign

at

af-

Bene-

vento, to be attributed to fording several rivers, to

my

exposure to snow, continual cold, and rains, I became

obnoxious
hospital

to the causes of disease,

fever from the

landing, on the third day

and contracted the

English prisoners.
after the

Netvvith

symptoms appeared,

MEMOIRS, &C.

288

where I
had marched two

I had resolution enough to set out for Burgos,

was

in

hopes to rejoin the guard that

days before. But I was seized with delirium on the route,

and

in all probability I

kind assistance of

my

must have perished but

I was carried to Burgos, and after a dangerous

was so far convalescent as to be able to set out
ris,

where

for the

pupil and cousin, Alexis Larrey.

I arrived with great difficulty.

disease
for Pa-

CAMPAIGN IN AUSTRIA.

CAMPAIGN
^V^V

WAS

trian

IN AUSTRIA.

^ 'V <&

,ey

^*

a convalescent at Paris,

still

289

campaign was about

when

the Aus-

Without waiting

to open.

the entire recovery of my constitution from the shocks

had sustained

in Spain, I set out

it

on the 22d April, 1809,

to join the imperial guard, then in Bavaria.

On

our arrival at

French and

Strasburg,

Austrians at Ratisbon

learned that the

fertile

victory over the

a few days afterwards,

a large body of prisoners, on

passed over the

we

army had obtained a

allied

their

way

to

we met

France.

We

plains of the nearest countries of

Germany. At Munich,

I paid a short visit to Dr.

me

Soem-

mering,

who

his rich

and valuable collection of pathological anatomy.

gratified

a third time with a view of

sanguinary conflict took place at Eberberg, be-

tween our advanced guards, and

After a few days' forced march,
previous to

me

its

entering Vienna.

kindly, and ordered

for another

me

that of the

we

enemy.

overtook the guard,

The emperour

to prepare

my

received

ambulances

campaign.

The enemy, on

leaving the capital, had caused the

gates to be shut, in order to oblige the inhabitants to defend themselves.

After passing the Danube, they cut

away the bridges.

A bombardment
a

for a

few hours, and preparations

siege, induced the inhabitants,

Vol.

li.

Oo

and the troops

for

in the

MEMOIRS, &C.

290

was agreed

propose a capitulation, which

city, to

on,

and the next day we took possession of the town.

New preparations

were immediately made

on

to carry

the campaign, and bridges were constructed to pass the

river

and pursue the enemy,

its left

who had

taken position on

bank.

The

place at which the

Danube

divides into several

branches, and forms a number of islands, was select

ed

for the

islands,

is

Lobau, one of these

purpose of crossing.

of considerable extent.

On the 21st of May, the

imperial guard and several divisions from the

main body,

took possession of this island. Bridges were immediately

thrown over the remaining branch of the river, and the

enemy commenced
Our troops remained

attack on the advanced posts of the

with

spirit;

but

was

not decisive.

masters of terra-firma, and next morning covered the

landing of such divisions as were enabled to reach Lofor one half of our forces was detained on the right
bank of the Danube, by the breaking of the first bridges;
notwithstanding, a general attack was made, and the ter-

bau

rible battle of

Elchingen was fought, in which the infan-

try of the guard bore the brunt,

pidity

was

and

indecisive.

22d, to the

isle

and displayed such

This engagement,

valour.

We

fell

intre-

like the former,

back during the night of the

of Lobau. This

was

effected

with much

difficulty,

on account of the small number of bridges, and

the slight

manner

in

first

ambulance was

rest,

on the

left

which they were constructed.

post;

bank of the

the requisite operations on

verely
slightly

ger,

wounded during

at the enti

river,
all

those

the conflict.

who had been seThey who were

without dan-

as fast as possible to the island,

other ambulances awaited them.

fo-

where we performed

w winded, and could be transported

were carried

My

ance of a small

where

CAMPAIGN IN AUSTRIA.
At
shal

on

a short distance from this dangerous post, the marduke of Montebello was mortally wounded: he was

foot,

returning from the

rour's head-quarters.

ing, struck his

its

291

field

of battle to the empe-

A ball of large size, after rebound,

knee, passed through

left

direction without losing

thigh, cut the integuments,

force,

its

it,

and changing

grazed the right

and a part of the vastus

inter-

nus just above the knee joint, which fortunately was not
injured. He instantly fell, and suffered a violent concus.
sion of the brain,

and general prostration of organick

power.

Being immediately informed of this accident, I repaired to the spot in all haste, and had him conveyed to my
ambulance His face was livid, his lips pale, his eyes dull
and watery,
His

tible.

his voice feeble,

intellect

was

so

and pulse scarcely percept

much

disordered, that he

was

ignorant of his danger.

I

was

quite

overcome

at the sight of

one thus severely

wounded, who had honoured me with his friendship, and

to whose wounds I had before attended in Syria and
Egypt. But I

summoned up

all

my

resolution,

and

re-

quested the assistance of some of the most experienced

surgeon majors.

We examined

That on the

both wounds with great

was simply dressed, as not

being serious. But the wound of the right knee was
alarming, on account of the comminutive fracture of the
care.

right thigh

bones, rupture of the ligaments, tendons, and popliteal

artery.

My comrades were unanimous in favour of imme-

diate amputation, but

as so

little

no one was willing to undertake

it,

prospect remained of his recovering, under

circumstances so unpropitious.

Being encouraged by

veral successful results in similar cases,

and

led

se-

on by a

small glimmering of hope, I determined to perform

it

was completed in less than two

minutes, and he showed little sign of pain.
myself.

The

operation

MEMOIRS, &C.

292

I applied the usual dressings, and after conducting the

duke

to the island of

him,

I intrusted

regret I

left

Lobau, where the emperour met

him

Mr. Paulet. With

to the care of

him; but I was the only inspector on the

and a great number of wounded on the

field of battle,

island, whither they

the

all

had been transported,

We never rested from our

our assistance.

wounded were

required

still

labour, until

operated on and dressed.

To my co

?,

Messrs. Rayfer, Cothenet, Mouton, Jourda,

labourers,

and Maugras,

am

I particularly

indebted, for their assis-

tance on this occasion.

Notwithstanding the promptness and efficacy of the

wounded were

means used by

us, the

condition: they

were stretched on the

still

a perilous

in

earth, collected in

groupes on the bank of the river, or scattered about in

the interiour of the island.

The

earth

was dry

in conse-

quence of the heat of the days, but the nights were moist,

The

wind often covered

the wonnded with clouds of dust. They were but imperfectly protected from the rays of the sun, by th*, branches
and even

cold.

frequent squalls of

of trees, or bundles of reeds.

The breaking down

of the bridges,

boats to bring provisions, added

and we
for

all

suffered

still

and the want of

to our misfortunes,

much; more particularly the wounded,

good food and comfortable drinks. I was obliged

order broth

made

of horse-flesh, which, for

want of

was seasoned with gunpowder. Yet, this broth was

black, but quite pleasant: it became clear by boiling.

On

the third day,

provisions,

we

fortunately received

and were able

all

were

rebuilt,

and

salt,

not

sorts of

to issue rations regularly.

the fourth day, the bridges

to

all

On
the

wounded conveyed to the hospitals prepared for them

by inspector general Heurteloup, at Ebersdorf and
Vienna. I received the wounded of the guards in the superb barracks at Reneveck, formerly appropriated to the

CAMPAIGN

293

IN AUSTRIA.

use of the imperial school of artillery, and here they re

maincd

until their cures

were completed.

The weather was now variable, and very stormy. I

to visit the duke, who had been removed to Ebers-

went
dorf.

found him very weak, in a state of great depres-

sion

and death-like paleness. His ideas were incoherent.

and

his voice interrupted.

the head,
quently.

He

He

complained of a weight in

and oppression, and sighed

felt restlessness

fre-

could not bear the weight of the light cover

ing on his bed.

He

had hitherto used acidulated iced

drinks.

The temperature

of the air had suddenly been reduced

by the changing of the wind from south to north, and by
the storm of rain on the preceding evening.

who

proposed to the physicians,

sence, to cover

him with

flannel, to give

at short intervals, with good wine,

drinks.

and

His strength was

his sleep

were dressed

more calm.

in

On

wounds

and

my

ab-

him good broth

to

omit the iced

some measure improved,

the next day, his

for the first time.

purulent serum, the

I therefore

attended him in

They had

wounds

discharged a

of the stump had a good ap-

pearance, and that on the right thigh led us to anticipate

nothing unpleasant: a portion of

united.
gestive,

We

covered the

its

first

my

in

warm

sweetened

twenty-four hours he was so calm,

began to indulge a hope of

to the opinion of

edges had already

plasters with a simple di

and soaked the compresses

wine. During the

that I

first

colleagues.

his recovery, contrary

But on the night of the

day after the accident, a dangerous paroxysm of fever

came on. Doctors Lanfranc, Panlet, Yvan, and myself,
met in consultation, and agreed to give him bark in large
doses, with the addition of sulphurick ether, which was
done. A second though less severe paroxysm of fever
sixth

returned about

two hours

after the first,

and

a third. ap-

MEMOIRS, &C.

294

peared in the course of the day, with delirium, and complete prostration of the vital powers.

Still

his

wounds

had no appearance of gangrene, but the suppuration was

diminished. Dr. Frank, of Vienna, also visited him, and

approved of what was done.

day

But he died on the ninth

after the accident.

was

desired to

embalm

his

body, which was con-

veyed, during the night, to the castle of Schoenbrunn.

At break
death,

was

of day, next morning, eighteen hours after

we commenced

rapidly advancing. I found

vessels,

move

and

little

it

difficult to inject

to evacuate the cavities. I

the

was obliged to re-

the cellular substance from the surface of the

all

body and
but

the process, though putrefaction

interstices of the

muscles

the heart contained

blood, and the brain had left the dura mater,

about twelve millimetres.

the pia mater to the brain

The vessels which pass from

were broken, a small quantity

was effused in its circumvolutions, and the

were full of a reddish serum.

of black blood
ventricles

Having completed

this

dangerous and painful task, I

returned to the hospital of the guards, where a great

numwounds were complicated with acute diseases.

Tetanus and the hospital fever were productive of the

ber of the

To the former disease the young solwere most obnoxious who had been wounded in

greatest mortality.
diers

the ginglymoid articulations, or deeply in the soft parts,

with

loss

of substance.

The symptoms accompanying

nearly similar to those
the tetanus

was more

we had

the latter disease

were

seen in Egypt, but there

severe, and bore a nearer

resem

Germany
and Egypt,thatwhen traumatick tetanus followed wounds
of the nerves in the anteriour regions of the body, it was
of that kind called emprosthotonos, and when the nerves
blancetothe hydrophobia. I remarked, both

of the posteriour regions

were

in

injured, opisthotonos

was

CAMPAIGN
the consequence.

Again,

IN AUSTRIA.

295

a limb were wounded, so

if

that the injury of the anteriour

and posteriour nerves was

was produced. Trismos or trisseldom caused by wounds, but is generally

equal, complete tetanus

mus

alone

is

the consequence of general tetanus.*

marked

that this disease

is

have also

not often caused

re-

by wounds,

unless the temperature of the atmosphere pass suddenly

from one extreme

to another.

The wounded who were

exposed, more especially in the spring, to the cold moist

air of the nights
vail,

when

the north north-west

were more obnoxious

to tetanus:

the disease seldom appeared

the air

was

that this

nearly uniform. f

winds pre-

on the contrary,

when the temperature of

Hence we may conclude

change of temperature

is

a predisposing cause

of tetanus, and that surgeons should guard against

their treatment of the

On

opening several dead bodies,

we

we

in

have also disco

vered a considerable quantity of lumbrici in the

tines, but

it

wounded. +

intes-

found no evidences of inflammation. They

might have acted as an additional cause of

tetanus.

* I speak of traumatick tetanus alone, for spontaneous

or internal tetanus is not always followed by the same results. See the authors who have written on this species of
the disease.

f After the battle of Eylau, not a

soldier of the

guard

was seized with this disease; and I know that but few of
the line were attacked by it. The most remarkable case in
which tetanus terminated fatally, was that of a young officer, son of general Darmagnac, the consequence of amputating his arm. I saw him in his last moments. On dissecting the stump after death, with Mr. Ribes, we found the
median nerve included in the ligature with the artery. The
extremity of this nerve was tumelied and red.
J These observations and suggestions of our author most
strongly inculcate the necessity of attending to the inferences which naturally grow out of the doctrines on inflain
mation. noticed in vol. i. p. 179. Tr.

MEMOIRS, &C.

296

A remarkable appearance

was observed

a soldier belonging to the 75th regiment,

in the case of

who ha

consequ 'nee of a wound of the right thigh.

in

'

tetanus

The

ball

its anteriour part, was lost in the thick

thigh The cold bath, recommended by

having entered on
portion of the

some physicians, was

it

The

used.

first

two applications of

produced a most distressing sensation, and the patient

derived no benefit.

he

felt

into

it;

into the

When

he saw the bath a third time,

an invincible dread of water, and refused to go

but he

was covered with a

water without suspecting

sheet,

it.

As

immersed, the tetanick

rigidity increased,

violent convulsions.

was necessary

stantly
tition

It

from the bath

to his

bed

to

and plunged

soon as he was

and he

fell

into

remove him

at this

moment

in.

deglu-

was obstructed, and the muscular contraction and

rigidity

had reached their acme; a tumour, as large as a

hen's egg, suddenly appeared on the edge of the linea

al-

He

his

ba, under the umbilicus.

intellectual

faculties

always remarked
the day

all

lived several hours,

and

remained unimpaired, as I have

in traumatick tetanus*.

his functions

At

the end of

suddenly ceased, and next morn-

ing he died.
* I have seen the general cold bath in traumatick tetanus produce increased rigidity, general spasm, and difficulty of respiration, without an amelioration of the symptoms
when first used. But when repeated, these unpleasant symptoms did not return, at least to so great a degree; and finally the spasms, rigidity, and profuse perspiration were
completely arrested by it. When the sudden immersion of
patients labouring under tetanus has produced spasm, &,c.,
I have directed the cold water to be poured gradually over
the body ; if they could not bear this, a sponge to be dipped
in cold water, and applied to every part in succession. By
moderately raising the temperature of the water at first,
such patients have been enabled to U6e the bath, and then
its temperature was gradually reduced with advantage. In
cases of traumatick tetanus that have fallen under my notice, I have ascribed the cure principally to the repeated
use of the cold bath. The patients were kept in it but a few
minutes, and then removed to their beds. Tft

campaign

297

in Austria.

I proceeded to open the

body

in

presence of Messrs.

Galette and Trachet, surgeon majors.

was

It

as un-

yielding as a plank, and perfectly straight: consequences

of complete tetanus.

The tumour
still

apparent

spine,

and

his

before noticed near the linea alba,

was

the abdominal walls were retracted to the

jaws firmly locked. After making a cruabdomen, we laid bare the parts which

cial incision in the

formed

this

tumour, by a careful dissection.

It

was com-

posed of a portion of the right rectus abdominis, contracted at

shape of a pin-cushion, in conse-

this part into the

quence of a rupture extending quite across

was seen below

ture

though extensive,

filled

This rup-

it.

with black coagulated blood

must have been been spontaneously

it

produced when he was plunged into

viscera of the abdomen were reduced

The

the cold bath.

to a small

mass, and

forced into the hypochondriack and pelvick regions;

found several lumbrici

we

small intestines, but no

in the

traces of inflammation: the cavities of the heart

were

The

brain

from blood, and

free

their walls in contact.

presented no remarkable appearance.

wounded

thigh,

we

On

opening the

discovered the ball on the linea aspe-

ra of the femur, near the great trochanter.

had been wounded

sciatick nerves

and

the ball, and where

this

twofold

injury,

it

The

cruiul

at the entrance of

passed through the soft parts

was

by

the tetanus doubtless produced.

few died with tetanus after amputation we opened

two who had fallen victims to it in one,
been amputated, the median nerve was
had
whose arm

the bodies of

found included

in the ligature

and tumefied below the

mushroom*

it

was

also

with the humeral artery,

ligature, so as to

resemble a

much swollen above the

ligature,

and of a red colour.

This appearance

Vol.

ii.

fca

been observed by other anatomists.

Pp

MEMOIRS, &C.

29'g

On

inspecting the other,

ted nineteen days before,

whose

we

leg had been

amputa

also found the nerves en-

larged at their extremities, and adhering to the surround-

ing parts. Several years ago I observed that the ends of

nerves, which had been divided in amputation of limbs,

were considerably enlarged, forming a kind of button,

whence very fine diverging nervous filaments seemed to
rise, doubtless

intended to convey sensibility and

throughout the cicatrix of the stump, which

a great

The

number of

plain

why tetanus

is

vitality

formed of

with these filaments.

vessels united

existence of these vessels

injections of Dr.

is

proven by the elegant

Soemmering. This

fact serves

to ex-

appears at particular periods, and

persons after amputation suffer more or

less

why

from varia

tions of temperature. In the former of these cases a ner-

vous twitching commenced, and extended rapidly from

the extremity of the divided nerve to

branches, and from these branches

to invade the
it is

its

neighbouring

to the trunks, so as

whole nervous system except the brain

a singular fact that the brain

is

the nerves, and in particular those of animal

tensively injured. In the great

number

life,

for

when

not disordered

are ex-

of persons that I

have seen attacked by traumatick tetanus, the mental

powers and
is

faculties

were not perceptibly

altered.

then the most certain diagnostick by which

we

This

distin

guish traumatick tetanus from the convulsive affections

that follow injuries of the brain.

In the

last

of the preceding cases I took notice also

that there had been a suppression

and repercussion of
wound, and cutaneous
transpiration had been checked by a sudden change from
a high to a low temperature.
The wounded who were most exposed to the cold
the purulent discharge from the

moist air of the night during the spring, after being sub
ieetcd to the excessive heat of the day,

were generally

CAMPAIGN

299

AUSTMA.

IN

seized with tetanus, which never appeared, except

Reaumer's thermometer rose

23 degrees above

zero, and

12, 10, 9, 8 degrees. I

true causes
less

fell

made

Having made myself

at

the

noon

when

to 19, 20, 21,

and

during the night to 13,

same remark

in

Egypt.

perfectly acquainted with the

of this disease, the plan of treatment

was

complex. I also used with great success several

means which were suggested

had acquired of the
nerves.
1st.

These

When

the knowledge I
phenomena of the

be noticed

being divided

When

by cold moist
Sdly.

me by

the nerves are included in the ligatures with

arteries, after

2dly.

shall

to

pathological

:*

they are suddenly and severely acted on

the sloughs

air, after

When

fall off:

they contract intimate adhesions with the

neighbouring parts of the cicatrix

4thly.

When

there

tremities of bones, or

is

a fracture of the articulating ex-

when

tear the sensible parts of the

foreign bodies puncture or

wounded

limb.

* Though many respectable authors and a great many

practitioners are not afraid to apply the ligature on the
nerves when they tie the neighbouring arteries after amputation or in the operation for aneurism, yet I am of opinion
mannei*
that it may prove dangerous, in consequence of the
symptoms
in which it is performed or from some unforeseen
that mav take place. For if the ligature be not applied so
arrestio-ht that the course of the nervous tiuid is completely
have always remarked that these symptoms ensued,

ted

if the
and even when the nerve is in a state of strangulation
symptoms
parts still swell beyond the usual period, these
may be produced from the twitching in the nerve above the
circumstances
ligature. It must then be difficult under any
adtoapply a ligature on a nerve without inconvenience,
of its
moment
the
pains
at
acute
no
were
there
that
mitting
least prudent
application which is not the case. It will be at

of a ligature on the nervous cords,

to avoid the application
temperature favourable to the dea
in
especially
more
and
we be obliged by circumstances
If
tetanus.
velopment of
it should produce by its
to include tl.em in the ligature
the nerve.
a complete and total constriction of

tightness

300

MEMOIRS, &C.

I have often removed the symptoms of incipient teta-

nus by adopting such means as are suited to remove

causes, viz.

a nerve

is

his pa'n,

by cutting the

an artery

ligature of

included, and to

which the

and where the nervous

its

which

in

patient refers

all

irritation takes its use.

This division of the ligature arrested the disease

in

its

forming

state and expedited the cure of the wounds.

no danger of haemorrhage,

There

is

be not

debilitate!

namia.

A few

if

the vital powers

and there be no predisposition

ady-

to

hours of direct compression, which brings

the walls of an artery into contact, are sufficient to in-

duce adhesive inflammation,

moir on haemorrhage. In

o,

a* I explained in the

me-

der to perform the de'icate

operation of dividing the ligature of an artery, a grooved

probe

is

to

be introduced between

and the

artery,

the point of a very sharp straight pair of scissors

passed

down

ceeded in

soldier

is

and

to

be

groove to cut the ligature. I have suc-

this

this operation five times.

was threatened with

were fastened firmly

have remained there during
ligatures

In one of these cases

tetanus, in the others the

in the cicatrices,
life,

and might

as I have frequently

seen.

Epispasticks of cantharides applied to the

which suppuration
irritated

is

by the contact of cold moist

prevent tetanus.

When

lity

in

air,

will also

made on
symptoms, the natural sensibiof the diseased nerves and the secretion of pus will

the appearance of the

be

wounds

suspended and the denuded nerves

re-established.

promoted

warm

at the

these applications are

first

The

cutaneous transpiration

is

to

be

same time, by embrocations of very

camphorated

oil

of chamomile, with the addition

of tincture of opium, by covering the patient with flannel,

and by the exhibition of vermifuge medicines, if there be
a suspicion of

worms

in the intestines. I have used these

SOI

CAMPAIGN IN AUSTRIA.
remedies with success

when

cold has been the predispo

sing cause.

When

I suspect the compression of a nerve by the en

largement of the neighbouring vessels or by the adhe

mt

sion of parts of the cicatrix, I do

hesitate to apply

the actual cautery until I reach the points of the disor-

dered nerve, and sometimes

cany

the cautery even to

a greater depth. This application, justly recommended

by

the physicians of antiquity, has produced most sur

prizing

effects.

By

destroying the adhesions and pre-

venting the twitchings of the nerves

and
It

it

removes spasm

irritation.
is

also possible, that the calorick

may relieve the

por produced by the action of cold and moist

tor-

on the

air

nervous system.

In the fourth case amputation of the limb was indica

ted and followed by success. I have spoken of it in my
first

memoir on

tetanus. (See

campaigns

in

Egypt.)

Without going more minutely into the theory and

symptoms of this disease, I shall report the most remark
able cases of cure from the

ed

means

that I have just point

out.

CASE FIRST.

Pharles Yorick had his right thigh amputated for an

ext -nsive fracture of the knee by a cannon ball. He was

attacked with tetanus on the eighth or ninth day. The ir
ritation or

patient,

nervous spasm, according

commenced

at the part

to the report

where the

applied on the vessels. The

had diminished and become sanious.

of the

was
wound

ligature

suppuration of the

We used epispastiek

ointment in the dressings, prescribed

warm

oleaginous

MEMOIRS, &C.

302

and camphorated liniment

to the surface of the whole

body and diaphoretick drinks and strong doses of opiates. These means were continued three days and scarce-

ly retarded the progress of the disease.

some of the principal branches of the

Suspecting that

crural nerve

were

cluded in the ligature of the femoral artery which

still

in-

re-

mained, I cautiously passed the point of one blade of a

pair of sharp scissors
directing

it

down

along a groved probe and

between the artery and ligature divided

it.

This simple operation appeared to relieve the tetanick

symptoms

some time, but

for

extended too

far,

and I am

moisture to which

cold and

the irritation had already

of opinion that the action of

he was

exposed during a

warm

day, was the prin-

stormy night succeeding a very

cipal predisposing cause of tetanus in his case.

As his symptoms
was very

continued to advance, and deglutition

difficult, I

resolved to apply the red-hot iron on

which was done next

the whole surface of the stump,

day.

By

applying an iron brought to a white heat seve

ral times, the

tensive.

with

The

fortitude.

To my

better in the space of a

ed, opened at will,

The

made sufficiently deep, and exwas very painful, but he bore it

cautery was
operation

was decidedly
The jaws before lock-

great surprize, he

few hours.

and

his deglutition

was

less difficult.

rigidity of the muscles gradually disappeared,

ration

was

re established in the

sloughed off in due time. This

wound, and

suppu

the eschars

wound healed from

the

circumference towards the centre, and before the expira

tion of

two months, he was

quite well In the

mean

time,

the use of camphor, opium, and diaphoretick drinks

continued.

was

CAMPAIGN IN AUSTRIA

303

CASE SECOND

John Viessc was attacked

fifth

day

left

thigh.

The

We

actual cautery

removed

tion

in the same manner on the

having undergone the amputation of his
adopted the same plan of treatment.

after

all

the

was the lust resort. Its first applicasymptoms of tetanus, but perhaps it

might not have proved so

had not been premised.

He was

successful, if general remedies

in an uncommon manner, and the

stump was about to form, when he fell into
of adynamia, from which we could with difficulty

improving

cicatrix of the

a state

But he

retrieve him.

France with

others.

finally recovered,

A rigidity in

or jaw remained with

the

lipsL,

tic

and was sent

to

the stump and inferi-

doloureux, in the muscles of

but these gradually disappeared

CASE THIRD

ball struck

Francis Demare, and carried

away

the

skin and a part of the spine of the right scapula, with a

portion of the trapezius, and of the infra and the supra

spinatus muscles.

The

division of the strangulated apo-

neurotick ligaments, and the excision of the disorgan

ized flaps,

was made on the field of battle. Some loose

were also extracted at the same time, and

pieces of bone
the

wound

puration

dressed with a

split roller,

&c.,as usual. Sup-

went on without any unfavourable symptoms.

and the wound began

was suddenly

to heal

around

its

edges,

when he

seized with tetanus, which, like an elec

304

MfeMOIRS, &c.

from the wound over the whole

trick shock, extended

nervous system, and in a few hours he was

of

in a state

complete opisthotonos.

His head was thrown back on the shoulders, the jaws

difficult. I immediately pre-

locked, and deglutition very

scribed diaphoretick drinks, and large doses of opium.

Camphorated
were made
ings

oleaginous,

to the

and

narcotick applications

whole surface of

his

touching

it.

dress-

In short, every remedy and care was lavish

The

ed Upon him.

was suspended,

secretion of pus

edges of the cicatrix enlarged, and

wound was

the

The

body.

were mild, and applied over the wound without

half

its

former

size.

in forty -eight

He

the

hours

then complained

of a painful compression in every part which had healed.

He
as

told us that the

if

forcibly

edges of the wound were as painful

seized with pincers; and

the slightest

touch on this very delicate cicatrix, more particularly

with metals, made him utter the most acute

cries. The
symptoms of tetanus were evidently becoming more and
more alarming. The superiour extremities were uncommonly rigid, and drawn backwards: the cervical verte-

brae

was

were thrown

into a Curve posteriourly,

quite obstructed. In vain

we

and deglutition

extracted

two

inci

Not a
and when

sores to introduce the tube of the sucking bottle.

drop of

fluid

clear water

could pass into the oesophagus,

was brought near him, he

sions:he had the greatest dread of

seen in cases of tetanus.

mentcd

The

salivary

at this critical time, and

all

creased to an alarming degree, and he

toms of delirium.

It

now

fell

into convul

as I have often

it,

foam was aug

the
still

symptoms in
had no symp-

appeared impossible that he

could survive twenty -four hours,

if

some

was not adopted. I now ordered four

efficient

remedy

large irons to

be

brought to a white heat, and applied them in immediate

succession over the whole

wound, and

particularly on the

CAMPAIGN IN AUSTRIAparts of the cicatrix

where

305

I suspected that

some branch-

es of the accessory of Willis (the spinal nerve)

compressed and enlarged

painful, but I

wound was

persisted in

every part of the

until

it

deeply and completely cauterized. This was

scarcely done,

when

a copious perspiration took place,

and the symptoms were

sistance,

were

This application was very

and called

arrested.

for drink.

He

sat

up without

neously. I gave him a glass of nitrated milk of sweet

which were mixed

as-

His jaws relaxed spontaal-

laudanum,

monds, in
and a few. drops of Hoffman's anodyne liquor. I ordered
the camphorated narcotick liniments to be repeated, and
his

body

be wrapped

to

in

sixty drops of

very warm flannels.

An

abun-

dant critical sweat followed: he became quite calm, and

enjoyed several hours of easy and refreshing

the following morning, I found

him

free

toms of tetanus, with the exception of a

about the jaws and

spine.

The

from

The

cicatrix then

pletc within sixty days,

when he

France.

shoulder and

This cure

is

On

symp-

slight stiffness

wound

the greatest

eschars sloughed off between the ninth

and tenth days, and the

out pain. He improved

for

all

dressings of the

were mild and simple, and applied with

delicacy.

sleep.

daily,

and

commenced withwas com

his cure

set out in

good health

degree of stiffness in the motions of the

arm of the wounded side still remained.

among the most remarkable in military

surgery.

CASE FOURTH.

Jacques Lucas, a grenadier, had the calf of his leg

carried away by a ball. He was dressed on the field of
battle

with the same precautions as in the foregoing case,

Vol

ii.

Qq

MEMOIRS,

806
and then carried
ded.
trix

to

ICC.

Reneveck, where he was well atten

wound separated, and the cicawas forming, when he was attacked by tetanus, but

The

eschars of the

manner

not in a

sudden and violent as in the

so

we also used the

dos ;-s of

opium.

same means, and

last case,

in particular large

Notwithstanding, opisthotonos was

completely, though gradually, formed, and attained

its

few days the jaws were locked, and debecame more and more difficult. Being already

third stage. In a
glutition

convinced of the inefficacy of the usual remedies, I did

not hesitate to apply the actual cautery

the irons

were

brought to a white heat, and applied in immediate sue

cession

the

mare's case.

improvement was nearly

The symptoms

as rapid as in

De-

sensibly abated, but he con-

tinued to feel a stiffness in the jaw, in the spine, and in

the leg

chars

and

hot iron,

When

foot of the injured extremity.

after the first cautery,

fell off,

which

entirely banished all tetanick

The wound now remained

be in the best condition

to

the es-

I again applied the

be healed;

symptoms.

appeared to

it

but by the most disorderly in

temperance, he brought on an ataxick fever, with gangrene of the leg, and

after his tetanus

fell

a victim to his

own

imprudence,

had been evidently and completely cured

CASE FIFTH

A chasseur had the index of the right hand extirpated

at

its

articulation

with the metacarpal bone, in conse

quence of a wound of
of Esslingen.
its

this finger

by a

ball, in the battle

troublesome haemorrhage from one of

arteries induced us to apply a ligature

and the concurrent nervous branches were

in

it.

on the vessel,
also included

Several days elapsed without accident, and the

ci-

CAMPAIGN
catrix

tetanus came on. I lost

which still remained on
The operation made no change in the condi-

in dividing the ligature,

the artery.

tion of the patient

and the

all

the progress of tetanus

endangered

patient's life

cautery on the

was
and

307

was nearly complete when

no time

toms

IN AUSTRIA.

little

stump as deep as

gradual,

possible.

The symp-

disappeared as by enchantment, and this soldiet

in a short time entirely relieved

his

was

applied the actual

wound

from the

disease,

healed kindly.

case sixth.

To
was

A part of

with tetanus after a wound.

the tarsal bones of the right foot had been carried

by a

large ball. Suppuration took place,

tetanus

was

who

these cases I shall add another of a soldier,

also attacked

came on

indicated

away

and traumatick

proposed amputation of the leg, which

by the nature of the wound, but he refused

him

to submit. I confined

to the use of anodynes, dia-

and camphorated lineaments. The

disease was arrested in some measure, and assumed a

phoreticks, narcotick,

chronick form, that

is

to say, the general

mained nearly the same and although

;

rigidity re-

epispasticks

were

applied on the wound, the secretion of pus could not be

re-established.

His disease

now seemed

ground, and emprosthotonos followed

he

felt

an acute pain

in the right

slowly to gain

at the

same time

elbow, which was suc-

symptoms of
local inflammation. Emollient anodyne cataplasms were
applied, and the doses of narcoticks were increased for

ceeded by redness, tumefaction, and

all

the

the tetanus
the

now

threatened to destroy the patient.

symptoms of inflammation succeeded

puration

an abscess formed above the

To

those of sup-

joint; I

opened

it

308

BIEMOIRS, &C.

with a bistoury, and

discharged a large quantity of

it

grayish pus: he was immediately relieved.

of the body and extremities immediately

jaws, before locked,

now opened

at

The
left

rigidity

him, his

command, and he

swallowed medicines and food with the greatest ease,

though previously he could with

al-

difficulty take the narco-

symptoms of tetanus finally diswound healed, the abscess became cleim,

up. But just as I expected to see him per-

tick draughts. All the

appeared

and soon

the

filled

fectly restored,

all

his

left

became

sule

paralyti'k,

and

the arm, fore-arm, and hand in particular, were quite de-

prived of sensibility and motion

state a considerable time,

but

and appealed

when

he hemiplegia: but

H"

the

remained
to

wa m

in

this

have no disease
weather

set in,

he was attacked with the dysentery, which soon carried

him
It

off.

was evident

abscess was the

wound in the foot of the same side
was produced by a metastasis of puru-

in this case, that the

consequence of the
that the paralysis
lent matter,

and

that the purulent discharge

scess had proved critical.

The

from the ab-

paralysis alone remained,

and would doubtless have disappeared eventually

had

if

he

lived.

Tetanus also seized on

but as

it

many others of our wounded,

mode of treatment, I shall

yielded to the usual

not notice them. I

sequence of a

shall

merely add the case of an

who was attacked

wound of the head.

of light dragoons,

officer

with tetanus in con-

CAMPAIGN

IN AUSTRIA.

SQti

CASE SEVENTH.

In a charge of cavalry, Mr. Markeski was wounded

by

a lance on the right side of the forehead, the point of

which glanced obliquely upwards and inwards, making

a deep fissure in the os

One

frontis.

of the branches of

was divided by the cutting edge of the

Nine days passed without the appearance of any
unpleasant symptom, and the wound was treated as
usual but on the night of the ninth day tetanus came on,
the frontal nerve

lance.

with convulsive motions of the

lids

of the eye on the

jured side and total loss of sight in this organ.

He

in-

had

slight delirium, acute local pain, locking of the jaws,

and emprosthotonos was evidently about

first

applied emollients on the -wounded part, and pre-

scribed opiates and diaphoretick drinks

no

to take place. I

relief,

and

the disease

they proeurcd

advanced with such an alarm-

ing aspect, that I doubt not he must have died in twentyfour hours.

I probed the wound and soon ascertained its direction

The probe produced great pain, and I was induced to
lay open the wound from one end to the other with a bis

toury and grooved director; with a single cut I divided

the frontal muscle, nerves and vessels.

He was
four hours

now

instantly relieved,
all

the tetaniek

and

in less

than twenty-

symptoms had disappeared.

thought he might recover

but on the twenty -fifth

day symptoms of inflammation of the brain, and

its

me-

ninges, with the characteristicks of effusion, appeared: I

had been prepared

to expect these

delirium before noticed, which

tanus.

But

at that

is

consequences from the

nc>:cr a

symptom

of

time I had discovered onlv a small

te-

fur-

MEMOIRS, &C.

310

row

in the external table of the os frontis,

point of the lance. I

made by

tht-

applied a large vesicatory over

and prescribed cooling drinks and antispasmo-

the scalp,

The

dicks.

now

disease

advanced, the fever increased, de-

still

and he died on the 27th day.

lirium followed,

On inspecting

the cranium,

we

bone detached

ble of the frontal

found the internal ta

end of the

at the

fissure,

and a considerable effusion of bloody purulent matter

under the right anteriour lobe of the brain, which was
here also in a state of suppuration.

When

the

first

symp-

toms of compression appeared, after those of tetanus had

subsided, I proposed the application of the trepan on this

but was induced to omit

fissure,

several of
effusion

my

colleagues,

would follow so small a

did not pursue

dicium

my

first

from the decision of

intention :

of opinion that no

I regret that I

fissure.

" occasio jyrceccps, ju

difficile."

Many
ted

it

who were

of the

wounds among our men were complica-

with fracture of the cranium, and required the trepan.

whom we

In two cases on

tended to the base of

under the

symptoms

the operation

was

this

operated, the fractures ex-

bony cavity

in the left

on a level with the meatus auditorius.

The

temple,

ball buried

deeply behind the parts and the crotaphite muscle,

and stopped

same

men sunk

two chasseurs

successful.

A grenadier was wounded by a ball

itself

these

that ensued, but in

side.

at

The

the base of the mastoid process of the

ball

was not discovered

mination, and this apparently trifling

dressed: indeed

it

at the first exa-

wound was simply

soon cicatrized, and on

.the

fifteenth

day he thought himself well, and requested to be

dis-

harged. But being about to leave the hospital, he

was

CAMPAIGN IN AUSTRIA.

311

seized with vertigo, weight, and lancinating pains of the

head, which obliged him to be carried to his bed again.

Next morning
tention,

examined

wound with

his

great at-

and discovered a small red fluctuating tumour,

near the base of the mastoid process behind the

ear.

free incision with a bistoury discovered the ball under the

base of this process. I extracted

simply dressed.

He

felt

symptoms of disordered brain

to increase

and the wound was

it,

immediate

relief,

but

still

the

returned, and continued

a lethargick fever ensued, with hemiplegia

of the right side, and he died in a stupor.

We opened the cranium next morning, and discovered

a fracture at the part before mentioned, which extended
to the base of the os petrosum,

The

cells

lection of

and towards the sphenoid

of the mastoid process

were

carious,

and a

col-

matter had formed in the lobe of the brain,

contiguous to this part, and a purulent effusion in the

middle fossa of the base of the cranium.

On

the opposite side of the

cranium

we

found a bony

pyramid, which projected about four centimetres from

the concavity of the internal table of the parietal bone,
into the brain, carrying the

membranes before

it.

His

companions assured us that he had never been indisposed

before the late wound.

wounded on
fore.

They knew

that he

had been

the head, while in Italy, several years be

Indeed I took notice of a depression,

trix, opposite the exostosis, in

a sabre wound.

It

like a cica

appearance such as follows

does appear probable that this internal

was so gradually formed

commodate herself to it.

exostosis

that nature could ac-

His comrades had remarked, that he persisted

in

what

ever he undertook with the most determined obstinacy.

I

showed

Soemmering

the cranium
at

Munich.

and brain of

this subject to

Dr

MEMOIRS, &C.

312

Peter Auger, a grenadier, was also

wounded by

in the right temple; after penetrating the skin

a ball

and croto-

squamous portion of the tem-

phite musle,

it

poral bone,

and then divided into two pieces, one of

fractured the

which penetrated
itself

into the

cranium, and the other buried

under the temporal muscle.

Symptoms of concussion and compression of the brain

came on at the same time, and rendered his situation critical; I lost no time in dilating the wound, which could
not be done without dividing some branches of the temporal artery. Having secured them with a ligature, I pro
ceeded with the operation, and

laid

bare

the injured

all

portion of the cranium. I soon discovered one piece of

the ball in the muscle, and easily

removed

By means

it.

of an elevator I raised up a large scale of the cranium,

and was so fortunate as

to seize the other piece of the

with a pair of dressing forceps, and extracted

ball

from

its

nidus,

Through

between the dura mater and the

this accidental

of black fluid blood

dressed according to

opening a considerable quantity

was discharged, and

art.

From

this

the

the

an extensive

continued to suppurate several days

ation of the circumference of the

wound

But

wound wa*

time the symptoms

gradually abated, and finally disappeared

wound
exfoli-

took place.

the space thus left, gradually diminished,

catrix of the soft parts

it

craniuni:

and the

was soon completed; he was

ci

dis

charged cured before the forty -fifth day. But the pulsa
tions of the dura

mater could

still

be

felt

under the

cica-

trix.

to

The following cases of wounds

make us acquainted with some

sources

by which nature

is

uncommon

re-

able to rise superiour to the

most unfavourable obstacles, and

functions.

of the head will serve

of the

to

keep up the

vital

CAMPAIGN IN AUSTRIA

313

CASE FIRST.

soldier of the 61st

regiment of infantry, returning

from exercise on the 23d of March, 1810, levelled his

gun in sport at Christopher Cros, of the same regiment,
and under the impression that
fired the piece:

his

comrade,

his

Cros

fell,

was not charged, he

it

and

head was found

to the great surprize of

to

be transfixed by the

longest part of the ramrod, which had been accidentally

Cros was immediately carried

the musket.

left in

to the

hospital of Grosgerau, where Mr. Caizergues* attended

The wounded man had travelled from the spot

where he received the injury to the hospital, distant about
to him.

and a quarter, partly on foot, and partly in a carHe neither bled from the nose nor ears, and his

a league
riage.

functions

were unimpaired when he

arrived.

The ramrod had entered his head in the middle of the

made its exit on the left side of the neck

os frontis, and

ends were of equal thickness, and formed an angle

with the exteriour of the cranium of about two inches.

its

The

singularity of the case,

Caizergues found

and

in extracting

it,

difficulty that

induced

him

Mr.

to call

colleagues together at the hospital.

all his

The

result of the consultation

should be extracted by

tempts, a portion of

its

that this fracture

According

was
to

was, that the ramrod

anteriour part. After

this iron

some

it

was

easily perceived

the consequence of a flaw in the

Mr. Caizergues,

this

fragment was

This surgeon gave me the detail of this case, and

tame time sent me the cranium of the subject of it.
*

Vol.

ii.

at-

rod was broken off by the

pincers which were used and

rod.

th

Rr

at the

MEMOIRS,

314

&C

about fifteen centimetres in length ; neither stained with

blood, nor the substance of the brain.

Attempts were made in vain to extract the portion of

which remained, by the extremity that projected

from the neck. They used the strongest pincers and the

the rod

it, for this end was marked

and crooked by the instruments applied on it.

greatest exertions to effect

It

was decided

that the

crown of a trepan should be

ram

applied on the cranium, as near as possible to the

rod. Contrary to all the precepts of art,

posteriour edge of the occipital

was necessary

and

in opposition

was applied on the

foramen. For this pur-

to the danger of such an operation,

it

up the thick layers of

the trapezius spleneus, and great complexi muscles, and
pose,

it

to divide the vessels

to cut

and nerves

to

come

at the bone.

Mr. Caizergues did not mention the difficulties which he

must of necessity have encountered, nor the phenomena
that occurred during and after the operation.

He

stated that the trepan

was

obliged to resign

expectation of extracting

useless,

merely

and that they were

it,

and

leave the patient to the resources of nature alone.

He

observed that the

all

man

bore the operation wiih great

courage, and retained his intellectual

died on the 25th

inst.

He

faculties.

did not state the

But he

symptoms

tha^tbllowed the operation, or preceded death.

On
the

inspecting the cranium after death, the course of

ramrod was ascertained, and the injury of the parts

was apparent.

The
sinuses.

os frontis

The

was found to be pierced between the

was round, and without fracture,

aperture

and near the size of the ramrod, which then passed

in

a horizontal direction, between the two hemispheres of

the brain, without wounding them, but tore the falx.

It

then penetrated the body of the sphenoid bone, under

the foramen opticum, passed on through this bone, from

CAMPAIGN IN AUiTRIA.

315

the point of the os petrosum, and the cuneiform portion

of the occipital, inclining towards the left condyloid

aphophysis of

foramen, and

Through

this bone,

its

came

out near the occipital

point penetrated the adjoining soft parts.

its

whole conrse, the ramrod had not injured

one important organ. Having

two hemispheres of

passed between the

first

the brain without injuring them,

it

then glanced under the sinus of the carotid artery without piercing

it.

It

was even separated from

this sinus

by

a bony scale, which was almost detached from the sphenoid. In short,

it

was

at a distance

from the third pair of

nerves, and the internal jugular.

The
by

resistance opposed to the rod

their elasticity arrested

firmly fixed in the bones through

On

by the bones, and

progress, and

its

which

examining the cranium of

it

remained
had passed.*
it

this soldier,

two

ques-

tions naturally arrose

What would

1st.

abandoned

have been the

he had been
same time, every ne-

result, if

to nature; while, at the

cessary attention had been paid to his situation and

symptoms? Death appeared to have been inevitable but

at what period would it have taken place? To these que;

we

ries

can give no answer, as

we

did not see him, and

therefore unable to decide on the degree to

which

his animal or organick functions were impaired.

This

were

inquiry appears to have been

2dly.

mg

What

entirely neglected.

advantage could be derived from apply

the trepan, admitting that

ed without danger?

When

it

could have been effect-

the pincers and other

means

used to extract the ramrod had proved ineffectual, the

See plate XI. where a drawing

as

it

the

was pierced with the ramrod.

museum

is

given f this head

now deposited in

It is

of the faculty of medicine at Paris.

MEMOIRS, &C.

316

trepan could hav* been of no service.

It

was

therefore

unnecessary. Bat setting aside the difficulty of applying

it

on

this part of the occiput, did

fatal to the patient?

prove injurious and

it

The cerebellum may have been

in-

jured by the teeth of this instrument, or at least the dura

mater may have been wounded

were of very

ture

rent parts, and

for the

edges of the aper-

different degrees of thickness in diffe-

wc know that the slightest punctures,or le-

sion of the cerebellum, are sufficient to produce death.

The

caution laid

down by

authors

is

then well founded,

namely, never to apply the trepan on the cranium, be-

low

the line of demarkation,

between the cerebrum and

cerebellum.

Without

attributing the death of Cros to the opera-

tion, I think

it

would have been more reasonable,

the attempts which were

body, to have
Besides,

it

left it

made

undisturbed, and awaited the event.

more dangerous by

could scarcely prove

presence, that by the injury which

duced

in the interiour of the

On
that

after

to extract the foreign

it

its

had probably pro

cranium.

opening the cranium after death, I was convinced

it

might have remained some time without destroy-

ing the patient, as no organ

was

injured by

it.

CASE SECOND.

Among

the

wounded

of the line

who were

not able to

bear the transportation from Reneveck to Vienna, and

were

my

name
as

therefore united to the

care,

was a remarkable

of the

he had

faculties.

wounded
case.

of the guard under

I could not learn the

young man, (about twenty-one years of age)

lost all his senses,

The organick

and almost

functions

were

all

his

still

animal

nearly in

CAMPAIGN
natural state.

tjheir

of Eslingen

by a

He

ball,

317

IN AUSTRIA.

had been wounded

and a

in the battle

wound remained in
The eye of the

fistulous

his left temple, near the orbit of the eye.

same

side projected outwardly, and

powers. But he could

still

had entirely

lost its

discern light and large ob

The left half of the cranium was

more arched and voluminous than the right
When the temporal region was examined by the eye or
touch, a space as large as the finger was perceived to ex

jects with the right eye.

evidently

tend upwards and backwards, in a semicircular manner,

along the course of the coronal, as far as

the sagittal

which

suture. It

was

its

junction with

evident that this space, in

the finger could be placed,

was produced by

a se-

paration of the frontal and parietal bones.

Authors give us many cases of the separation of the

bones or sutures of the cranium, followed generally by

But

death before the ninth day after the accident.*

never saw a case

like this, in

beyond the ninth day.

We

which the patient survived

shall

be better prepared to

appreciate the resources of nature in such cases,

the appearances are given which

we

when

discovered on open

ing his cranium after he died of the hospital fever, then

very general

in

our wards. At that time, his

wound was

nearly healed.

This

moved,

man
in

always continued lying

in

bed, and seldom

consequence of the paralysis of

muscles

his

His appetite and digestion were good. Respiration,

culation,

and

eir

secretions, continued to be regularly per

formed.

After examining the head carefully, and probing fhe

wound, I discovered a hard body deeply seated near the
orbitary sinus.

I dilated the superiour part of the sinus,

and with a strong pair of pincers extracted the

*

See memoirs of the academy of surgery,

ball.

Vol.

I.

It

MEMOIRS, &C.

318

was then moveable, though

at first it

was

firmly fixed in

the bone.

After extracting

this ball,

which was

tened, I discovered a deep cavity, and

The wound was

of the brain.

dry

irregularly

felt

flat

the pulsation

dressed superficially with

and he took bark, wine, and antispasmodicks.

lint,

After

operation,

this

which was

in

August, he ap-

improve, and the enlargement of the suture

peared

to

seemed

to diminish gradually.

When

I set out for

France,

November, we were in expectation of his

recovery five months had now elapsed since he was
wounded. After the ball was extracted, he talked likt a
about the first of
:

child

which

is

beginning to stammer: for example,

just

he expressed an affirmative by the word baba, and a negative

by

/a/a,

and when he asked

cibly pronounced the

any thing, he

for

words dada or

tata.

About

ginning of December, of the same year, he

fell

for-

the be-

a victim

to the hospital fever:

The surgeon of

the hospital

at

Reneveck was

obliging as to send the head of this

cask

filled

man

so

to Paris, in a

with a solution of hyper-oxygenated muriate

of mercury.

Mr. Aumont, an expert hospital-surgeon of the guards,

proceeded

and

soft

to dissect

it

in

my

presence.

The integuments

parts about the cranium being carefully removed,

he divided

this

bony case vertically, from

side to side, that"

we might be able to see the disorder occasioned by the

in its anteriour part.

adhering

We

to the sutures: it

had acquired great thickness

and strength along the parietofrontal suture, which

dilated.

The

the fracture

ball

found the dura mater strongly

was

circumvolutions of the brain contiguous to

were

effaced,

this portion of the

and the membranes covering

cerebrum were

also very thick

and

adhered to each other. After detaching these membranes

and raising up the brain,

we

discovered an aperture in

CAMPAIGN IN AUSTRIA.
the frontal,

319

below the angle of the temporal bone, and be

hind the external angular apophysis.

The edge

of this

aperture, of about three millimetres in diameter,

round and polished,

had formed

in

opening similar to the same process

in this

in soft parts. Externally,

ly

was

consequence of a cicatrix which

and anteriourly and superiour-

might be seen a cicatrized groove, which extended

to

the distance of three centimetres towards the most pro

minent part of the

was once a

frontal

fracture; a

little

bone on the same

further behind

side.

we

This

found the

parieto -frontal suture, thin and transparent with large in-

which scarcely touched each other, and two

lines which ran parallel with the suture, at an unequal distance from each other, and disappeared when they came near the sagittal suture.
dentations

curved transparent

The

tenuity

and imperfect

ossification of the coronal

suture, and the transparent lines marked out the separation which I had discovered while this soldier was alive.

Near

the orbit, I

end of the thumb

saw a depression which admitted the

It was evidently formed by the exter-

nal portion of the orbitar plate of the frontal bone, which,

being fractured by the

after

side of the orbit,

thus destroyed

its

ball,

had pushed down the

compressed the globe of the eye, and

vision.

This piece of the frontal bone had been detached by

was now re-united by a membranous sub

which was ossified in particular parts, when he
died finally all the soft or hard parts injured by the ball,
after undergoing a new organization, were cicatrized, and
the ball, and

stance,
;

made every arrangement for completing the

this man, when he was carried off by the conta-

nature had
cure of

gious disease.

But he must have laboured under

lona time after his
-

wound had

serious infirmities a

healed.

For besides the

appearances noticed in the fractured part, the

left lateral

320

MEMOIRS, &C.

part of the cranium

was much enlarged, while

there

was

a perceptible diminution of the transverse diameter of

the orbit on the

wounded

This curious case points

side.

out the resources of nature, even in the most desperate

circumstances.

few

I shall indulge in a

which

above case
of

its

of

a separation so

existence,

my

reflections

were

colleagues,

The ball having

uncommon

in

as to raise doubts

not attested by a

it

who saw

it

with

me

great

number

before his death.

rrived at the end of its rectilinear course,

entered at the part where the

frontal,

on the manner

extraordinary separation was produced in the

this

indented e^ge of the

the anteriour and inferiour point of the parietal,

and the extremity of the ala of the sphenoid bones meet,

and leave a space imperfectly

ossified.

The

ball separated

these bones, and the weakest and most fragile

was broken,

and pushed

into the orbit, while the

and

bones were separated at the same time. In

this

parietal

space the ball continued to act like a wedge, and the

was displaced and

which commenced while the

separation gradually increased until

extracted.
ball

edges of the frontal

still

The

ossification

it

now closed up this vacancy, and united

new suture, the limits of which were ea-

remained,

the bones

by

osseous vessels of the indented

sily seen: that is to say,

edges, which were separated, expanded themselves so as

to

fill

up the

interval,

tisses to unite,

grow

If well-directed
at first,

and the

and

to

form other tenons and mor-

together, and form a suture.

and cautious attempts had been made

ball extracted, the tedious operations of

nature might have been

much abridged

not ground to fear that

might be driven with fragments

it

of bone into the cranium and

wound

but

was

there

the brain, or produce

alarming haemorrhage from the deep temporal and meningeal arteries? I

am

was adopted. Besides,

of opinion that the wisest plan

it

is

difficult,

nay impossible

to

CAMPAIGN
establish certain

321

IN AUSTRIA

and invariable

rules relative to the ex-

traction of foreign bodies; the

knowledge and sagacity

of the surgeon must supply these, and hence this is the
most difficult part of military surgery. The following fact
supports this opinion.

At

the battle of Eslingen,

wounded by

Bazamon, a

chasseur,

a ball,

right side of the face,

and buried

deeply in the right

itself

lateral part of the neck. It entered at the right

the

mouth,

laid

open

this part,

uncovered the

mutilated his face. Several of the molar

jaw were broken

riour

was

which passed obliquely through the

and

teeth of the infe-

appeared

off; the ball

angle of

teeth,

have

to

turned obliquely to the right of the base of the tongue

outwards and backwards towards the pharynx, then be

hind the sterno-mastoid muscle into the space betwixt
the transverse apophyses of the fifth

vertebrae,

where

Though
thought

it

it

was wedged

well aware of the course

most prudent to

make no

I first attended to the complicated

pared off

its

and

sixth cervical

it

had taken, I

in.

attempt to extract

wound

it.

of the face,

edges, brought them into exact apposition,

and retained them so by

five sutures,

and a proper ban-

dage. They soon united, and the wound healed in a few

days without deformity. But he always complained of

very acute pain

suspected to

in that part

be lodged.

He

where the

foreign

body was

uniformly inclined his head

and when the integuments of the neck

uttered
in the vicinity of the wound were touched, he
the most piercing cries. Tetanus had supervened; he

to the opposite side

could not

move

his

jaw, deglutition was

difficult,

and he

continually discharged a bloody froth from the mouth;

emollients and anodynes were applied externally, for

with

difficulty

Vol

it

could he swallow a portion of broth,

and a

MEMOIRS, &C.

322

few spoonfuls of the milk of sweet almonds, with theaddition of nitre and opium.
Besides the symptoms just noticed, those which attend
effusion into the cavity of the

thorax succeeded, namely,

pain in the side, affected stertorous cough, with bloody

expectoration, difficulty of respiration, and an inability
to lie

on the unaffected side; small accelerated pulse,

burning heat, and frequent sensations of suffocation. All

the muscles of the

arm and neck nearest

head to the

H^

left.

wound were

with an obstinate contrac

in a state of tetanick rigidity,

tion of the

the

laboured under anxiety

and insomnia, and when obliged

to

be moved, he expe

rienced great pain.

Without being able

ball, I

to decide exactly

was persuaded,

veral surgeon majors,

cal surgery, that

no

on the

seat of the

in opposition to the opinion of se

who attended my

lectures

on

clini-

and
symptoms which had taken place depended on the irritation of the cervical nerves, which
were either ruptured or strongly compressed by the ball
effusion existed in the thorax,

that the alarming

We persisted in the use

ternally.

About the

of emollient applications ex-

fifteenth

day an erysipelatous red-

ness appeared on the right inferiour part of the neck,

and extended
fluctuation

was now

to the

thorax

an obscure and deep seated

was perceived under it. The expectoration

and the symptoms which had induced

purulent,

the belief of effusion

now

disappeared.

The

local pain

was more
nued to increase.

lancinating, and the tetanick affection conti-

The imminent
of several

clanger of the patient, and the existence

symptoms

indicating that the ball

was wedged

between the transverse apophyses of some of the

vical vertebrae, induced

me

to

last cer

plunge a bistoury in the

lowest angle of the triangular space

left

between the pos-

terior edges of the sterno mastoideus, and the anteriour

CAMPAIGN

323

IN AUSTRIA.

edge of the trapezius. The edge of the instrument was

directed gently outwards to avoid the jugular vessels, and
to arrive

was

tion

with greater certainty at the

and

difficult

painful, but I

This opera-

ball.

was so fortunate
much trouble.

as

seize the ball,

and to extract

was

and wedged under the transverse process

flattened,

it

without

It

of the sixth cervical vertebra.

soon as the operation was completed, he

As

lieved,

and

soundly for three hours

slept

he had slept since he was wounded.

toms disappeared:

in short,

we had

The

the

felt re-

first

tetanick

time

symp-

every promise of a

speedy cure, when a purulent discharge took place from the

new wound, mixed

with bubbles of air at every inspira-

We could no

longer doubt the communication of

ration.

the

wound with

the substance of the lungs,

bable that a purulent

fistula

and

it is

had formed between the

proseat

of the ball, and the nearest lobe of the lungs.

The wound remained

covered
It

is

a long time fistulous, but he re-

finally.

evident that

if

had not dared

to

plunge the bis-

toury deeply into the neck to extract this ball, the disor-

der occasioned by

have increased

it

among

until death

the cervical nerves must

would have been the conse-

quence.*

was admitted into the hospital at Reneday after the battle, for a tumour on
seventh
the
on
veck,
the abdomen, about two inches from the umbilicus on
grenadier

the right side. It

was

as large as the first

covered with

a considerable ecchymosis, and fluctuated.

One

of

my

* This man appeared a second time in my hospital at

injury of the
Paris with a disease unconnected with the
then sound and
were
wounds
the
of
cicatrices
The
neck.

firm.

MEMOIRS, &C.

324-

colleagues
effusion.

tion

He

was

As

of opinion

that

was a sanguineous

it

me

he wished to see

before

the opera-

was performed, he was brought to my hospital

had no symptoms of strangulated hernia. This tu-

mour disappeared when in a horizontal position, and re

ruined when he rose The nature of this tumour could
not be mistaken, and we decider! that it was formed by
the epiploon, and the intestine.

He

had been grazed by a

when near th end of its course. His jaeket, and the

skin of his abdomen being pressed on by this ball,
ball

had yielded

to its action,

but the rectus and the aponeu-

abdomen being less elastick, were ruptured

ventral hernia was instantly produced. The diges-

rosis of the

and a

tive functions

were

at first disturbed,

of the part followed, as the rupture

scarification of the

compression,

but no strangulation

was extensive. Rest,

tumour, camphorated wine, gentle

emollient

enemata,

acidulated

diluting

drinks and regimen, prevented inflammation of the

testines,

the

in-

and removed the symptoms which appeared

at

commencement.

The

was

hernia remained, and he

put on the pension

list.

It is

more than probable that in this case a button

money intervened between the ball and the

or a piece of

seat of the hernia,

and thus increased the

In the three following cases, the

ball

injury.

meeting with no

hard or prominent part, while passing over the exteriour

of the abdomen, after depressing

its

walls in an uniform

manner, produced a more deep-seated injury of the

or-

gans, as will be evident.

An

artillerist

came

to the hospital of

Reneveck

several

days after the battle of the 22d his abdomen was

:

much

tumefied and distended, without perceptible fluctuation,

CAMPAIGN

325

IN AUSTRIA.

and

his respiration difficult, his face livid

len, his inferiour extremities painful,

slightly swol-

heavy, and

stiff,

and accelerated.
immediately prescribed moderate venisection

and

his pulse small

in the

arm, and extensive cupping over the thorax and abdo

men. He was put on the use of diluting laxatives and diu

These means had produced a moderate im

reticles.

provement of the symptoms, and he felt himself better

But his abdomen still remained distended, and an ob
scure fluctuation
la;

was perceived

in

it.

I directed

two

ge vesicatories to be applied on the hypochondria and

abdomen, and they proved highly beneficial.

Shortly after, a fatal remittent fever came on, and he
died on the fifteenth day after entering the hospital.
During the three last days of his illness, the abdomen in-

sides of the

creased greatly in size.

after his death, we

Twenty-four hours

The
tity

first

opened the body.

abdomen allowed a large quanbloody serum to escape; this was a portion

incision into the

of black,

of a considerable effusion of fluid, with

minal viscera were covered.

The

which the abdo-

intestines

were

slightly

tumefied, and injected with blood of a brown colour.

The epiploon livid, the liver and spleen enlarged, and
o-or'red

with blood.

The

tained clots of blood,

ed,

and we

found

was surprized

lungs were also

in the cavities

quantity of a similar
I

the.

effused fluids of the pelvis con-

much

obstruct-

of the chert a large

iluid.

that this

man had

survived so long

informed us that bring exhausted with fatigue after

place, where he
the battle, he laid himself down in a low
and that he
him,
supposed the balls could not touch

He

over his
should not have perceived the passage of the ball

abdomen, but from the noise

it

produced

a few steps before him, carrying

in

rebounding

away some

buttons of

MEMOIRS, &C.

326

and giving a violent shock to the abdomen.

his jacket,

v*as then unable to rise

to his quarters,
that his injury

and walk, and was carried

where he remained a month, supposing

was

not so severe as to require admission

into the hospital.

The abdomen was

painful,

and

An

slightly inflamed.

ccchymosis appeared about the umbilicus, which he bathed

brandy. His disease grew worse, and he Was con

in

veyed

to the hospital,

where our assistance proved una

vailing.

Rene
tal

with symptoms exactly similar to those

The

ceding case.

were

and the undulation of a

ascites,

pre

in the

evidences of sanguineous plethora

conspicuous, and he seemed to labour under

less

cavity
first

same hospi

Taillandier, a grenadier, entered the

was not

fluid in the

abdominal

We

doubtful, as in the preceding case.

used cups, rubefacients, light drastick purges, and

diureticks.

of the

These proving of no advantage, and the

abdomen

increasing, I resolved

to

size

puncture

it.

Monro, with a small canula, and

made the puncture much below the part pointed out as
most proper by authors. Six or seven litres of a fluid
I used the trochar of

the above case

precisely similar to that in

charged, which,

when

few minutes, deposited a large quantity of

The viscera of the abdomen appeared

state,

and

was

was

dis-

permitted to remain at rest for a

fibrina.

to

be

in a

good

willing to attempt a radical cure, or

rather to meet the existing indications. It appeared to

be necessary to evacuate

which remained

For

this

down

all

the fluid and clots of blood

in the circumvolutions of the intestines.

purpose, I introduced a blunt pointed bistoury

along the groove of the canula, and

sion of about

made an

inci-

two centimetres downwards, following the

fibres of the external oblique.

A large quantity of blood,

CAMPAIGN IN AUSTRIA.

327

was discharged. Camphorated emwere made over the abdomen, and a suita-

partially coagulated,

brocations

ble bandage, &c.

He was

put on the use of sto-

at intervals,

and as no inflamma-

applied.

machicks and laxatives

tory symptoms supervened, I applied a large vesicatory

on the abdomen. During the first fifteen days, there was

no appearance of a new collection, and I began to expect
his recovery, but he

and

seized with rigours and a fever,

finally, a legitimate ascites

ten litres of the

The
left

was

common

was formed.

drew

oft'

yellowish serous fluid~bf ascites

operation had been repeated several times before I

him

at

Vienna.

man

This

informed us that his abdomen was injured

by a rebounding

The

he was putting on his knapsack.

was not so great as in the forego-

ball, as

internal disorder

ing case, though the vessels of the peritoneum and viscera

were diseased

same manner, and to the sero -sanwas added the accuperitoneal serum which could not be ta-

in the

guineous effusion which followed,

mulation of the

ken up,

in

consequence of the debility of the absorbent

system.

third soldier

was

injured in the

same

lay on his back, he informed us that he

bounding

abdomen.
to

ward

it

for the last time,

As

battle.

saw a

and threatening

he

ball re-

to fall

on hi>

He

suddenly raised the breech of his musket

off;

but a

moment too

late.

The

ball

had

rolled

over his abdomen like the wheel of a carriage, with a

rapid motion.

The walls

of this cavity were immediately

inflamed, and he afterwards had some transitory symp-

But he always remained an invalid from

toms.

that

time.

chasseur

in the

was wounded

middle of its course.

in the

same buttle, by a half

away the skin, a por

It carried

MEMOIRS, &C.

328

tion of the left os ilium, the insertions of the large

abdomi*

laid bare a portion of the

abdomen, and

nal muscles of the

sigmoid curve of the colon. The subsequent symptoms

were

we

very alarming, and

at first

despaired of his re-

covery. But on the 21st day, the eschars

granulations

wound

were thrown

in a short time.

and covered

out,

Some

came away,

this

enormous

portions of bone exfoliated,

and the cicatrix was then speedily completed. He completely recovered his health, and set out with us for
France.*

Two
the

soldiers

same

were wounded

in the urinary

organs in

In one, a grenadier, the ball entered the

battle.

right buttock, thence passed through the pelvis,

and came

out in the left groin, after penetrating the bladder ob-

from below upwards, and from right to

liquely

During the

twenty-four hours, the urine

first

left.

was

dis-

charged through both wounds, but afterwards passed

may

through the natural passages. This

dinary, but

if

we

place in gun-shot

we may
is first

attend to the

wounds during their different stages,

when a wound of this kind

easily conceive that

made and

cus, with

which

dilated,
it

separation

is

it

permits the fluids of any vis-

communicates, to have free egress;

because the edges of the

this

appear extraor

phenomena which take

wound

increased

by

are

still

separated, and

the evacuation of the

vessels.

In the second stage, which always begins at the end of

the second clay, the edges of the

and swollen. They come

tures of the

wound

in

wound

are obstructed

contact and close the aper

thus preventing the discharge of

urine, or other fluids through them.

During the campaign on the Rhine, I saw several

were afterwards perfectly

cases of similar wounds, that

cured.

CAMPAIGN IN AUSTRIA.

329

In the third stage, which begins between the seventh

and ninth day, the sloughs fall off, the wound is opened,

and the urine again escapes through it.

During the first stage of a gun-shot wound, the urine
with difficulty insinuates itself into the cellular membrane through which the ball has passed, because
cells are obstructed

by the

traction of the injured parts.

parts

its

and subsequent conDuring the third stage, the

friction

which have been disorganized slough

off,

and the

wound being

thus opened, the urine insinuates

the cellular

membrane, and produces most alarming

inflammation and gangrene. After hav-

symptoms,

viz.

ing dilated a

and dressed

it

wound communicating with

according

to art,

gum

urine

is

thus

drawn

off

the bladder,

elastick catheter

should be passed into this viscus, where

The

itself into

it

must be

from the internal

left.

orifices of

wound, and it heals in a short time.

Thus we treated this man, and others with

the

wounds, many cases of which

different campaigns.

open

until the injured

The

other soldier

ed his legs to

fire his

have seen during the

The wound

similar

of the buttock remained

bone exfoliated, and came away.

who was wounded,

had just extend-

piece at a body of the

enemy which

approached on the flank, when he was struck behind by

a ball of moderate size, from the batteries of Eslingen,

which passed through the upper part of the space between his thighs, carrying away a portion of each, with
the

margin and cutaneous sphincter of the anus, the skin

of the perineum, the bulb of the urethra, the skin of the

scrotum, and the right

testis.

The

was ruptured near the abdominal

was denuded, and the skin of

tis

torn.

Vol

it

Tt

right spermatick cord

ring, while the

left tes-

the penis and prepuce

MEMOIRS, &C.

336

He was

as dead on the field of battle, but after se

left

was brought

veral hours, he

peared

It

with the greatest care.

it

was

ambulance, and thence

be incurable, and he was so mueh debilitated, I

to

dressed

to the

Reneveck. Though the injury ap-

sent to the hospital at

necessary to cut

first

away

several flaps of the

disorganized parts, to take up the spermatick arteries,

and several branches of the gluteal, which bled

cut off the

ragged

parts. I inclosed the left testis

portion of the dartos,

gether as possible,

'I

with

it

lint,

in the

which remained sound, and brought

the irregular edges of this extensive

dressed

when

by a

split roller

&c, as

wound

as near to-

of fine linen, and

usual.

he laceration of the organs of generation, the injury

of the internal organs, and the effusion

ol

urine into the

wound, produced the most acute symptoms, namely,

sea, occasional

tions

from the

fainting spirits

in-

nau

tense pain, painful anxiety, ardent thirst, insomnia,

vomiting and fever, with convulsive moleast accidental irritation.

by promises of a

I supported his

final cure,

and he bore

the frequent and painful dressings most heroically.

To

prevent the effusion of urine into the wound, I

passed a

gum

catheter into the bladder, though a great

part of the urethra

was

destroyed. But

owing

to the in

flammation which had extended to the bladder, he could

not retain

it

there,

and I was

in

this respect obliged to

had him dressed with great care under

A copious suppuration came on and re

trust to nature. I

my

inspection.

moved

the inflammation of the neck of the bladder and

the retention, to which succeeded an almost habitual in

continence of urine, while on the other hand a retention

of the foecal mater took place from the contraction of the
sphincter of the anus, in consequence of the destruction

by suppuration. For twenty-one

wound he had no alvinc evacuations frc-

of cellular substance

days

after the

CAMPAIGN
<^uenl

enemata and

move

it.

On

IN AUSTRIA

suppositories

were

foecal

as the

symptoms were aggravated by

matter extending up beyond the rectum, and

removal by

its

insufficient to re-

examination I discovered a mass of har-

dened

isted for

33.1

art

for this

a necessity ex-

it,

purpose a dilator and

He was much
symptoms heretofore

seoop were successfully used.

this

operation and the

now

declined, and the fever

left

him.

He

in ceasing

calmly

slept

several hours, for the first time since the accident.

continence of urine gradually passed

wound approximated, the

off,

The

charge his urine through an

orifice

in-

the edges of the

was

cicatrix soon formed and he

cured before the fourth month. But be continued to

in the

by

relieved

dis

which remained open

perineum near the beginning of the urethra, the infe-

riour wall of

which had been carried away by the

Constipation

was prevented by the

and

positorics, encinata,

ball.

frequent use of suppo-

suitable diet

this

was

a remar-

kable cure.

In reverting to the consequences of the battle of

gram

I shall

speak of some

uncommon

the shoulder joint and of the leg and

We

now made

at

foot.

preparations for crossing the

and attacking the enemy

Wa-

amputations

in his lines

on the

left

Danube
bank of

this river.

All our wounded and such as were invalid were sent

to

France.

On

guards marched

the

first

bridges had been thrown

Eslingen. At four

p.

Lobau.

under the

command

army and

the

same place where

over before the battle

m. the troops

island of

was

of July the

to cross the river at the

flotilla

were united on

with

of count Barte

of
the

3000 land troops

(now

rear admiral)

prepared to cover our passage over the further

arm

of the river and to attack the advanced posts of the ene-

my who
It

were entrenched on the

was intended

to

left

bank of the Danube.

carry every operation into effect at the

MEMOIRS, &C.

332

game instant, and the order of attack was given just as

a most violent storm burst upon us. The report of the
artillery of both armies, was heightened by reiterated
and loud

claps of thunder

accompanied with

hail

and

torrents of rain. So complete was the darkness that we

could distinguish nothing except by the flashes of light

ning or of the

Notwithstanding these formi-

artillery.

dable obstacles our troops

made good

their landing

on the

opposite bank, possessed themselves of the enemy's batteries

and immediately formed on the plains. Several

now thrown over at once and the whole ar

bridges were

my

effected a passage in

surprised by

The enemy being

operations

moved

the lines of

we

hot, but their

was

before

new position on

which a general though

in

each other during the night and at

attacked them again.

The

contest

grew

wing was soon broken and gave way

left

and the enemy's

celerity of these

fought in the evening. Both armies

in sight of

day break

the

precipitately to take a

Wagram,

decisive battle

remained

few hours.

right

and the centre kept

in

was

Danube
reserve com-

closely pressed on the

check by the corps of

posed of the imperial and royal guards, while his ranks

were thinned by

the fire of the artillery,

to thunder on every side.

were

At

which seemed

length the Austrian lines

carried, their divisions dispersed or destroyed

the terrible execution of our cannon,

by

and the victory was

complete.

With my

flying

ambulance I followed the movements

moment, and we dressed

wounded on the ground as fast as they were brought
up: but the number afterwards became so great, that I
of the guards

till

the decisive

the

found

it

village

many

necessary to establish a hospital

in the

nearest

whither the wounded of the guard and a great

officers of the line

were conveyed. Before night

500 wounded were collected

at

my ambulance. The ma-

CAMPAIGN
jority of

other

whom

being severely wounded by cannon or

shot required

important operations.

necessity of immediate amputation

confirmed.

And

do not hesitate

a large portion of our

in

Two

twenty four-hours.

that the

demies afforded

to say, that

of our guards
fell

members

me

Here

was most

but

the

evidently

without

wounded must have perished

amputation at the hip-joint

confess

o30

IN AUSTRIA.

who

it

with-

required

victims to delay. I must

of the faculty and the aca-

little

encouragement

to

under

take these operations, and though the success obtained by

me

in

sive, I

as I

others of a character nearly similar had been deci-

was induced

to omit extirpation in these cases.

had not the most

satisfied

distant

with the application of a

Wounds which were

trochanter.

common

insisted

cries; their pain

was

on the operation

me

Their

intolerable.

quest and the reiterated solicitations of

led

dressing to

attended with fractures of the great

But these men

with incessant

And

hope of saving them, I was

my

re

colleagues

though unwilling, to undertake the extirpation of

the thigh.

Seven hours had elapsed since they were woun-

ded. I did not entertain the least expectation of their re

covery, and in undertaking the operation thought only of

removing the cause of

tacle

their pain,

and a distressing spec

from the sight of the wounded.

According to

my plan

moral artery; after

I first applied a ligature

this the vessels

were

tied,

on the

fc

and the ope-

ration completed in fifteen seconds without loss of blood,

and both these men immediately became calm and one

of them

The former had a pulse scarcely per

was nearly exhausted; befell into a
and
died three hours ait;>r. The se
Upothymia
fell

asleep.

ceptible, his strength

state of

eond passed the remainder of the night with composure

in a state of extreme prostration. I saw him at

ihough

four in the

repose;

morning and

when

retired to take a

I returned at six o'clock he

few moments
had expired.

memoirs,

334

6a-

I have long since observed, that

when

large

wounds

haye been received near the trunk, a species of disorder,

or violent spasm, seizes on the nerves of organiek

and

destroys the patient, unless,

made

When
tem,

life,

mu-

indicated, the

limb be instantly removed, or the proper incisions

tilated
"be

when

remove

to

very

it is

sequences, as

the cause of the irritation.

spasm has invaded the whole nervous

the

difficult, if

was

not impossible, to arrest

sys-

con-

its

the case in the foregoing. Internal

had been directly impaired, and had suffered most

functions had ceased, while those of animal
still

In both cases

going on.

the

life

life

its

were

pulse disappeared

and there was scarcely any respiration, when

moved his limbs, and cried out, and still ap
them
one of
entirely,

peared to see and understand.

I
ly

am

quired
as

of the opinion, that

if this

operation

were

instant

performed by an expert surgeon, when the wound

it,

as in these

amputation

eases of

The

at

two

cases,

it

re-

would succeed as well

the shoulder-joint, but

few successful

which were formerly recorded.

army being encouraged by

surgeons of the

surprising success

humerus,

in

my

which attended

first

the correctness of

the

the extirpation of the

campaigns, and being convinced of

my

principles,

have since performed

the same operation with courage; and, to the immediate

practice of

it,

a great

number

of our brave fellows

their lives. I shall report the cases in

it

at the battles of

support

mance

Eslingen and

my principles

which

Wagram. These

and practice

owe

performed
cases

relative to the perfor-

of amputation on the field of battle, and teach us

to disregard the opinion of

advise us to postpone

it

Faure and

until the

his partisans,

who

wounded have been

brought to the hospitals, and the primitive symptoms

have ceased.

He

produces fear

in the soldiers,

pretends that the sight of operations

and hastens the death of

CAMPAIGN

My former answer to

the wounded.

may

335

IN AUSTRIA.

the latter objection

The encouragement which the wounded mu-

suffice.

each other under operations, and the con

tually aftbrd

fidence which

the

wounded attended

when

soldiers feel

to

under the

they se?

of an enemy,

fire

the

com

pletely refute the former. Inexperience, or pusillanimity

alone could admit such

tion of a limb

the circle of

is

difficulties.

"

The

surgical amputa-

the most philosophical operation within

human knowledge,"

says the celebrated

Du

who are our cotem

fouard. And
poraries, call this operation cruel and barbarous. The
truly intelligent, bold, and experienced man can alone
know and appreciate the wonderful effects of amputation.
I can now call on a crowd to witness its efficacy, who.
yet celebrated surgeons,

without

it,

must have passed

now notice
gen and Wagram.
I shall

At

my

the gates of death.

a few cases that occurred at Eslin

the latter engagement, the first

ambulance was

of light artillery.

brought to

A large ball had carried away a part of

his right shoulder,

ticulation.

who was

general Daboville, then colonel of

and fractured the scapulohumeral

ar-

large portion of the pectoralis major, the

and latissimus dorsi muscles were torn away,

and the acromion and humeral extremity of the clavicle
were fractured. The head of the humerus was broken in
deltoid

to three pieces,

was wedged

and driven into the

axilla.

into the brachial plexus,

nerves broken.

The

axillary artery

One

of

them

and several of its

was much

distended,

and ready to break. An aneurismal dilatation had alread}

taken place in it. His pulse was scarcely perceptible, and
death seemhe appeared to be in articulo mortis. Indeed,
the sup*
under
hesitated
that
I
ed to approach so rapidly,
operation. But
position that he could not live under the

MEMOIRS, &C.

336

I resolved to go through with

it,

more with an expecta-

tion of relieving his pain, than of seeing

Th

my

operation

was performed

in a

him

survive.

few minutes, and,

Had

great surprise, succeeded completely.

it

to

been

delayed in this case a few minutes longer, he never

would have gathered the

A
to

which he deserved.

laurels

was

portion of the pectoralis major

tie

the artery

above

its

dilated part.

where he

a miserable bed of straw,

he was sent to Vienna. During

times

fell

into syncope,

cut up in order

Me was

placed on

lay very quietly until

this period,

he several

and 1 was apprehensive

that

he

could not support the fatigue of this short journey, and he

was

therefore

removed among the

last.

conveyed him

on a sedan prepared for the purpose. The dressings were

renewed, but the pieces

in the deepest part of the

were only changed every

His wound was very

fifth

large, but he continued calm,

spoke with a more audible voice.

hours of the

first

wound

day.

He

and

also slept several

and second night. The dressings were

simple, and performed under

Mr. Therrin, surgeon major of

my own
artillery.

inspection,

The

by

colonel's

strength gradually returned, and in a short time he could

use light food,

and was cured perfectly

in three

months

Case second

Mr. Rodelsturdz, a major of the 92d regiment of

fantry,

was brought

to the

lar injury of the shoulder-joint.

But he retained a greater

degree of strength, because he had

it

lost less

blood.

The

was immediately performed. In both these

was impossible to preserve the flaps, and the

operation
cases,

in-

same ambiddnce with a simi

CAMPAIGN
wounds were

337

IN AUSTRIA.

therefore very large, with great loss of sub-

and they healed very slowly. The major did well

during the first nine days, but tetanus appeared on the
night of the ninth, and gave us serious alarm. Its prostance,

and must have proved fatal, unless the

most energetick means had been used.
The tetanus had attained its acme and most perfect
character on the third day. The jaws were locked and
gress

was

deglutition

rapid,

was

difficult.

the internal exhibition of

Epispasticks to the

wound and

opium were of no

avail.

had come away, and I was sure that

none of the nervous branches had been included in them.
I resolved to apply the actual cautery, particularly on the
All the ligatures

most painful parts of the wound. An iron of a white heat

was applied once on that part whence the pain seemed to
pain, but immediately
rise. It was attended with acute
produced a copious sweat, and a perfect calm. The musthe functions
cular rigidity was immediately removed,

were
nick

re-established,

symptom

in

and he was relieved of every

a few days.

The

teta-

superficial eschars,

produced by the cautery, sloughed off, the wound healed

in
over without further delay, and he was quite cured
ninety days.

CASE THIRD.

regiment of the line,

Louis Picard, captain in the ninth
humerus fractured by
had the superiour extremity of the
arm near its superiour
a ball, which passed through the
articulation.

The

injury of the soft parts

was

less exten-

cases, and I was enabled to

sive than in the preceding
flap: I followed the plan
form an anteriour and posteriour

Vol n

Uu

MEMOIRS, &C.

3o8
laid

down

in

my

campaign

in

Egy pt. These two

flaps

soon united, and the captain was perfectly cured in six

weeks.

CASE FOURTlf.

Charles Jouffroy, an

wound

artillerist

of the guard, received a

nearly similar to the preceding. But in the latter,

the ball had injured the parts so that the

not be formed, and I

Ledran

was obliged

two

flaps could

to follow the plan of

he also recovered.

CASE FIFTH.

Claude Levert, a grenadier, had

his left

tured, near the superiour articulation,

The

deltoid, pectoralis major,

humerus

frac

by a cannon

and latissimus

dorsi,

ball.

were

chiefly destroyed, the capsular ligaments lacerated, the

acromion fractured, and the head of the humerus

di-

vided into two pieces, and luxated towards the sub scapu
lary

fossa.

I extirpated the humerus according to the

indications presented

no

flaps

The

by the wound, but could reserve

yet this extensive

wound

gradually

filled

diarthrodial cartilage of the scapula exfoliated

grees, a vascular granulation

was thrown

up.

by

de-

out from the

glenoid cavity, and united with the vessels and surround

ing soft parts to complete the cicatrix.

CAMPAIGN IN AUSTRIA

339

CASE SIXTH.

Peter

Girardel, of the artillery,

received a severe

wound of the shoulder, in the same battle, on the 6th of

July. The humeral extremity of the clavicle was fractured, and three ribs laid bare
pectoralis major.

The

by the destruction of the

axillary artery

was broken

in the

brachial plexus, and produced an aneurysmal tumour of

the size and shape of a pigeon's egg; hence

cult to tie the vessel,

and

was

it

was

diffi-

obliged to dissect up to

the clavicle, to apply the ligature above the dilated part.

He

bore

it

heroically,

and the operation was completed

without accident. His symptoms were alarming for

se-

veral days, abscesses formed above the clavicle towards

the latissimus dorsi, and under the scapula

made

sions into them, and dressed them according to

edges of the

wound were approximated by

vessels of the periosteum of the ribs

tions,

and united

in the

quite cured in four

ject of the

art.

inci-

The

degrees, the

thrw out granula-

formation of a cicatrix; he was

months and a

half,

and with the sub,

preceding case, received the decoration of

the legion of honour from the hand of his majesty.

arm at the joint in the cases of five

wounds were not very remarkable,

I also extirpated the

soldiers,

whose

though requiring the operation.

I

had previously performed the same operation on three

others at Eslingen, being fourteen in

all,

twelve of whom

afterwards enjoyed perfect health: the thirteenth,

of

mclan

'holy,

taken up dead

in

fit

threw himself from a window, and was

and the fourteenth died within

twenty-four hours.

the first

340

MEMOIRS, &C.

Experience has since taught me, that amputation

joints in recent injuries

bus, than amputation

continuity of a limb.

is

more

This difference

pari-

when performed in the middle or

The cases of extirpation of the aim,

must tend to confirm

just reported,

at the

successful, ceteris

in the

this opinion.

amputation

results after

in the

continuity of a limb, appears to depend

On

1st.

the division

of*

the bone,

which must

exfoliate

either in a sensible or insensible

manner, where

been mutilated by the saw.

necessary that a cha; ge

be produced

in

its

It is

it

has

texture and shape, to enable the osse-

ous vessels to shoot out, and to form the cicatrix. This

process

is

of various duration, according to the age,&c. of

the patient,

renders
2dly.

it

and retards the success of the operation, or

uncertain.

From

irritated,

the division of the muscles they are often

or contract, unpleasant symptoms often follow,

and nature

required to form the cicatrix of several

is

parts separately.
3dly. Ft

limb

for

om

the disorder of the parts in the

if this

common amputation would then be in

But when amputation is performed
cess

is

1st.

more

wounded

disorder extend to the articulation, the

vain.
at the joint, suc-

certain, for the following reasons:

Because the section

is

made beyond

the limits of

the disease.
2dly. Because the bones of the contiguous parts are

not injured, and do not become diseased, in consequence

of the operation.
Sdly. Because there are

cept in certain cases

no muscles to be divided, ex-

some portions of muscle,

the fibres

of which are divided longitudinally, rather than transversely.

The

division of the tendons

is

productive of no

inconvenience, because they are insensible, and

when long exposed

unless

to the air, never exfoliate, but are

CAMPAIGN

341

IN AUSTRIA

easily consolidated with the cicatrix of the flaps.

gle difficulty exists in this operation,

unsuccessful

may be

sin

and may render

namely, including the nerves

of the arteries: but this

ill

it

the ligatures

easily avoided

by

attcn

tion to the rules of operating.

Finally, I do not hesitate to assert, that nine of ten

where amputation of the extremities

has been performed at the joint; while two thirds of the
same number will scarcely survive, when the operation

cases will succeed,

is

performed

in the continuity of the limb.

rence in the result will

still

be greater

This

diflfe

in chronick dis

eases of the bones, namely, in deep seated caries, and

scrofula, spina ventosa, or necrosis

eases

may

appear to be limited

for

though these

dis

to the centre, or scat of

disease, they generally extend to the articulation above

them, or
i

to its vicinity.

have confirmed
I

shall

great

number of such

among

our

amputation was performed

for

report four cases that occurred

guards, and on

cases

this fact.

whom

chronick diseases of the extremities.

case FIRST.

Peter Leray, aged

thirty, a chasseur, entered the has

wound which he received by a sabre two

days before. The olecranon, the head of the radius, and
the capsular ligaments, were completely divided. The
Ups of the wound had been approximated, and at my first
pital

with a

visit,

we

had no reason for apprehending the alarming

symptoms which ensued the same day. The lips of the

wound were separated by inflammation, and discharge i
a reddish yellow albuminous fluid. The arm and fore

MEMOIRS, &C.

342

arm were much

swollen, and the fever

came on with

paroxysms, insomnia, and delirium.

The symptoms

cated; and in a short time the

carious,

more alarming

rapidly assumed a

character, in opposition to the

means which were indi

articulating bones became

and gangrene took place

the forearm

he was

in

The

fever also

in the wound, and in

became more ardent, and

Though

imminent danger.

gangrene was advancing, I resolved

to

the traumatick

amputate. But I

called a consultation of the different surgeons,

who

all

agreed in the necessity of the operation, but also thought

it

should be performed in the continuous part of the

limb. But I
joint,

was

under the

in favour of taking

belief that the.

thus far diseased.

The

nute, according to

my

it

off at the shoulder-

bone and

soft parts

were

was performed in a miEvery precaution was taken

operation
plan.

to exclude the nerves of the brachial plexus

from the

ligatures of the vessels.

His

was

situation

critical for several

of the succeeding

days, but he daily improved on the internal use of

to-

nicks and proper dressings: the fever of absorption dis-

appeared, the suppuration was gradually re-established,

and on the
cured.

first

of

March, he

dissection of the

left

the hospital perfectly

amputated limb discovered

the disorder of the joint, and a caries

which extended

from the external condyle of the humerus,

dullary cavity.

A purulent

fistula

into the

me-

was formed along

the

course of the vessels, from the original seat of disease to

the neck of the humerus,

where

caries

had also com-

menced. The body of the bone was even enlarged, and

the peritoneum inflamed,

where

the disease of the articulation

it

was contiguous

to

CAMPAIGN

34'

IN AUSTRIA.

CASE SECOND

John Cotentain, a dragoon, aged

hospital about the

of his

left leg,

of a horse. I
cident,

first

forty, entered the

He

March, 1811.

of

had a wound

complicated with fracture, from the kick

first

saw him on

the third day after the

and could not then proceed

to

ac-

amputate, because

symptoms had appeared, and advanced

with such rapidity, that the wound fell into gangrene on
the fifth day. Fever and delirium succeeded, and he was
very ill on the eighth or ninth day. Symptoms of legitimate ataxia continued for some time, and produced the
gangrene. The means adopted could not arrest the fever,

the primitive

and deep -seated

caries

extended from the fracture

to the

knee-joint, seized on the condyles of the femur, and the

knee tumified and became very painful. In this state se

veral weeks elapsed, and there was no interval in which
amputation could be performed with any prospect of sue
cess.

local

After two or three violent paroxysms of fever, the

symptoms abated several eschars sloughed off,
:

and every thing promised

morrhage

fairly,

when

a profuse ha?

took place from the anteriour tibial artery

I then resolved to amputate, as the only

means

of saving

man, now reduced to the last extremity.

twenty days after the operation, nothing
first
the
During
remarkable occurred. Suppuration was perfectly re es-

the

life

of this

tablished,

the

ligatures

came away, and

the

wound

be slowly but surely healing, when he was attacked with symptoms of adynamia, and the hospital

seemed
sore.

to

An

emctick was prescribed

in

divided portions,

and then cortex and camphor. Suppuration went on, se

veral sloughs came away, and he appeared to lie again

MEMOIRS, &C.

344

improving, but he seemed to labour under melancholy

from some unknown cause; he soon relapsed, and finally

died with coma, &c, on the forty -first day after the operation.

The

dissection of the limb discovered

two

interesting

phenomena

The

1st.

the

bony

was in a state of necrosis, from

was divided to the trochanter minor

os femoris

the place where

fibres

it

destined to form a

new bone

arose

from the sound parts of the os femoris, and had already

covered a large part of the deficiency. These fibres were

arranged

bony

in strata,

and were prepared

to

form a new

cylinder.

2dly.

The

femoral artery was retracted several milli

metres above the stump,

its

into spiral rugae or folds.

internal surface

The

part under the ligature

had contracted adhesions, and above

detached

yellow clot of blood.

the muscles

were of a

was formed

it

The

circular form,

I found a small

divided ends of

and had united to

each other, but not to the general cicatrix of the stump,

Had he been
would have surmounted every ob

except by vessels and cellular membranes.

more

youthful, nature

stacle.

CASE THIRD

Philip Patlour, a grenadier, aged forty-five, had a fistulous ulcer for several years in the right

elbow

joint,

with

caries of the articulating bones, the consequence of chro

nick syphilis, for which he had submitted to various

was absolutely necessary to ampu

was convinced beforehand, from the exand continuance of the caries, that the whole ha

plans of treatment. It
tate the limb.

tent

CAMPAIGN IN AUSTRIA.
merus was concerned

345

Under

in the disease.

this belief,

I proposed to extirpate the arm, instead of amputating

it

in the middle, but several distinguished physicians

were then

present, opposed

my

the adoption of the latter plan.

patient

felt

along the humerus

and

when it was

insisted

slightly press-

ed with the fingers, and also the uneasiness of the

from the

least motion,

who

on
But the pain which the
opinion,

joint,

added to the chronicle character

of the disease, convinced

me

had taken

that the caries

entire possession of this bone. Still

it

was decided

that

the operation should be performed in the continuity of the

limb.

During the

first

twenty-four hours after the operation,

the patient appeared to be easy and free from pain. I

prescribed such medicines and regimen as were suited to

his condition.

On the

comwere re-

third day, the dressings being

pletely filled with a fetid yellow serum, they

newed, with the exception of the lowest pledgets of lint

that had not yet been separated by the secretion of pus.

The stump became

the flesh livid

up as the shoulder, and

had previously prognosti-

painful as far

and

torpid. I

cated the unfortunate result of this operation

at the se-

cond dressing gangrene was found to have taken place

wound, and a considerable tumefaction took place

in the

along the humerus, and

and continued pain

in the

same

at the shoulder joint,

with acute

the skin and muscles appeared to be

state of laxity, as

on the former day, and

without any signs of inflammation.

sympathetick

fe-

ver from absorption followed, and he died in defiance of

all

this

our antisepticks on the ninth day.

man

effects of

On

It

was

true that

was affected with a syphilitick cachexy, the

which were apparent

dissecting the arm,

ries of the

we

in the viscera after death.

discovered an extensive ca-

head of the humerus, and along the whole

course of the medullary cavity.

Vol.

ii.

Xx

The

capsular ligaments

MEMOIRS, &C

346

were diseased, and the

soft

part in a state of putrid

composition. This case supports the principle

de

which

have previously advanced.

CASE FOURTH.

Henry Schupp,
to the

a lancer, aged twenty one,

was

sent

fever-wards of the hospital, June 7th, 1811, for

chronick scrofulous pains of the right arm, and the

The medicines

stage of a phthisis pulmonalis.

last

that he

had taken from well-informed physicians, had not been

sufficient to arrest the

progress of the disease: the cough

and purulent expectoration were habitual the paroxysm?

:

of slow fever, with viscous sweats, returned every even

He

ing.

slept

rice-milk.

none, and could scarcely digest broth or

large abscess suddenly formed above the

right elbow-joint.

This being viewed by the physician as

abscess, he

critical

wounded

to

was

sent to the

be operated on.

the fluctuation evident,

wards among the

At my

first visit,

finding

and the abscess very extensive,

About a litre of dark

gray fetid pus was discharged, mixed with clots of
blood. I made several counter openings, through which
skeins of thread were passed, and after applying some
pledgets of lint on the wounds, I surrounded the arm
I opened

it

without hesitation.

with compresses dipped in

He was

reduced

bility,

and

fatal.

When

fell

claret with

into a syncope,

camphorated wine.
emaciation and de-

which threatened

to prove

he revived, I immediately gave him

ether,

cordial mixture to

broth and wine.

tion

warm

to a state of extreme

warm

and prescribed an antiseptick and

be taken day and night, with good

He

passed fifteen days after the opera-

under favourable appearances.- The purulent expec-

CAMPAICTJtlN AUSTRIA.
toration

and the paroxysms of fever had diminished, but

New

the cough continued as before.

above the original abscess emollient

:

were made

for

these abscesses,

next morning before

my

and would have proved

spot.

fistulas

formed

topical applications

some time, and I made openings into

which discharged a large quantity of

He

blackish ichorous matter.

on the

347

much

felt

relieved, but

a haemorrhage took place,

visit,

fatal, if the

surgeon had not been

I arrived about fifteen minutes after, and on

examining the wound

was

to discover the artery,

sur-

prised to find the lower third of the humerus deprived of

periosteum and muscles, and in a

its

even quite into the

state of necrosis,

which was open

articulation,

in seve-

ral places.

was

thus induced to take off the

The

joint.

patient

was

he was so weak that with

and

in short his condition

my

colleagues,

under

was

whose advice

my

mind

at the shoulder-

he

sat in

the chair,

so alarming, that none of

I requested on this occalest

he should die

hands. His haemorrhage could not be arrested,

and being convinced

the case of

he must

that

young Barrc,

die,

and

calling to

I immediately amputated.

were instantly made, the

was taken care of by an expert assis-

external and internal flap

axillary artery
tant,

and the ligature quickly applied

every small artery was

the part, and he

was put

of a powerful cordial

broth and

claret.

his thorax

he lost no blood:

tied, a suitable dressing

to

he remained several days.

and

difficulty

spoke in favour of amputation,

sion,

An

arm

transferred to the operating room;

bed

in the

The

adapted to

same room, where

operation had the effect

he took several draughts of good

He was

covered with

warm

flannels,

and abdomen embrocated with hot

oil

of

the ligaments of the

el-

chamomile, strongly camphorated, &c.

Dissection discovered that

bow

joint

all

were destroyed, and

that the articulating sup-

hemoimJ^c.

348
faces

were deeply

affected

with

caries, the

lower half of

the humerus deprived of periosteum, and in a state of ne

head of the humerus was also affected with

crosis: the
caries.

The soft parts were

one of the

in a state of put refaction,

collateral arteries

Though he appeared
I did not dare

to

and

opened.

be tranquil after the operation,

to expect a recovery until after the fifth

day. During this time he remained in a feeble and al

most dying

The

state.

discharge from the

wound was

black and sanious, the pulse small, and the excretions al-

most suspended. I increased the dose of the tonicks, and

appplied a stimulating digestive on the

stump,

first

sprinkling

it

wound

of the

with camphor and a few drops

of sulphurick acid, and our attentions were redoubled.

On

fifth day a paroxysm of fever came on,

and was followed by a copious fetid sweat, which pro

the night of the

duced a favourable revolution in his case.

From

this

time the suppuration was established, and

became abundant
functions

resumed their
removed the pain, and refreshed

the organs gradually

tranquil sleep

him, and to our great and agreeable surprize, he continued

and was discharged, cured, on the 10th

of October, the seventy -fifth day after the operation. The

to improve daily,

principal disease, viz. that of the

the

symptoms of

chexy disappeared
This cure

is

arm being removed,

phthisis pulmonalis,
;

all

and scrofulous ca

he even became corpulent.

worthy of

attention, both

on account of

the success of an operation, performed under the

most

unfavourable circumstances, and the disappearance of

the phthisis pulmonalis.

Baron Desgenettes inspector general of the medical

staff has communicated to me a fact no less curious* which
* In
ficer,

West's picture of the death of general Wolf the ofis seen supported in the arms of another, wa6

who

CAMPAIGN

349

IN AUSTRIA.

also proves that causes producing great disturbance in

the

human

bo.dy

terate diseases,

nation of

may

and

in

operate a salutary change in inve-

some measure

phenomena which

affords us

an expla-

excite the astonishment of

the most intimate observers of nature.* I flatter myself that

these cases with the preceding view of the advantageous

consequences of amputating

encourage practitioners und

the shoulder joint,

at

assist

them

in

may

deciding on the

proper plaee for performing amputation in recent or

chronick cases.
If

med
two

it

be important that amputation of a limb be perfor

in the

preceding cases

it is

limbs have been mutilated

not less necessary

by

when

a ball. In such cases a

delay of a few hours almost uniformly proves

fatal to the

patient.

wounded by a. ball which penetrated his thorax and cured

him of confirmed phthisis pulmonalis.
* Another fact nearly similar came under our notice. Lt.
Col. Haevemeuraged35,of the 2d. regt. Holland lancers, had
been for two years afflicted with a fistulous wound and ca-

He suffered acute and incessant pain through the whole extent of the arm to the shoulder, and the fore-arm and hand were in a state of atrophy.
He was pale, emaciated, had an incipient phthisis and scrofulous cachexy: the symptoms of the latter he had at a tender age. The wound of the arm and caries had been produced by a ball in Spain. He had come to our hospital to
submit to amputation, of the necessity of which he was
full consultation of physicians and surgeons
fully aware.
decided that amputation should be performed in the continuity of the arm, the superiour third of which appeared to
be sound. But taking experience for my guide I did not
deviate from my plan, but extirpated the arm at the shoulder-joint. He immediately found himself relieved: the ligature came away in due time, and he was soon cured.
All the symptoms of phthisis and scrofulous cachexy
disappeared, and he regained his strength and usual good
appearance. On dissecting the arm we found a caries extending to the head of the humerus and a disease of the medullary membrane; this confirmed my prognosis.

ries of the right elbow-joint.

350

MEMOIRS, &C.

Before the erection of the flying ambulance with which

we dressed the wounded on the field of battle, we seldom

saw men who had lost both legs or both arms: because
was delayed

the operation

vous irritation arising

The

too long.

twofold ner-

consequence of the destruction

in

two limbs, produced such disorder in organick life that

the wounded expired in a short time under most acute

of

pain.

Let

this state

of disorder be once established, and

amputation cannot arrest

its

many -soldiers who were

lost

been performed with

twenty-four hours.

because amputation had not

sufficient expedition in the first

Of

three

ted during the battle of

because

progress. I have seen a great

who had both

Wagram

the

first

legs amputa-

only survived,

was done within a few minutes af*

The other two died in defiance of all my

in his case it

ter the injury.

attention.

The stumps

of the first of these

were of an

exact length and enabled him to walk conveniently with

wooden
is

my

legs;

an attention

rated on in this
tulate,

to this uniformity of the

rule of practice in such cases.

manner

in

Many

stumps

soldiers ope-

Egypt and Poland congra-

themselves on the ease with which they walk with-

out crutches. Indeed they do not always require a cane.

Thirty of our guards had their thighs amputated for

extensive fractures of the knee or lower part of the thigh.

we

In these cases

followed the plan of Petit,* namely,

as high

up

as

is

and separating

it

from the muscles,

deemed necessary, we

cut through the

after dividing the skin

superficial layer of loose muscles, including the vessels,

and

finish the

second by a deeper cut above the

first,

and

Colonels Corbineau and Dosmenil were amputated by

on the field of battle, after this plan. The former had
his left thigh removed for a large fracture of the knee, and
the latter the right lea;, from the destruction of the whole
foot and a part of the leg. They recovered under the subsequent care of Mr. Lachome.
*

me

CAMPAIGN
n this

manner the

IN AUSTRIA.

351

conical shape of the stump

is

prevent-

do not heal the stump by the first intention (the

reasons for which I have given in several parts of my
ed. I

work), but approximate the edges with a

split roller, which

covers the whole wound, and a compress round the whole

stump. In defiance of these precautions, abscesses in the
thick part of the thigh frequently follow,

when

the shock

of the ball has been very great. I have observed that the

most common cause of these abscesses

is

or more of the aponeurotic^ expansions

a rupture of one

by the

ball.

When

these ruptures are deep, and at a distance from the di

vided parts,

we

consequences
their effects
incisiuns, as

cases.

cannot discover them, or prevent their

but

they be near the face of the stump,

if

may be obviated by making perpendicular

we often did, with great success, in many

The apertures

thus

left facilitate

the discharge of

the fluids, prevent inflammatory strangulation, and puru

lent fistulas of the parts.

with flaps

is

the mode of amputating

when this complication is

Hence

evidently the best

connected with an extensive local disorder of the superi

our part of the thigh, so that

it is

necessary to saw

off the

bone near the great trochanter. This plan is then prefer

which lays bare a great ex

able to the circular operation

A greater number of vessels is

which
also opened,
are not always discovered at the time
of the operation, and distressing haemorrhages are the
consequence: besides, the cicatrix of the stump is more
tent of sensible parts.

slowly formed than in the flap operation, and the latter

is

when operating
not be made very

the only plan which should be pursued

on the

thigh.

But

these flaps should

large or placed in exact apposition. It will be quite suf

ficient,

after

applying the

split

roller

upon them,

to

keep them together by two strips of adhesive plaster

and long compresses properly

often completely succeeded

applied.

among

This plan has

our guards. It would

MEMOIRS, &C.

352
be useless

to report the cases here,

and I

shall therefore

were attended witn some remarkable

notice such only as

appearances.

John Aubin, an
charging
velocity,

artillerist,

The

piece.

his

was

ball,

rebounded before

it

by a

struck

ball

while

though flying with great

met him, and while ascend-

ing struck the external and inferiour side of his thigh,

buried

lodged

in the

him

had

it

He

asserted,

killed another artillerist not

and complained only of an inconvenient

far distant,

weight

in the limb.

the ball

remained

that there

it

neighbourhood of the groin.

that after leaving

amputate

this bone, turned upwards and

and the adductor muscles, and

deeply behind

itself

outwards between

it,

None

in the thigh.

I found

was a

of the surgeons suspected that

ball in

On

seizing the limb to

unusually heavy, and I decided

it

it,

as I

had often seen while ma-

king the incisions, during operations.

Under this impression and supposing that the thigh

was injured high up, I wished to amputate with the flaps.
I then made an incision parallel with the axis of the
the thigh and discovered a 51b. ball, which was extracted
through the incision
difficulty. I

the operation

by the

which were found

easily

when

formed a short

enlarged, with considerable

flap externally,

internal flap, in the thickest part of

the femoral vessels ;

I isolated the

and completed

we

secured them

fragment of the femur as high up

as possible, to apply the

teum. Notwithstanding

saw above

the injured perios-

this precaution

an exfoliation of

one half the bony cylinder took place. This exfoliated

part

was about

five centimetres in length. I

ted the flaps and fixed

them

in contact

approxima-

by means of ad-

hesive straps and applied the usual dressings.

being weighed before

me and my

pupils

was

The

bullet

deposited,

CAMPAIGN

353

IN AUSTRIA.

together with the exfoliated bone, in the anatomical museum of Dr. Soemmering at Munich.

The shock

of

the internal organs

all

and the pro

tracted pressure of the ball on the nerves of the thigh,

produced acute symptoms;

and

fever, dysenterick flux,

greatest care, the danger

covered and

now enjoys

viz. deep-seated abscesses,

local gangrene. But,

was

by the

obviated, and he finally re-

his health in the

bosom of his

fa-

mily, at Draguignan.

Two

grenadiers were

wounded

The

first lost his

which fractured

up

and

was induced

different.

below the knee joint, by a

the lower part of the femur

the aponeurosis

given, I

leg,

man-

at Eslingen, in a

ner nearly similar, but the consequences were

For the reasons already

skin.

amputate with

to

rence to the circular mode.

ball

and broke

He never had

flaps in prefe-

the least fever,

and was nearly well in two months, when I left him.

The second had the knee struck and the articulating
bones crushed by a

bull

which had nearly

finished

its

parabola.

The femur was

fractured and the soft

extensively

He

much

was
small and countenance death like and delirium had come
on. In his case, as in many others, the concussion was
more extensive in consequence of the resistance of the
parts to the ball, which had ceased to move in a right
parts broken up.

line,

pain, his pulse

and the internal organs were subsequently affected*

The limb of
by

suffered

the ball,

the

which

first

was

grenadier

flying with

like a cutting instrument

its

and he

quite carried

away

greatest velocity acted

suffered

no consecutive

This commotion or shock from the ball is greater

the person is standing erect: and the inferiour extremities which support the whole weight of the body are more
injured ceteris paribus than the superiour limbs.
*

when

Vol

ii.

354

MEMOIRS, &C.

acute symptoms, but soon recovered.

The

effects of the

percussion were limited to the injured part.

But

in the latter case, the ball

had nearly completed

its

parabola and could not divide the parts so completely as in

the

first.

Those which were

elastick yielded to

its

ction,

but the firmer parts were broken or torn, and the effects

of the percussion were thus extended

affected all the internal organs.

far

and wide and

This accident

is

fatal in

proportion to the delay of the operation.

This

man was

operated on immediately after the

wound and in the same manner as the first. The local

pain was removed and the general anxiety ceased, but his
pulse remained weak and contracted, and he was tormented with unpleasant dreams. The suppuration was not copious, but

we were

encouraged by the appearance of the

stump, when suddenly he

felt

great pain, a fatal fever fol-

lowed and destroyed him on the tenth day

after the ac-

cident.

On

we

found the viscera collapsed

fluid

blood: the cellular substance

opening the body

and injected with black

surrounding the semilunar ganglions was

filled

with a

reddish serum, and the ganglions were also tumefied.

The

brain

was not

in contact

with the cranium by the

space of several millimetres, and its vessels were injected.

These appearances were the consequences of the shock
he had sustained. The prognosis in gun-shot wounds must

be according

to the character of the injury

ner in which the

Before I

from a

A
trate
first,

ball

and the man-

has acted.

make some remarks on amputation

I will notice a

body

ball

of the leg

remarkable case of contusion of the thigh

complicated with the introduction of a foreign

into the part.

grenadier

by one

was

ball.

carried

the last of three

It

away

who were

passed through the

laid prosr

abdomen

of the

the hip of the second, and grazed

CAMPAIGN tM

353

ATTSTRTA.

the thigh of the third.

The two first who died on the spot,

destroyed the rectilinear motion of the ball,
and when
it reached the third it
rotated on its axis and its effects
were less to be dreaded. But he was knocked
down by it,
and when brought

to the ambulance we discovered all

the signs of an extensive contusion on the anteriour
part of the thigh. There was a small longitudinal wound

surrounded by a large ecchymosis. He assured us that

nothing had touched him, save the ball which fell not far
off.

As

I could not introduce a probe through the cellular

membrane, I merely dressed the wound as usual.

He was conveyed to the hospital, where he passed
teen days without any

an acute and deep seated pain

the discharge from the

fif-

uncommon symptoms. But now

in the thigh took place:

wound was brown,

ichorous,

and

of a particular odour; signs which indicated the presence

of a foreign body, and an injury of the bone. After this,
I discovered with a probe, a hard sonorous

body under

Though the fistuopen by a free inci-

the vastus externus, close to the bone.

wound was

lous

extensive, I laid

it

and introduced a pair of polypus forceps (instead

of bullet forceps), and extracted a piece of crooked copper, about nine centimetres long, and half a centimetre
sion,

wide, which proved to be the ferule of a rammer

could the ball carry this ferule before
less left

how

upon

it

while

it,

How

which was doubt-

ramming down

the charge

and

could this piece of copper, after having been fas-

and passing through the bodies of two

men, separate, just as it struck the thigh of the third, and
penetrate to the bone, at the same time making a wound
tened to the

ball,

disproportioned to

its

nation of the

fact.

diameter? I cannot offer an expla-

saw something of a similar kind

du-

ring the campaign in Poland.

After extracting

and

this copper, the

he returned to duty.

wound seen

healed,

MEMOIRS, &C.

356

During our campaign

in

two

in

Egypt

I amputated the leg,

cases, very near the knee-joint, through the con-

and nearly on a

level

the fibula, which I then removed.

My

dyles of the

tibia,

with the head of

success

removed

the doubts which I had before entertained o fthis opera-

In

tion.

this operation should

which

caries

we

not be apprehensive of

spongy substance of

easily takes place in the

a bone, and advances rapidly

from a disorder of the

joint,

and

there

is

and an

no danger

anchilosis of the

stump? Neither of these accidents occurred

in these cases,

and the cicatrix of the stump was completed nearly as

soon as

when amputation

at the usual place

of the leg had been performed

namely, about four inches below the

tuberosity of the tibia.

Since the expedition into Egypt, I have frequently amputated on this

new

from amputating

plan,

when wounds prevented mc

commonly choscrt, and I

at the place

have met with equal success.

Surgeon Garrigues performed

ably above the part
plains

its

this operation consider-

recommended by authors, and he ex-

advantages in his inaugural

thesis, printed

in

While paying a just tribute of applause to the work

whose opinion wc adopt in

1806.

Of this respectable surgeon,

part,

we must

confess,

by a kind of enthusiasm he has

passed the bounds prescribed by experience and ana-

tomy.

Without entering on an analysis of

shall describe the plan of operating

tuted to that hitherto selected,

mits, above

which

patient to the

we

and

have

substi-

shall point out the

li-

cannot go, without exposing the

most acute symptom. The reader

perceive the difference between

Mr

this dissertation, I

which

my

may

then

rules and those of

Garrigues.

Though I had performed amputation through the con

many cases, after the battles of Austerlitz and

dyles in

CAMPAIGN IN AUSTRIA.
Eylau, yet I had never seen

it

351

attended with a suc-

cess so uniform as after the battles of Eslingen

gram, and during our

last

the cases of amputation

campaign

were numerous and

Wa

and

Austria,

in

where

of various-

descriptions.

At Wagram and at
many of the guards at
ceived from the

fire

upper part of the

degree, that

all

Eslingen, I amputated the legs of

The

this part.

severe

wounds

re-

of the artillery, often extended to the

and very near the knee,

leg,

my

colleagues

to such a

who saw them, were

of

opinion the operation should be performed on the thigh

I endeavoured to

remove

their fears relative to the"^

operation through the condyles of the

tibia,

and assured

them with the confidence which experience gives, that

it was not more dangerous than amputation at the usual
place: but care should be taken never to carry the knife

much higher
the section
tella.
it

than the tuberosity of the

below

drawn from
generally pass below

If a line be

will

tibia,

but to

make

of the tendon of the pa.

the insertion

this point

around the limb,

the head of the fibula, and

across the inverted points of the condyles of the tibia:

but the relation of the tuberosity of the tibia to the head

of the fibula,

is

not always the same, and the former

should therefore be always taken as the limit, above

which the knife should

For

not pass.

far up, the ligament of the patella

vial

bursa behind

it

is

is

often injured,

if it

be applied too

detached, the syno-

and the insertions of

the capsular ligaments on the sides are divided

tion of the patella, effusion of synovia,

life

a retracdis.

symptoms

will

ease of the articulation, and other acute

ensue, and endanger the

deep seated

of the patient, or require

subsequent amputation of the thigh.

By making the

section on a level with the tuberosity of

its

attachments, with the ten-

dons of the flexors of the leg,

which move the stump,

the tibia, the patella retains

358

MBMOins, &c.

and the condyles are cut so low that

from caries.

we have

nothing to

-fear

When
on the

a parallel

leg,

is

drawn between

this

new

operation

and amputation of the thigh, as recommended

by authors

in such

cases as in

new

adoption of the

we

plan,

my

opinion require the

are convinced that the su-

periority of the former, as respects the

wounded,

is incal-

culable.

In the

place, the

first

exposed, because

The

invaded.

wounded man

of the

life

is less

dependencies are not so extensively

operation

in either case,

stump of

its

and the

is

performed with equal

cicatrix will

facility

form as soon on the

the leg, as on that of the thigh.

have never

seen a caries of the spongy portion of the tibia, in conse-

quence: on the contrary, this spongy substance is soon

removed by the vascular action which takes place in it,

and the cicatrix soon covers

tion takes place.

remains

is

When

it,

and no apparent

exfolia-

the portion of the fibula

happens, extirpate

short, as generally

have often done. The head of that bone

now

is

body, and impedes the use of the wooden

leg.

which
it

as I

a useless

As much

of the skin should be saved as possible, to cover the face

of the stump:
i

leg,

where

Such

is

necessity

it

it

should be cut vertically to the axis of the

lays near the tibia.

the operation

demanded

it.

which

On the

and about two inches of the

firm point on which to rest.

have adopted, when

stump formed of the knee,

leg, the invalid

The

may

find a

support of his body

is

sure, and he performs loco-motion with great ease, and

without a cane.

An

artificial

leg of a natural

shape

may

worn under the knee while bent, provided

easily

be

the length of

the stump do not extend

limb. This will be

were introduced

beyond the calf of the artificial

more convenient thr.n if the stump

into its cylinder, as

is

done when ampa-

CAMPAIGN
tation is
is

not

many
acute

performed above the ankle

recommended by

an operation which

intelligent

cannot procure these

symptoms

359

IN AUSTRIA.

surgeons, because

artificial

legs,

and because

generally follow from the scantiness of

the cellular substance and flesh

at this part of the leg,

and from the thickness of the bone. The stump heals

with difficulty, and there is more nervous irritation produced than from the usual operation besides suppuration
:

takes place with

difficulty,

and becomes sanious.

frequently amputated above the ankle, and almost

patients

all

the

have died of nervous fever, or tetanus.

General ****, amputated at

example

have

of this. Finally,

it is

Wagram, was

better in

to take off the leg too high than

all

a striking

possible cases,

toobw; and

never to

operate on the thigh, unless the articulation of the knee be

really injured.

I shall here add the cases of several

tated

on the new

plan, since

my

who were ampu-

return to Paris.*

CASE FIRST.

was brought to the hov

left leg. The anteri
our and superiour part of the limb was extensively contused, and the tibia and fibula fractured. The whole shoe
of the horse had acted on him. At first sight, this wound
Louis, brigadier of dragoons,

pital for the kick of a horse on the

appeared by no means alarming, and

opinion, the majority of

my

in opposition to

my

colleagues were of opinion

it

* I report these cases in preference to others, because I

at leisure to attend to the effects of the ope-

was here more

ration.

MEMOIRS,

tec.

might be saved. With reluctance I submitted

opinion, and dilated the

and

ters

wound

to this

to extract the loose splin-

to dress the limb, after wetting the

bandages

in

During the first

symptoms were mild on the
12th day, acute piercing pains came on, with gangrenous
inflammation of the wound, fever, insomnia, &c. We
met them by the proper remedies, but they continued to

camphorated vegeto-mineral water.

stage of the

wound,

the

was threatened with

increase until the limb

and

his life in

sphacelus,

imminent danger.

Abscesses formed, and a ha^mmorrhage followed from

the anteriour tibial artery,

and obliged us

tion,

which produced great prostra

A phenomenon occur-

to amputate.

red in this case, namely, a convulsive hiccough, which

was produced by

the slightest pressure

on the leg or the

dressings.

The surgeons who were

tion, now advised it on the
still

at

first

opposed

thigh, but as the

to

amputa

knee was

sound, I operated on the leg, and even risked a se-

cond operation above, should the condyles of the

be fractured or carious.
think
fold

When

tibia

acting thus in doubt, I

wounded to the risk of a two

him of the knee,
The section was therefore made

better to expose the

it

operation, rather than deprive

which

is

invaluable.

through the condyles, a short distance above the tuberosity

of the tibia

the first

we

arrested the adynamia produced by

symptoms with great

but his strength

difficulty,

was gradually restored, and with great care we brought

him through, and retained his knee. The stump was
completely healed

in

four months.

vooden leg without crutch or cane

He

walks with a

CAMPAIGN

We

dissected the leg,

361

IN AUSTRIA.

and found both bones broken

and stripped of their periosteum the muscles lacerated

and injected with blueish blood, and the cellular sub:

stance filled with black purulent matter.

CASE SECOND

came to the hospital in December,

1810, with a fistulous wound of several years' standing
Bernard, a

fusileer,

in the superiour part of the right leg.

deep-seated

caries of the tibia, enlargement of three -fourths of this

bone, atrophy of the limb, and incessant pain attended.
effects of

These symptoms were the

at the battle

now

ball

a gun-shot

wound

which entered

at the

and buried
fistulous opening, had fractured the tibia,
the thickest part of the limb.

itself in

since

of

Wagram. The

been extreme; he had

fallen into

His

sufferings

had

a slow nervous

fe-

extreme emaver, with insomnia, frequent diarrhoea, and

and diseased
thigh,
the
ciation. The leg was bent upon
sound, and I thought proif the caries had exper to operate on the leg, and then
not expect) I intended to the condyles, (which I did
thigh. In this
the
through
tended to make the incision

high up, but the knee

oase

we

was

still

should have performed

two operations

instead of

knee sanctions such a

one; but the importance of the
measure, as I have before explained.
condyles, just above
Finally, I operated through the
opposition to the opinion of
the tuberosity of the tibia, in
and the cicamany consulting surgeons. It succeeded,
within 125 days, when he left the hos*
trix

was complete

pital in

We

corpulency.
a state of approaching
found two-thirds of the
dissected the limb, and
comand at the part where the caries

bone carious,

VOL.

II.

MEMOIRS, &C.

362
menced, the
the tibia

ball

and

was

seen flattened and

wedged between

The muscles were

fibula.

and

discoloured,

in a state of extreme atrophy.

I shall add another important case. Mr. Poltz, a dra-

goon, received a most severe kick from a horse while

manoeuvring, which fractured his

a strong boot.
pital,

where

He was

left

leg,

though he wore

immediately brought to the hos-

The wound occupied

I received him.

the

supcrionr and anteriour part of the leg, both the bones

were comminutively fractured up to the condyles of the

tibia, and there was considerable haemorrhage. I did not
hesitate,in this state of things, to remove the leg, and, contrary to the opinion of

my colleagues, who decided

on the

thigh as the most proper part, I amputated through the

condyles of the

tibia.

Here

it

was

uncertain whethe

the

fractures extended into the condyles, but in that case

better to subject the patient to a

it

is

few moments of addit on-

him of his knee; but his knee

was sound, and he recovered sooner than either of the
preceding. The limb was shattered as if struck by a ball.
The same practice is not to be adopted in amputating
alpain, than to deprive

the superiour extremities at their superiour part, for in-

stead of leaving a short stump,

arm when
a

level

stump

is

the

better to extirpate the

it is

humerus cannot be taken

with the

off

insertion of the deltoid

drawn towards the

axilla

in

and very inconvenient

tetanus: the

merus

is

the

ligatures

on the

the axilla, irritates the brachial

plexus, and increases this retraction,

ful

muscle

by the great pectoral

and dorsal muscles. The application of

deep seated vessels

below, or on

which proves pain

to the patient,

and often causes

stump always remains inflamed, and the hu

finally united to the scapula

that this portion of the

to accidents. I

arm

is

by anchylosis, so
and exposed

quite useless,

have heard many

soldiers

and

officers of

CAMPAIGN IN AUSTRIA.

363

qvery description, regret that their amputations had not

been made at the shoulder-joint.

B >sides,
young

this

operation

is

rendered so simple, that a

common

practitioner can succeed as in

of the arm, and

a necessity

for

it is

amputation

always to be preferred when there

going above the insertion of the

is

deltoid.

We often amputated the foot with complete success be

tween the two rows of
sus

and metatarsus.

tarsal bones, or

between the

important to reserve

It is certainly

every part of the limb which supports the body, and

litates

foot,

tle

loco-motion.

An artificial end may be

and the patient walks securely

Some unusual appearances were

of Wagram.

tar-

as

faci-

applied to the

on a natural

foot.

observed after the bat-

George, a grenadier of a strong constitution, was

wounded by a ball, which had nearly terminated its parabola. He was knocked down, but there was no external mark or trace of injury. He lay speechless, and his
companions thought he had been killed by the wind of
the ball, which

fell

a short distance from him, but he after-

wards recovered, and was brought

to

my

Another grenadier was grazed by a

him. Without losing his equilibrium,
his voice

hospital at Paris,

ball

which

fell

near

he was deprived

of

and became dumb.

This second case would seem

to confirm the erroneous

opinion of some celebrated surgeons of the present day.

How many similar phenomena, which form the basis ol
because they
false hypotheses, still remain unknown,

have not been examined into? The ball in the first case
having nearly completed its parabola, passed obliquely
over the thorax and superiour part of the abdomen, so
that while turning on
the muscles

its

axis,

it

rolled over the

abdomen

and skin being acted on perpendicularly

to

MEMOIRS, &C.

364

the axis of the body, yielded to

its

force,

and neither

so-

were at first produced,

being more tender, were

lution of continuity nor ecchy mosis

while the other subjacent parts,

much

injured, distended,

H^re

the branches of the eighth pair of nerves

and deprived of

to have received the shock of the

their electricity.

seemed

After a general

ball.

syncope, or sudden death of several minutes' deration,

he was unable

When he
by

to utter a single

word, or

to art'culate.

recovered from the syncope, he inform-d us

writing, that he

felt

a fulness extending fiom the ensi-

form cartilage along the thorax and neck,

an

to the

tongue

jaw, which he could not move. Tetan'ck contraction

ens-ied; the integuments of the thorax

flame

and a large ecchym

1,

gastrick region

two

>sis

and abdomen

appealed

or three days after the accident,

proved the contact of the

ball with his

in-

ab.ut the epi-

and

body. These symp-

toms were removed by anodyne camphorated liniments,

and cooling drinks; but he remained dumb. The muscles
of the

jaw gradually regained a part of

while the muscles of the tongue

cerned
this

in

organ

duced

its
fell

in size.

itself,

their

power,

and those con

motions, remained rigid and paralytick;

into a state of atrophy,

The

sense of taste

and was much

was

re-

quite destroyed,

but after a long t'.me he could taste sapid fluids or liquid

aliment in the n>strils, and probably this extraordinary
faculty

would have improved

appeared

to

have

in time.

lost its sensibility,

His stomach
and

its

also

contractile

power appeared to be much diminished, for his digestion

was slow and painful, and for this reason he was obliged
to eat frequently,

and

to

take but a small quantity of food

He was even deprived of the sensation of appeand emetick medicines produced no vomiting nor any
kind of sensation. This man was seen by professour
at once.

tite,

Dum^ril, and by several other celebrated physicians at

the hospital of the guards,

where he submitted

to a va-

CAMPAIGN IN AUSTRIA.
riety of treatment,

365

and was then placed on the pension

list.

Was
these

it

the shock of the ball

symptoms? Or

alone which produced

did the ball destroy the electricity or

galvanism of the principal nerves of animal

life,

viz. the

eighth pair? I believe both causes co operated.

In the second case, the

ball,

under similar circumstances,

grazed the neck. The parts were whole, and a

slight ec

chymosis could scarcely be discovered under the skin of

the neck,

and superiour part of the

chest.

The same

may

the loss of

nerves were injured, and to this injury

the voice be attributed. All the assistance of art

sufficient in these

The

two

was

in-

cases.

application of cups to the part, immediately after

the accident, general bleeding, covering the thorax and

abdomen with

the reeking skin of an animal (a sheep for

example) which has been stunned and quickly flayed, and

diaphorctick drinks are the means by which the consequences of such an injury

whether more or

sions,

may be arrested, These contu-

less apparent,

cannot receive too

much attention.
After the battle of Wagram, the enemy retreated pre
cipitately to Snaim, and we pursued and cut him off from
Moravia, and confined him

by

the

in this city

and

its

environs

wings of our army, which had been engaged;

a parley was he'd during the following night, and a

pension of

hostilities

bui
sus

agreed on.

Both armies encamped, and the negotiations were con

tinued: headquarters were established at Sehcenbrun and
Vienna, where they continued till peace was concluded
and proclaimed a few weeks
In

this interval

after.

I attended to the

wounded and

sick

guards and gave a course of theoretick and clinical surgery,

in order to profit by the remarkable cases which occur-

&C

MEMOIRS,

666
For

red.

purpose I had an amphitheatre prepared,

this

and rooms

wnere the surgeons of the army

and of Vienna who attended this course were admitted.

The
built

for dissections,

academy

military hospital of Josephine

and arranged, and

its

is

medical institutions in

well

full vi-

gour: in this school and under the direction of the acade-

my, military surgeons are educated.

seum of anatomical preparations in
this

I visited the

mu-

the great hospital of

academy, and of the imperial university, and the

pathological preparations in the

school of the

same

museum

of the clinical

by the celebrated

hospital, collected

Franck and Quarin.

The

my

report, containing the result of

ring this campaign, with the

list

emperour,

who

of the guards

&c, was

rendered invalid by wounds,

confered upon

operations du

me

the

who were

presented to the

title

of baron, with

he annual sum of 5000 francs*

When our troops evacuated Vienna to return to France,

I transported

all

our sick and

arrived in December, 1809.

1810, I resumed

my

wounded

On

the

to Paris,
first

where

of January,

duties at the hospital of the guards.

I shall give an account of the most interesting diseases

that have
period.
less

come under

Many

my

notice from that to the present

of these required operations of

importance, and were attended by some

phenomena, affording subjects

which were given once a week

My

more

or

uncommon

for the clinical lectures

at this hospital.

*
colleagues, Messrs. Desgenettes, Percy, and Heur
teloup,by the same decree, also received the 6ame title and

pension.

MEMOIR
ON HYDROCELE,
Followed by some Reflections on the Operation for Fvi
tula in Ano.

TTYDROCELE
-*--*- diers,

is

common

disease

among

practitioners, both

on account of the

ill

success and the

consequences of the various operations performed

fect

sol

and one which has occupied the attention of

a radical cure.

The

to ef-

cure by injection, introduced by

Monro, the regimental surgeon, who

lived

about the

time of the celebrated Edinburg physician of that name,

is

doubtless the least dangerous, and possesses

vantages than any other ; but

danger. I have seen

it

prove

expert surgeons with mild

more

ad-

not entirely free from

is

fatal,

fluids,

though performed by

such as pure wine.

These unfortunate occurrences have induced most men

who labour under hydrocele, more especially such as are
of advanced age and irritable habits, to submit to the inconveniencies of the disease

all

their lives, rather than

undergo an uncertain operation.

The numerous
under

my

cases of hydrocele which have fallen

care in the hospital of the guards since

my

re

MEMOIRS

368

turn from Egypt, have afforded

becoming acquainted with

me

an opportunity ot

the advantages of the different

plans proposed for a radical cure. Without regret I have

given up the operations by excision, incision, cautery,

and seton, which are always uncertain, and very often

followed by most alarming symptoms.

by

rally succeeded

confess that

my

have most gene-

injecting alcoholick fluids, but I

many

of

my

must

have suffered much

patients

and encountered great danger from

under

One

it.

of them died

eyes with peritoneal inflammation, the conse-

quence of the operation,

which were used

defiance of

in

to arrest

it.

all

means

the

Gangrene soon followed.

During the campaign in Austria, I thought of substituting to the operation by injection another plan; namely,
the introduction of a gum-elastick tube into the tunica
vaginalis testis, through the canula of the trochar, to fa-

vour the discharge of the serum, and

to irritate the sac

ad

libitum.

I never reduced this intention to practice until I re-

turned to Paris.

The

first

nous injection:

for,

attempt was

who

ary, 1810, on a dragoon

when

made

in

Febru

could not bear a light vi

a few drops of this fluid

were

introduced into the tunica vaginalis, he cried out with

vehemence, and

in a

few seconds

fell

into convulsions. I

immediately withdrew the syringe, and pressed out the

injected

wine through the canula of the

in order that the operation

might not be

trocar.

But then

in vain, I intro

duced part of an elasticktube through the canula, secured

it

in the tunica vaginalis,

ing,

when

and that
I

slight

removed

and kept

it

there

till

next morn-

finding that the serous discharge had ceased,

symptoms

of inflammation had

the tube, supported the scrotum

sory bandage, and awaited the

result.

come

on,

by a suspen-

AND CASES.

369

slight swelling of the testis, with pain and redness

of the skin were perceived, which indicated the adhesion,
of the tunica vaginalis, to the tunica albuginea.

These mild symptoms continued

three days

after this, resolution

On

on gradually.

and the

testis

During

of

its

the fifteenth

to increase for two or

commenced, and went
day, he was quite well,

natural size.

may

his treatment, I

observe that he took light

food, and that no other remedies

were adopted, than

cool-

ing acidulated drinks and enemata.

The numerous cases of this kind among the dragoons

which have been admitted into our hospital, have occupied

my

attention. Since the first case to the first of

Oc-

tober, 1811, thirty -three guards of different ages and con-

with hydroceles of various size and duration,

stitutions

have been radically cured by

These

space of time.

plan in a very short

me to

enable

facts

fear of contradiction, that

my

it is

assert without

preferable to every other,

proposed for the radical cure of this disease. I

after

attempt

to

show why

shall here-

these advantages are to be ex-

pected.

In thus claiming
ral celebrated

it

as

my

invention, I admit that seve-

surgeons of the eighteenth century, among

them Monro of Edinburg,had spoken of a

ly similar.

They

praetice near-

used the canula ot the trocar which had

been introduced, and

left

it

in the

tunica vaginalis, a

longer or shorter time. Monro, the father,

who was

author of this plan, without having ever carried

effect,

recommended

it

with some

son, expresses great fears from

hesitation.

its

it

Monro,

the
into

the

adoption, because he

says the testis would be scratched, and other unpleasant

results follow.

My illustrious

preceptor, Sabatier, in his

surgical works, (Article Hydrocele) admits the objec-

tions of these surgeons,

So

that

Vol

no practitioner
ii

and disapproves of the

since

Monro

3A

operation.

the son, has attempt

Memoirs

370
cd

or endeavoured to correct

it,

was

imperfections.

its

entitled to their attention, since

Still it

Mr. Sabatier ad-

mits that Fabricius ab Aquapendente has formally recom-

mended
It is

this

mod*

of operating as the best.

matter of surprise, that during an age in which

surgery has been carried to such a degree of perfection,

no one has thought of rendering the operation

cele

more simple, and adopting

Monro

sen.

has observed)

tion, or arrest its

we

this

for

hydro-

plan by which (as

can increase the inflamma-

progress with an instrument completely

under our controul.

After receiving the

first light

ject,

I endeavoured to

Now

what are the

come

of experience on this sub

at the rationale of this fact.

intentions of a surgeon

who

wishes to

cure a hydrocele without disordering the general func^

tions of the patient, or injuring the testis, surrounded as

by the fluid of disease ? It is

by the most simple means, and

to evacuate this

it is

To

quent formation and collection.

tions, the

irritated in

The

effect these inten-

contents of the sac must have a free exit,

and the membranous organ which

be

fluid

to prevent its subse-

secretes the fluid

must

a gradual manner, and for a proper time.

exhaling vessels must inflame and be obliterated

the source of the watery effusion must be dried up, and

finally, the

and
sive

two serous membranes must come in contact,

by a species of adhe-

unite internally to each other,

inflammation, and the

cured.

disease will be

radically

My plan appears to embrace these intentions.

My new

plan has often been noticed in

clinical surgery, at the hospital of the

of my colleagues have reduced

my

lectures

on

guard, and several

to practice.

it

My pupils have attended to its

effects in thirty success-

ful cases.

To perform

this operation, I

use a small trocar of the

kind preferred in paracentesis, so that the canula will

AND

admit an elastick catheter of

is

371

CASES.
sufficient size.

This trocar

be plunged into the most depending part of the

to

When

the fluid

is

evacuated, a

gum

sac.

elastick catheter of

convenient length should be introduced through the canula of the trocar,

nula

may

which

still

a bandage moderately
strict

remains in

its

place.

The

ca-

then be removed, and the catheter secured by

The

tight.

patient

is to

observe

repose and suitable regimen.

presence of the catheter in the tunica vaginalis

little pain or uneasiness. During the first twelve

The

causes but

hours, the serum

the secretion

flammation

is

discharged through the catheter: then

is

suppressed, and entirely disappears.

now commences, and

In-

a complete adhesion

takes place between the tunica vaginalis and albuginea,

except at that part occupied by the point of the catheter,

which should be
ceases

for this

re moved as soon as the serous discharge

is

the certain sign of incipient inflam-

mation.

This mild inflammation

is

generally established before

the
the second day, according to the age and irritability of
When
patient, and proves sufficient to produce adhesion.
the patient

very young and

is

withdrawn ;

for if

it

be

irritable,

a few hours are

The

catheter should then be

left until

the serous secretion has

sufficient for this purpose.

too violent
ceased, the local inflammation may become
have seen
and suppuration and abscess may follow, as I

two or three cases, when the

moved at the proper time. But

in

catheter had not been reif

the hydrocele be chro-

previous opera
nick, or the patient have submitted to
a longer time.
it may be permitted to remain
tions,

By

strictly

irritation, the

catheter.

attending to the effects of this mechanical

surgeon may arrest it by withdrawing the

The

testis is

then slightly swollen and painful,

place, and without the necessity

but resolution soon takes
If there be induration of the
of any topical application.

MEMOIRS

372

mercurial frictions on the part will remove

testis,

on

whom

have operated

manner

in this

All

it.

for hydrocele,

No

recovered withou a relapse bef re the twentieth day.

sympt ms ever occurred, and small abscesses

serious

se'dom formed a proof that

;

mild as

it is

this

mode

of operation

is

as

infallible.

The operation for fistula in arfo, which was also common among our soldiers, and very familiar to us, was
so far improved, that we considered it as respects its facility

and

safety,

this operation

unsuccessful, and

though much improved about the end of the

required further perfection.

I have seen

labouring under this disease,

who were

last

century,

many

persons

operated on by

new

expert surgeons, and were attacked by

is

to

be attributed to a want of attention to the im-

mediate causes of

fistula.

now

speak of those with an

internal or intestinal orifice. It appears clear to

when

fistulas,

took their rise in the seat of the former disease.

which
This

Formerly,

on a par with venisection.

was both severe and

me

that

this orifice is not included in the section of the bis-

toury, the fistula continues or returns.

count of this perforation,

it

And

that on ac-

always forms from within

outwardly, and never from without inwardly, unless a

wound

may

anus will always be attended with

complete as soon as the abscess

sis

is

fistula,

which

opened

will

be

This progno-

should always be made, and the patient be informed

ol the

two

fold indication to

to the abscess,
o)

we

penetrate the rectum in this direction. So

conclude that deep abscesses of the margin of the

in

cleaned.

be

and the second

fulfilled.

The first

to the fistula,

relating

on which no

should be performed, until the abscess

is

well

373

AND CASES.

success of the operation then depends on

The whole

finding the internal orifice, which, to the inexperienced,

is

no easy matter, and

seat

its

is

this difficulty is

known To

not

principal object of

my researches.

ried on through the fistula

ternal opening,

it

increased

when

If the probe be car-

introduced into the ex-

generally passes into the bottom of a

a blind sac, formed internally by the

wall

broken through, and

easily

is

when

ascertain this, has been the

Its

fistula.

this accidental

thin

open-

ing leads into the intestine, so that the former orifice

almost always

left

below, or on one

side,

and thus the

is

fis-

by the incision, or returns soon alter.

This inconvenience more particularly attended the ope-

tula

is

not cured

my

ration of

ting trocar,

preceptor, Desault. I speak of his perfora-

by which he passed a leaden wire

to include

the diseased portion of the intestine.

If

we

attend closely to the structure of the rectum, and

manner

the

in

which the causes of

fistula act,

we may

be convinced that the internal walls of this mem

branous tube are injured only in those parts most obnox-

easily

ious to the causes of fistula,

tween the two

namely,

the sinus, be

in

sphincters of the anus, immediately ab

the internal sphincter,

where

the frequent contraction of

the anus produces a circular furrow, in which fceces and

foreign bodies such as portions of bone, or the seed of

&c,

grapes,

are easily arrested, and after corroding or

wearing away, or perforating the mucous membrane,

produce irritation, abscess, and fistula in the surrounding
cellular substance.

are

we

In

this part

of the intestine, therefore,

to seek for the internal opening. It

is

never found

above the furrow, of which I have just spoken, but gene

below it. It may be easily discovered with the
rally

naked eye, by carefully separating the edges of the anus

A.

probe

is

to

be then conducted through

this

opening.

MEMOIRS

374

curved tube with an open end

along the probe, and

a gorget, so that
the part

we may

may be

By

this

produced

and divide

single stroke

plan and careful dressing, the

assured of a cure between the fifteenth

and twentieth days. The

is

cut with firmness,

between the tube and gorget, with a

of the bistoury.
patient

then to be introduced

is

open end fixed on the beak of

its

cicatrix of

this

after the divided vessels are

order, and separated like the lips of a

into dis-

wound which

ne-

A piece of lint, if placed between the lips

ver unites.

this incision, will generally suffice for the first

The

wound

recent

thrown

cicatrix

is

of

few days.

without assistance, and

then formed

leaves a depression of greater or less depth.

This operation may be simplified, and rendered easier

to the surgeon,

and

less painful to the patient.

be done by using a
one of

its

flexible stylet,

extremities,

and a groove

grooved end should terminate

it

may be

in a

plate, so that

held with the fingers. After passing this stylet

get having bars across

its gutter,

far as the groove, or seize

;

it

fistula, fix it in

and then draw

it

a gorout as

with the fingers for this pur

thus the operation will generally succeed

with a

sharp straight bistoury, the small portion

thin

at

The

at the other.

rounded

through the internal aperture of the

pose

This could

with a small button

margin of the anus, turned aside by the

stylet,

of the

may

be divided.
After this plan I have often performed the operation

among our
pain.

tle

soldiers, who assured me that they felt but litThey were perfectly cured in a very short

time.

may observe

tor fistula in

ano,

the bistoury,

care

and

that the
is

and

most certain mode of operating

to lay open

its

internal aperture with

in order to effect this, the

greatest

attention should be paid in passing the tube

AND
through

it.

375

CASES.

This plan has never disappointed

my expec-

tations.

I shall not introduce the particular cases of persons

who underwent
spoken

of; I shall

facts relative to

datids.

operations, for the

two

diseases just

only notice, in a few words, some

a case of hydrocele, produced by hy-

376

MEMOIRS

CASE

Of a watery Tumour of

the

Scrotum

*v*y <x *y <v *> *v

1%/TR.

-^--

HARDOUIN,

tal

on the

mon tumour on

a dragoon, entered the hospl

of April, 1811, with an uncom-

first

the left side of the scrotum,

which

in-

commoded him greatly.

The situation of this tumour on

the course of the sper

matick cord,

(which was sound)

irregular shape,
sions

by

of the

in front

and the changes produced

in its

its

dimen-

had induced several inI showed it, to form an er-

particular circumstances,

telligent surgeons, to

roneous opinion as to
it

testis,

whom
its

character.

Some of them thought

an enterocele, but the greater number viewed

epiplocele.

When this man

tumour increased

till it

its

as an

some

time, the

greatest size,

and was

stood erect for

attained

it

then of the dimensions and shape of a large hen's

e*gg,

Containing two yelks, and having a transverse" depression

between them.

While

in this state the

acute pain and tension of the

disorder of the stomach:

patient

felt

abdomen, with nausea, and

when

laid horizontally

on

his

back, with the thighs bent, the tumour was reduced to

AND CASES.
half

its

and appeared

size,

377

to return into the

to pass partially into tne abdominal ring,

much

dilated. Tlie

tumour was

and fluctuated but

lent,

tient felt

abdomen, or

which

soft, irregular,

when

little;

we

found

and indo-

pressed on, the pa-

no pain, and the tumour did not retreat into the

still we had reason to believe it an epiplocele.

abdomen:

An

internal motion

my

at

first visit,

which

induced

I discovered in this tumour,

me

view

to

it

as being

by hydatids. I made several experiments upon

formed
it:

rest,

and the extension of the left thigh, allowed the tumour

to enlarge, and except when the patient moved, or suddenly touched it, the tumour remained in static quo : but
if a cold, volatile, or stimulating application were made,
it

and partly concealed

retracted, diminished in size,

self in the

abdominal

If this experiment

former position and

it-

ring.

was not

size.

repeated,

The scrotum was

it

resumed

its

not concerned

phenomena in a clinihydatids were posthat

persuasion
under
a
cal lecture,
and thus
contracting,
of
power
sessed of life, and of the
effecting the various changes, that we had seen in this tuin these motions. I explained these

mour.*

During

my campaign

in

Poland

observed that sheep,

When left in marshy pasturage-ground ki the spring, became

had prominent bellies, and finally died. Being desirous

knowing the cause of their derth, I had a number of
them opened in my presence, and T also frequently visited
that had no
the butcheries of the army to inspect others

lean,

of

from these
external appearance ofdisease. In all the sheep
found, adhenng
pastures, hydatids of different sizes were
to the

mesentery and

intestines.

At

different period*,, I

of them from the abdomen under the

separated
removed the external
hands of the butcher. I carefully
difficult, on account
covering of the hydatids which is very
coat of the animalcula.
proper
the
to
attachment
of its
the hydatid without any foreign connexion its

many

I then had
transparent albuminous fluid
proper coat was tilled with a
delicate blood vessels were
and
line
very
which
through
;

Vol.

ii.

MEMOIRS

&78

This dragoon having consented to the operation prd*

posed by me, I proceeded

to extirpate the

tumour. In

order to keep the hydatids alive, I divided the skin of

the tumour transversely, with a crooked bistoury, and
dissected

by

it

up with great

the union of

The

The

care.

two
were now more

was formed

parts, of the size of a horse chesnut.

contractions

to detach these

hydatid

evident. I expected

tumours entire, but the patient moved

and broke them. I then cut up their pedicles, and the extirpation

was complete. Small blood

buted over these living

of the tunica vaginalis

by

vessels

were

A considerable

vesicles.

distri-

portion

was removed from the testicle,

were produced

the invasion of the hydatids, which

in its substance, or

on

its

surface. After inclosing the

testis in

the dartos, I brought the lips of the incision to

gether,

and completed the dressing by a proper ban

dage.

An

irregular exertion of the patient, during the

night, disordered

thrown from

its

the dressing,

and

the"

testes

place. Inflammation followed

attendants. In such a case, the suture

proper, and I should have used

had

its

would have been

I not calculated

The testis was however

and he was discharged perfectly

on the composure of the

gradually restored,

it,

Was

with

patient.

cured on the 1st of June.

This

is

the only case within

my

knowledge,

in

which

hydatids have been discovered in a man.

The head of the hydatid was supported by a

neck and resembled a round tubercle. These
animalculae when put into tepid water lived several hours.
I made them contract at pleasure by touching them with a
probe or by pushing them from place to place. In this state
distributed.
small pliant

vekept

many of them

for a considerable time

3#

AND CASES.

ESSAY

On

the Extirpation

fTl HE
*

of Scirrhous or Cancerous

extirpation of scirrhous or cancerous testes, ac

cording to the general opinion,

very uncertain success.

this success is

is

an operation

Practitioners even

avow,

oi

that

very limited, more especially in hospitals*

I believe, reasoning
that

Testes,

its failure is

from

my

to be referred

experience in these cases,

more

to the treatment du-

ring and after the operation, than to the nature of the

disease.

When

this disease arises

from an internal cause,

it

may

generally be attributed to the presence of some particular

morbid

taint, or virus in the

system, the consequence of

the repercussion of gonorrhoea, herpetick affections, &c.

Guided by

this opinion, before the operation is pro-

posed, the patient should be subjected to such a regular

treatment, as

When

this

may be

indicated

by

the particular cause.

plan has been continued for a sufficient

length of time, the disease becomes local, and the opera-,

tion will succeed.

MEMOIRS

380
This preparation

is

of the utmost importance. For

my

experience has also taught me, that mechanical causes alone

seldom produce scirrhus and cancer in the

mammae

or in the
I nave

of

men,

testes of

women.

had a great number of

women under my

care

wounds and severe contusions of the mammae. But

the symptoms which followed were easily removed by

for

the

common means, and

I never

knew

a scirrhus or

cancer to fellow these injuries, unless there existed some

internal cause.

Among
virile is

horsemen

it

pommel

arrested

The

and low

diet.

But

the con

if

been very great, the inflammation cannot be

the testis swells

testis.

follow generally yield to local venaesec

tion, to topical applications,

tusion have

of the saddle, and

on the

that violent contusions are received

symptoms which

membrum

often happens that the

bruised against the

beyond measure, suppuration

follows, the tunica albuginea cracks or ulcerates, like the

proper coat of an artery in aneurism, and the organ

melted down.

different

am

acute pain

fully

fever.

for either of these diseases,

under scrofulous or herpetick

is

affections.

cause of scirrhus or cancer in

whom

means

in

had laboured
But the most

men

or

the repercussion of gonorrhoea, or leucarrhcea,

best

is

attends, with

convinced that every person on

have operated

common

now

But scirrhus and cancer appear

manner, and with other symptoms.

symptomatick

The most

of averting these unpleasant effects,

women,
and the
is

establish the local discharges as soon as possible,

to re-

and

to

exhibit proper remedies for the scirrhus or cancerous disease.

The uniform

success

which has followed every

extirpation of scirrhous or cancerous testis, after this pre-

381

AND CASES.
paratory treatment had been adopted, confirms

my

opi

nion.*

than thirty such cases on which I operated at

the hospital of the guard during the years 1810, 1811, but
one died, who was extremely timid and exhausted: he

Of more

had a cancer

in a state of suppuration.

vered sooner or

later,

In some

disease.

removed

at the

others reco

according to the character of their

and organs were both

cases, the skin

same time:

in others, extirpation of the

was sufficient but in every case, the canceinteriour of

disease was more or less evident in the

testes alone

rous

The

the organ.

When

the tumour

irritable, a difficulty

and the patient robust and

occurs which we should be prepared
is

large,

meet, namely, the immediate retraction of the cord infatal in consequence

to the abdomen. This may prove
spermatiek
effusion of blood in this cavity, from the

to

of the

arteries

which have not been

tied.

To

prevent this acci-

applied, and the

cident, the ligature should be previously
where it
operation,
the
cord strongly compressed during
the
through the abdominal ring. The skin of
of the sac, lefi
scrotum should be divided to the bottom
artery be
every
and
testes:
the
of
extirpation

passes

by the

carefully tied, so as to prevent the

blood^om

passing in

causing inflammation,
to the cellular membrane, pnd
lips of the
deep-seated suppuration, and gangrene. The

wound
tioners,

practi
should not be united, as advised by many
neces->
is
process
this
because it must suppurate;

and
strength of the patient must be supported,
cause of the disease contithe general treatment for the
sary.

The

in
* I often extirpated scirrhous and cancerous manunnc
in no case have I known the disjnv private practice, and
operation.
ease to return after the

382

MEMOIRS

The

nued.

articles,

The

dressings should be mild at

then with fine

lint

cancerous tumours in

size, in the

first,

and plasters of

of balsamicfc

cerate..

these cases varied in

all

cancerous disorder, state of the skin, and idio*

syncrasy.

been

I shall notice none of them, as thjey have

ed by the young gentlemen

course, except one, in

who

attended

collect-

my clinical

which a sarcomatous tumour

formed on the the spermatick cowl and

had,

testes.

casi;.

John Constantin, a dragoon, aged 32, entered the hospital with a hard, renitent, and unequal tumour, of the
size of a large hen's egg,

At

tick cord.

was

on the right

testis

and sperma-

the bottom of this tumour, a fluctuation

perceived, depending evidently on the presence of a

fluid in

the tunica vaginalis

best plan

would be

to lay

I conceived that the

testis.

bare this membranous, sac, and

the tumour, to puncture the former

and

to

With

remove the
this

more conveniently,

latter, after ascertaining its character.

made a

view, I

longitudinal incision through

the integuments of the tumour; the tunica vaginalis testis

was

laid bare,

part.

and then punctured

dissecting round
as

to

it,

were necessary

jury.

I extirpated

to secure the

it

and

after

with such precautions

cord and

be entirely destroyed, a proof that

ing the tumour.

most dependent

to view,

testis

from

in

After the operation, the tunica vaginalis was found

was a

It

must have increased

.in

at its

The tumour was now exposed

warm climate.

it

assisted ip form-

legitimate sarcocele,

which

to a large size in process of time, or

split roller,

wet with mallows-wa-

AND
ief

was immediately

lips together,

383

CASES-

applied on the

wound

and protect the denuded

testis

to
:

bring

the

its

wound

soon healed, the dartos united to the surface of the

testis,

and he was discharged cured in less than a month, with

the seminal organs uninjured.

This delicate operation

may be

expected

a proof of the success that

is

when operating

for

very large sarco

celes.

To

this

case I will add

uncommon

two others of hernia, with some

appearances.

Michael GillaumC, a grenadier of the guards, came to

the hospital on the 4th of September, 1810, with an in
guinal hernia of the right side he had laboured under
:

all

the

hours.

symptoms of strangulated hernia for thirty -six

The application of cold water, pounded ice, cata

plasms and baths, were in vain made to the part, and

venisection was used without success. This was the se-

cond time the hernia had been strangulated. The operation was required without delay and performed the same
day, September 5th, in presence of the* hospital-surgeons

and

my

pupils.

skin having been divided with eare, I laid bare

sack, which was ap
all the external surface of the hernial
parently formed of two distinct and separate layers, ha-

The

them.
ving a small quantity of reddish serum between
pushed
been
had
peritoneum
the
that
Was it not probable

each descent of the hernia, thus forming two sethe assis

parate saes? When I reached the second sac,
moment's reflection
tants took it for the intestine but a
intestine could not
The
contrary.
the
convinced me of

down

at

adhere, like the sac, by

surrounding parts:
in the

its

this

pedicle to the surface of the

adhesion could only take place

abdominal ring, and

Again,

its

surface

was

to

some

nbt uniform

parts of the

like

sac

an intestine, and

MEMOIRS

384-

were not

vessels

its

and

so well defined

as in the peritoneum.

thinly distributed

Without apprehension,

pinched

up the most dependent part of this membranous sac, and

opened it with a single cut of the bistoury. A considerable quantity of reddish
cut

up

all its

crooked
in

and

scissors,

The tumour,

it.

serum was discharged

I then

anteriour wall with a grooved director and

laid

bare the parts contained with-

of the size of a horse-chesnut, was

formed by a small portion of

surrounded by a

intestine,

part of the epiploon. According to the practice of

Louis

Petit,

John

and the opinion of the consulting surgeon

Dr. Ribes, after enlarging the ring, they were returned

into the

abdomen, without taking

Yet

lar state of the intestine.

into

view the particu-

I took care to separate the

epiploon from the intestine to prevent the latter from be-

ing confined or strangulated by

ed in

obscure and

this

was dressed with

over the

its

operation.

had taken care

where

separate to form this opening.

the

the cord

is

it

this,

dilate the
pillars

epigastrick artery,

internal pillar,

by the spermatick cord,

generally found

to

two tendinous

The

which runs obliquely behind the

ed

patient

and compresses above

lint,

external angle,

pressed towards

The

a fine split roller, applied immediately

wound with

and an inguinal bandage.

ring at

I completely succeed

it.

difficult

between

is

and

is

thus avoid

and

this artery

the hernia. Besides, with a very small incision at this

tendinous commissure, just mentioned, a greater dilata

ticn

is

produced than when the internal

divided.

The edges

of the ring are

mated, the cicatrix of the parts

tient

is less

is

pillar is entirely

more

more

easily approxi-

solid,

and the pa-

obnoxious to future hernia. In short, I have

always had reason to adopt

this plan.

After the operation the symptoms abated, and gradually

disappeared; nature

was

assisted

by enemata,

anti-

spasmodic^?, cooling remedies, camphorated oily enibro-

AND CASES.
cations

healed,

385

of the abdomen and regimen.

The wound
and he was discharged on the first of the ensuing

October.

would advise

that the strangulated intestine should

never be returned with the epiploon surrounding

until its

whole surface has been

The omentum

laid

it,

nor

bare and examined.

should be opened with great caution, and

separated from the intestine, and each returned separateIf any vessels of the epiploon be divided, they should

ly.

be

tied,

and the

wound. This

ligatures kept out of the

advice given by Ritch appears to be very correct.

Mr. Muriau, a chasseur, had had an inguinal hernia

of the right side, for the space of two years, and supported
it

by a

truss,

but by a sudden

effort the truss

was broken,

down and strangulated below the inhe tried in vain to reduce it, fainted away,

the hernia driven

guinal ring

and was carried into

my

hospital.

The

geon applied emollients, opened a vein

attending sur-

in the

arm, and

used the taxis, after having placed him in a proper position.

Local pain, vomiting, anxiety, and constipation

When

appeared.

I visited

him

now

in the morning, twenty-

four hours after the accident, I found a tumour as large

as an egg, in the right inguinal region, attended with

pain, tension, and slight redness of the skin.

The

vomit-

ing and hiccough were frequent, the features of the face

haggard, and the pulse small and weak.

means
and

to

we

reduce

it

were now

Some

other

used, besides the foregoing,

thus lost several hours. Finally, the reduction of

was thought impossible: I called together

surgeons of the hospital, and it was resolved that
the hernia

the
the

operation should be performed without delay. After dividing the skin and cellular membrane, I discovered the
hernial sac formed of several folds, which I divided in
succession ; for this reason the operation was tedious.

Vol.

ii.

3C

MEMOIRS

$86

When
rum

**,,

I opened the sac, a large quantity of reddish

se->

were extended upwards and

downwards by a grooved director, and crooked scissors.
escaped

the openings

I dilated the ring, according to

my

plan, at

its

external

commissure, and was then surprised to find that the

testine could not

be returned

its

reduction. I disengaged the ends of the stran-

gulated intestine, and with

one

in-

through the coats of the

knot of lumbrici which pre-

intestines, I discovered a

vented

my fingers pressed the worms

and the her-

after the other, into the intestinal tube,

nia then suddenly and spontaneously returned into the

abdomen.

He felt

immediate

abated; I dressed the

lient

wound

relief,

and the symptoms

as usual,

and ordered emol

enemata to be administered. Embrocations of warm

camphorated

oil

of chamomile were

made on

the abdo-

men, a composing antispasmodick draught was given,

with a tea Of orange-flowers for
passed a comfortable day

he

felt

common

enemata had yet produced no evacuations, but the

dough and vomiting had entirely ceased.
injections

and embrocations

to

He

drink.

a few colick pains

the
hic-

I ordered the

be repeated

he had two

copious alvine evacuations during the night, and slept

with composure three hours

he was much improved

thelmintick dose of

ol.

a perspiration ensued, and

I then ordered for

him an anwhich

ricini,and syrup of chicory,

removed five large lumbrici. He continued to improve

daily, and was discharged on the thirty second day inperfect health.

AND CASES.

Of

/~VNE
^-^

Complicated

Wounds of

of our grenadiers

in a duel,

387

the

Abdomen,

was wounded with a

A considerable portion of the small intestine had

diately protruded through

dish

brown

sabr,e,

on the right side of the umbilical region.

it,

imme-

which appeared of a red-

and arterial
was a collection of worms. I|e suffered much pam and distressing
anxiety; the pulse was small and vermicular; his counr
tenance ghastly, and his extremities cold. In this state
had he been seven hours when he came to the hospital.
colour, inflated, without heat

pulsation: within this portion of intestine

The

house-surgeon being alarmed at his condition, sent

me, and I found the symptoms a.s just described.

My first care was to dilate the opening of the abdominal

for

muscles which produced the strangulation, and I then ex-

amined the other portions of intestines to know if they

were wounded I found the small curve of the colon
wounded in two places, and the mesentery extensively
divided by the sword. The first indication was to extract
the worms which filled the strangulated intestine, which
they were still
I effected with a pair of dressing-forceps
;

alive.

I then introduced a suture through the lips of the

wounded
reduced

intestine,

it,

and

after bathing

it

with

warm

wine,

taking care to retain the ends of the thread

nsed in the suture.

When the wounded

intestine

was

re-

turned, a considerable quantity of black clotted blood

MEMOIR*

388

escaped, showing that effusion of this fluid had taken

place in the abdomen. I brought the lips of the external

wound

together with a roller, and applied compresses,

warm camphorated
He was conveyed to a

dipped in

wine, and a suitable ban-

dage.

clean bed, and took

grains of opium in sweet wine.

The symptoms

two

abated,

he became composed, the animal heat returned, and with

it

the internal functions

were

He

restored.

slept a short

time ; next day the abdomen was much more painful and
sensible to the touch, the urine entirely suppressed, tem-

perature elevated, and thirst ardent; the lips of the wound

had separated, but presented nothing remarkable. He
died on the seventh day from inflammation and subse

quent gangrene of the peritoneum and

On

opening the body,

we

intestines.

found the portion of intes

tine formerly protruded, nearly of a natural appearance.

The

lips

of the

wound, united by

suture,

were

aggluti-

nated to each other; the edges of the divided mesentery

were found lying on each other

in

folds,

together, so that the contents of the

and adhering

wounded

could not escape into the abdomen. This

intestines

a very re

is

markable circumstance, and pleads loudly

in

using the suture in wounds of th^se viscera.

Bu we found

a quantity of black decomposed blood

filling

favour of
f

up the

pel

vis and the interstices of the viscera in the iliack regions.

Inflammation had made them adhere

to the

ilium

peritoneum.

were

a state of gangrene

in

searches further,

to

each other, and

Several portions of the end of the

we

discovered

extending our re

the source

of

this

copious effusion: the superiour mesenterick artery had

been divided near

first

wound

But for the

the

its

origin,

and

at

a distance

from the

of the mesentery.
latter injury, this

wounds of

man might have

survived

the intestines, and finally recovered. Thi^

AND CASES.
ease

may

encourage surgeons

wounds of the

When a

to use the suture to unite

intestines.

surgeon

wound

soon as a

389

is

called to

is inflicted,

perform

this

operation as

very small, round crooked

needles should be used. These do not divide the small ar,

leries of the intestines, but only

their coats without leaving an

separate the fibres of

open wound, and the

fluids

cannot escape through these small openings, as happens

after using the triangular needle.

Etienne Belloc,aged seventeen, a fusilcer of the guards,

was wounded by

sword

abdomen, about two

in the

inches above the umbilicus, and on the right side of the

linea alba.

He was

April, 1811

brought to the hospital on the

dressing and bandage.

Next day

which permitted the omentum

right rectus muscle
quite through,

and

its

to

of

examined

the

escape through

wound,
it.

The

tendinous sheath were cut

and the instrument appeared to have passed

in a transverse direction deeply,

between the

first

and the attending surgeon applied a "'simple

from before, backwards,

great curve of the stomach,

and

the arch of

the colon.

The paleness of death was on his countenance, and he

was tormented with intolerable anguish, nausea, and c!
forts to

at

vomit; with hiccough, ardent

thirst,

the bottom of the wound, and great anxiety

was small and

feeble, his extremities cold,

longer audible: we had reason

but a few moments.

with

my

Still,

acute pain
:

his pulse

and voice no

to believe

he could survive

I reduced the

omentum, and

finger ascertained that the

sword had glanced

between the stomach and colon', but I could not decide

on the place where it had etopped the wound was
dressed, externally, with linen, &c., dipped in warm
:

wine.

The abdomen was embrocated

with

warm cam

MEMOIRS

S90
phorated

and covered with hot

oil,

I prescribe^

flanq^l.

cooling mucilaginous drinks, emollient enemata,low diet,

a particular position of the body, and perfect

felt

but

from

relief

little

this

treatment

He

rest.

the prostration

continued as before, the pulse

was

and anxiety and nausea attended

he w^s never at rest.

vomiting came on with

On

the night of the second day,

small and tense,

considerable efforts, cold sweats, and ajarmin.g syncope

he

discharged the contents of his stomach by vomit

first

ing,

and then

On

the fourth day, to these bilious evacuations succeed-

bilious

matter with clots of black blood

ed a vomiting of thick black blood,

the

chamber

Qn

the fifth

took place,
the

wound;

the

without any

and

filled

in

with

signs of effusion in

his

it

such quantity, that

in a

abdomen always remained

syncope succeeded
sixth,

was

few minutes.
day an alvine evacuation, equally copious,
preceded by violent coliek, and acute pains in
utensil

its ci&vify.

and

flaccid,

An

alarming

evacuations on the night of the

thes,e

companions believed him dead.

visited the hospital very early next

When

morning, I fouud

his

and he opened his eyelids

was imperceptible, and his
immediately gave him warm wine, had his

face covered with the sheet,

with

difficulty;

the pulse

body cold. I
body rubbed with warm camphorated
and wrapped
covered
this

in hot flannels.

his senses.

The

He

oil

of chamomile,

soon revived, and

coliek never returned,

rc~

and from

time he gradually recovered. I prescribed a mucila

ginous drink, with syrup of althea,. and orange -flower-

water, to which was added a small quantity of nitrated

alcohol

emollient enemata were given, and the oily

brocations on the

abdomen

entirely ceased, but

continued.

em-

The vomiting had

on the 9th, the bloody stools again

appeared, and continued until the 12th of April,

when

they lefthjm: a pain remained for a long time in the

bottom of the abdomen

below the wound.

On

the

AND CASES.

39i

sixteenth day he appeared to be out of danger, and took

light food.

The wound was

before the thirty -fifth day

simply dressed, and healed

convalescence was

his

tedi-

ous.

A remarkable circumstance occurred while the wound

was healing. The omentum, which at first formed a tumour about the size of a queen-apple, on the outside of
the wound, became gradually and spontaneously reduced,
and returned

into the

abdominal cavity, without forming

any adhesions with the wound,

a*s

fast as the

which united

the lips of

epiploon withdrew from between them. I

had made a similar observation under other circumstances, but I

had never studied nature

ous operations as in

this case.

in hei4

spontane-

This phenomenon, and the

character of the wound, confirms the precept of Mr. Sabatier,

who

directs us to leave the epiploon

on the outside

of abdominal wounds, above the umbilicus.

that nature
shall

we

was advantageously

Here we

sec

How

substituted lor art.

explain this fact? Doubtless the vessels of the

different parts did not

each other,

in

come properly

in conjunction

with

order to form adhesion, and anastamoscs.

though a great similarity of organization and internal

Thus in a stomp,
which has been long completed, the vessels

distribution, existed

the cicatrix of
of*

between these

parts.

the divided muscle do not expand on the cicatrix, and

unite with the vessels of the skin and cellular substance, but

combine with each othw to form a separate cicatrix on

the end of the muscle; this forms a union with the end of
the stump, by the vessels of the cellular membrane,
which pass into it: so it happens wheiv the epiploon ia
lelt in

wound

of the

abdomen.

After passing through

the different stages of inflammation and resolution, the

vital

power

of the

omentum

effects the retraction

of the

displaced part by a repulsive systaltiek motion: the vessels

do not sympathize with those of the skin or abdomi

MEMOIRS

392

nal muscles, form no connection with the neighbouring

parts,

and return

What
case? It

to their former situation.

was wounded

part of the intestinal canal

was

in this

not the stomach , because he vomited no

blood until he had thrown up the

bile,

and the

be

fluids

The sword also passed below

stomach. None of the small intes

fore taken into this viscus.

the great curve of the

tines could

be wounded in

could not have

been poured

symptoms

filled

otherwise the blood

Had

would have

abdomen, and the

into the cavity of the

of effusion

not the case.

this case

the intestinal canal, but

would have followed, which was

been wounded, the

the large intestines

blood should have appeared in his

but this

first stools,

Every circumstance induces me to be->

lieve that the second curve of the duodenum was wound
ed where it is covered by the mesocolon. It appears as
if the point of the instrument had pierced this membrane
with the intestine, while Belloc was in full action, and

was

not the

fact.

guarding himself. His immediate

live situation of the parts.

fall

The wound

changed the

of the mesocolon

no longer corresponded with that of the

may

suppose that the

lips

relu

intestine.

We

wound in the former soon

the blood was poured out by

of the

adhered together, and that

the small arteries of the intestine into

its

mained there several days, producing

cavity,

and

re-

local irritation

fixed pain, and sympathetick vomiting of the contents of

the stomach.

One

portion of the effused blood

was

dis-

charged in the same manner, and the other downwards.

By

attending to the direction and depth of the wound,

and

to all the

concomitant symptoms, I think

tine alone could

have been wounded.

this intes

AND

-CASES.

MEMOIR

Ow the

Consequences of the Operation for Empyetna.

T HAVE never been able

--

tion for

to ascertain

empyema, when performed

why the

opera,-

to evacuate san-

guineous or purulent collections in the thorax has been so

unsuccessful.

The

cases

which occurred

in the hospital

of the guard during the years 1810, 1811, led

quire into the causes of this failure,

and

me

to in-

make myself

to

acquainted with the resources which nature adopts in

cases where a recovery has followed the operation.

I have inspected the bodies of a great

number who

died in consequence of sanguineous, purulent, or aqueous

effusions into the thorax,

and these

dissections unequivo-

cally prove, that the lobe of the lungs in the cavity

where

effusion has taken place, collapses and retracts towards

its

root, gradually yielding to the effused fluid that space

which

it

formerly occupied.

The

no longer admit the fluids which

state.

They become

vessels of the lungs can

filled

them

in a natural

obliterated, adhere together,

and the

surface of the lungs adheres to the pleura costalis. Thjs

Vol

R.

MEMOIRS

394
organ continues

to diminish

and

in size,

internal

its

adhesions multiply in proportion to the increase of effused

Finally, the substance of the lungs disap

fluid.

pears entirely: their bronchial pedicle becomes contract

ed, and the air-cells totally obliterated.

lungs

is

now

The

lobe of the

incapable of being dilated, and though the

effused fluid be evacuated, the space

which

remains vacant. Nature not being able to

it

fill

occupied

up

this

va-

by the dilatation of the lungs, adopts other means

cuum
which

I shall

.We may now draw

attempt to explain.

the following inferences, namely, that the operation wifl

be more or

less uncertain,

the. effusion.

at

When

according to the duration of

the operation

is

therefore performed

an early stage of empyema, before the foregoing state

of the lungs shall have taken place,

it

may be

successful.

Under such circumstances, I have seen many

cases of

cure after the operation.

Whatever precautions may be taken to prevent the

left by the abstraction

admission of air into the vacuum,

of the fluid,
say,

the

still

the result will be the same.

empty space must remain

which
tated

is

to

the same.

The membranes

become irri
presence of a new fluid, name-

line the walls of the thoracick cavity,

and inflamed by the

ly, the

high,

That

the lungs cannot dilate, for reasons before given,

if

it

external air.*

When

this

inflammation runs very

impairs the mnctions of the heart and lungs, and

the patient sinks. If he survive these first effects, a copi-

ous suppuration takes place over the whole surface of the

pleura, lining the diseased cavity,

and goes through

its

different stages in a longer or shorter time, according to

the age of the patient, the duration of the disease,

The

observations contained in the note,

relating to the inflammation of

ply here. Tr.

wounded

and the

p. 179, Vol. I.
cavities, will ap-

395

AND GASES.
character of the effused
is

fluid.

mor^ abundant, the pleura

In adults, the suppuration

is

ficulty, the capillary vessels are

destroyed with more

dif-

not so soon thrown out

from the walls of the cavity, and it is almost impossible

that the large space left by the evacuation of the fluid,
can be filled up. Therefore, examples of cure at this age,
and a fortiori, at a more advanced period of life, are very
rare, if they exist at all. For the small number of such
operations detailed by authors, were performed on persons who were very young, or whose ages were not re,
corded.

means by which nature, with the assistance of art, may fill up the space just
spoken of, and remove a vacuum which the animal ecoI shall attempt to point out the

nomy cannot tolerate without great injury.

The accumulation of a fluid in one or both
the thorax has two effects. The first is, the
and distension of its

pliant walls,

cavities of

separation

namely, the diaphragm,

mediastinum, pericardium and heart, and the false ribs

and their cartilages. The second is the disorder of the

membranes, which, coming

have

with

in contact

their functions disordered or impaired.

this fluid,

The capacity

augmentation
of the cavity increases in proportion to the
fifteen
of the fluid, so that I have found five, six, ten, and
first
The
thorax.
of
the
cavity
litres of fluid in a single

evacuated,
operation of nature after the liquid has been
distended walls nearer togeis to draw the separated and
ther;

which

is

effected

by the laws of

elasticity,

and the

relapower of the parts. This diminution of the cavity is

capilof
production
is gradually effected. The
tive,

and

lary vessels

by

the pleura, mediastinum,

probably the lungs,

assists in effecting

it.

diaphragm and

The

power

intercostal

of contract-

muscles become useless, and

approximate, the cartilages lose their
ing The ribs
lose the

396

MEMOIRS

and encroach on the thoracick cavity. The process of ossification in the sternum and ribs undergoes
curves,

such a change, that the curves of the bones diminish,

while they increase in thickness and become cylindrical,

thus contributing to invade the cavity. Finally,

all

the.

powers of organization concur in producing this convergence, and gradual diminution of that space in the tho-

whence the effused pus, blood, or serum was drawn.

walls come together, and contract mutual adhesions,
or form an internal cicatrix, and the patient regains his
ordinary health. Such a termination may easily take

rax,

The

place, in persons
fied,

whose bones

are not completely ossi-

and whose capillary organs are susceptible of unu-

But

sual extension.

if

the patient be

more than

thirty

years of age, nature does not possess the same resources,

and a recovery

is

rare. I

know

of no well-attested cures

after this age.

The same phenomena will be noticed in the following

and may be explained by the pathological prepara-

cases,

tions in

my

From

possession.

these facts, the following inferences

may

be

drawn.
1st.

When we

have ascertained that a

fluid

has been

we should lose no
operation may be performed

effused into a cavity of the thorax,

time in evacuating

it

This

with greater confidence, as

difficult,

more

operating.

coming

it

is

neither dangerous nor

especially to such as are

The

accustomed

into contact with

membranes

presence of a liquid, particularly

if

habituated to the

the atmosphere be

cold and moist. Injections are rarely useful

tate the capillary

to

external air should be prevented from

they debili-

organs by therr mechanical action, and

their difference of temperature

or increase local irritation.

may produce a metastasis,

AND CASES.

397

2dly. The evacuation of the fluid may be sufficiently

encouraged by close and simple dressing. A small tent
covered with cerate, should be carefully introduced into
the orifice, to prevent, as far as possible, the admission of

The

air into the cavity of the thorax.

kept under

patient should be

regimen, while his strength

is

support-

ed by good stomachicks, and mild stimulating

articles.

strict

Convalescence after

this operation is tedious, as will ap-

pear by the following cases.

I shall

first

report an

uncommon

case of hydrothorax,

the diagnosis of which will serve as a guide to distinguish the varieties of thorachick effusion.

This case appears interesting, from the curious and

remarkable appearances which occurred during
tinuance,

and

its

con-

after the operation.

Avoine Chat elain, aged twenty-six, a drummer of the

guard, after serving during the campaign in Egypt, and
returning to France in good health,

was attacked

in April

1802, by a pleurisy, which passed gradually through it^

different stages. He so far recovered under the care of

my
to

colleague at the hospital, that he

Chamberry,

his native country, to

of convalescence.

He

He

when

then

able to repair

spend three months

then returned to his corps, but he

always complained of a part of

pain,

was

his side

which gave him

he took severe exercise,, or bent the trunk.

felt difficulty

tions, followed

of respiration, and slight palpita-

by paleness of

the countenance; emacia-

tion, anxiety, and disorder of the organick functions ap-

peared to have increased gradually and insensibly, sinee

his disease, until he was threatened with suffocation, arid

symptoms which he considered dangerous, and he

turned to the hospital on the 14th of May, 1804.

re-

MEMOIRS

398

He was
who

Sue,

placed under the care of the physician, doctor

remarked, while examining

he pointed out

first visit, that

disease,

that the heart

stone

thorax at his

and that the pulsations of the heart were

the right side of the thoracick cavity,

tion,

his

this part as the scat of the

whence he

had been removed from

its

felt

on

inferred

original situa-

by a mechanical cause. The patient said that a

had struck him on the right side of the thorax at the

siege of Acre. It was supposed that

if this

deviation of the

would be impeded, and ren

The pulsations at the wrist were indeed

heart existed, the circulation

dered languid.

very feeble, while those of the heart appeared stronger^

in consequence of the approximation of this

organ

to the

walls of the thorax.

This aberration of the heart having excited the curio-

and several physicians of the

sity of the pupils,

Sue requested

At

me

to visit the sick

first sight, I

was convinced

city,

Dr.

man.
under

that he laboured

a hydropick disease of the thorax, and I immediately

opposed the opinion relative to the manner and cause by

which the heart was moved from

was impossible

natural position.

its

that such a transposition of that

It

organ

could take place without proving fatal in a short time, or

Inducing symptoms which he could not survive.

I attentively
his

examined

his thorax

and every part of

body before interrogating him. This examination, and

few interrogatories, confirmed

fluid

was accumulated

rax; but I

knew

that

in

me

in the opinion that a

one of the cavities of the tho-

hydro thorax uniformly occupies

the left side of the chest: indeed the ribs

more

were evidently

horizontal on this than on the opposite side

intervals

between them were

larger,

the

and between the

the third and fourth rib, counting from below upwards, a

fluctuation

was

commonly

elastick.

perceptible, or at least, the part

The

least pressure

on

was

un-

this part pro-

399

AND CASES.

On

Sliced acute pain.

the posteriour part of the

may be
and

same

an oedematous swelling, which

side of the thorax, I found

considered as a eharacteristick of this disease,

an ecchymosis forms

in cases of sanguineous effusion,

on the same part, as Valentin has observed. The patient

always reclined on the same

side,

because he could not

remain on the other without experiencing great

difficulty

of respiration, and being threatened with suffocation:

was

equally painful to

rizontal position.

him

to stand erect, or to lie

it

in a ho-

His abdomen was swollen, the spleen

protruded the integuments over the iliack region, the pulsations of the heart

were

felt

under and behind the right

breast, opposite the middle of the arch of the fifth

There were no

sixth ribs.
wrist,

They
tid

and they were merely perceptible

could be perceived

arteries.

short,

and

in the

in the axillary, crural,

The motions of

laborious

and

arterial pulsations at the right

respiration

left.

and caro-

were languid,

the hypochondrium of the diseased

side without motion, the face pallid,

and

slightly bloated,

and the tongue white, and partly covered with saburra

The alvine evacuations, though by no means frequent,
were natural, the urine small in quantity and seldom
evacuated, the body emaciated, the skin rugose, and perspiration obstructed.
tion,

He

had a

slight

evening exacerba-

and laboured under continual insomnia and anxiety,

difficulty of changing his position.

inconsequence of the

In short, he was extremely feeble, and from

all

appear-

ances could expect to survive but a few days.

There was an immediate

necessity for evacuating the

fluxl from the thorax, and I proposed the operation for

consultation was called next morning of
empyema.

the physician of the hospital, and the principal surgeons

of the gaard, who decided in favour of an immcd'uitc

operation.

400

MEMOIRS
j

On the

17th of

May

the patient

operating room, where his debility

could scarcely

muscles,

sit

when

more than

was removed to the

was so great, that he

I had only divided the intercostal

ap.

the fluid rushed out to the distance of

four feet,

and the

orifice

grew

larger sponta-

neously. I directed the assistant to reserve the fluid,

which was discharged, but he neglected

so to do; but ac-

cording to the estimate of the assistants, the whole quantity

was

Notwithstanding the

fifteen or sixteen litres.

prostration of strength, the patient bore the operation

very well, and

opened.

The

felt

fluid

relieved as soon as the thorax

discharged

gray colour, and milk

like consistence.

me

which succeeded induced

had been contained

was almost

The

liquid

and that

The symptoms

to believe, that this fluid

in a particular cyst,

portion of the pleura, at a distance

nally diseased,

was

inodorous, of a

formed on some

from the part

origi-

had since gradually increased.

it

was completely evacuated, and he had no

a sound was introduced

syncope during the operation

and passed on to a considerable distance, without meeting any resistance. I introinto the thoracick cavity,

duced into the wound a tent, covered with cerate, and

compresses and proper bandages were then applied.

By

the production

and growth of

this cyst,

may we

explain the changes of situation which the organs of the

thorax and abdomen had undergone. Thus the lungs of

same

had been compressed and pushed back by

degrees towards their bronchial roots, and were almost

the

side

destroyed: the mediastinum being pressed towards the

right cavity of the chest,

had drawn with

dium and heart to the same

side,

it

the pericar-

and the pulsations of this

organ could thus be perceived between the

fifth

and sixth

ribs.

The
ration

operation

became

was followed by

less laborious,

a general calm, respi T

and the heart appeared

to

AND CASES.
Contract with greater

facility.

401

We neglected to put a ban-

dage round the abdomen, and the

denly set

was

at liberty,

became

intestines being sud-

inflated

a flatulent colick

the consequence. It yielded to embrocations of warn

camphorated

oil

of chamomile, and graduated and uni-

form compression on the abdomen.

was calm during

the night,

He

slept

two hours,

and I found him much im-

proved next day.

For
filled

several days after the operation, the dressings

appearance;
first

were

with a copious, serous, purulent discharge, of a gray

his strength gradually returned.

During the

days I permitted him to take some light potage,

which he digested with

difficulty, in

consequence of the

weakness and sudden -expansion of the abdominal viscera. We were obliged to direct aromatick and camphorated embrocations, tonick and moderately stimulating

enemata
to

to

be administered, and cordials and stomachicks

be given in moderate quantities.

The principal arteries of the body pulsated with

ficient force

suf-

on the third day, but the pulse did not return

and sixteenth day,

to the radial arteries, until the fifteenth

and then continued very weak and vermicular even after

an aneuffie brachial arteries had enlarged, and assumed
rismatick character. This fact shows that when the contractions of the heart are

not overcome

much impeded,

the resistance produced

by

this

organ can-

the various ra-

mifications of the principal arterial branches. It even appeared that these arterial divisions were on the point of

the
being totally obliterated, for the circulation through
fact
This
arrested.
entirely
almost
capillary system was
of the body
enables us to explain the constant coldness
the discoand
and extremities under which he laboured,
loration of the skin of the latter.

the fifteenth day the pulsations of the heart were

perceived near the same region, namely, on the right

On
sifil

Vol

u,

3E

MEMOIRS

402
lateral part of the

were more

tions

thorax

and more

borious,

full

but his respiration

was

less la-

and complete: the alvine evacua

regular, his sleep

was no longer

dis-

turbed by distressing dreams or pain, his countenance

resumed

its

now

subsided.

from the thorax continued

pearance

it

and the swelling perceived

natural colour,

before the operation

became more

The

fluid

and

fluid

fetid

I ordered the

Such medi-

dressings to be renewed three times a day.

cines

and aliments as were calculated

strength of the patient were

to assist nature in the

discharged

be nearly of the same ap-

to

still

to support the

continued, with a view

accomplishment of her intention,

which was the destruction of the

mation of the walls of

this

cyst,

and the approxi-

great cavity.

His strength

continued to improve, his functions were evidently returning to their natural state, the heart gradually returned
to

its

original position,

and

its

pulsations

were

felt

every

day nearer the sternum.

The

state of the patient

was now a matter of

surprise

he rose without assistance, and was able to take a few

was good,
The opening between the

steps with the help of his nurse, his appetite

and he
ribs

slept in

any

posture.

was much reduced

in size,

and discharged a small

quantity of laudable pus.

Professour Desgenettes, and several other physicians

saw him

at various periods since the operation.

He remained some time in this promising

and we entertained some expectation of his
with which he

condition,

recovery,

also flattered himself; but in the midst of

these expectations, he

was suddenly attacked with

ri-

gours, extreme anxiety, torpor, oppression, difficulty of

respiration,

and

cofick.

These symptoms appeared

to

be

the consequence of the repercussion of suppuration, and

cutaneous perspiration, caused by the cold moist air while

sleeping accidentally without covering, during a stormy

403

AND CASES.
night: stomachick cordials, dry frictions,

warm

flannels

body, and vesicatories, could

to the whole
not prevent him from falling into a hectick fever, with
colliquative diarrhoea, which reduced him, in a short
surface of his

time, to the last degree of emaciation

pain on the 31st of July, of the

I

proceeded to open

his

body

physician of the hospital, and

stomach and small

same

intestines

my

much

he died without

year.

in the presence of the

we

pupils;

found the

smaller than natural,

below the
and the spleen large and hard, extending
ribs
to

false

was reduced nearly

into the iliack region. The liver
to be pressed
half its natural size, and appeared

one

into the lowest part of the

hypochondrium.

A portion of

the cavity of the pelthe small intestines were lodged in

of the great devis; these changes were consequences

weight of fluid conpression of the diaphragm by the

thorax, where we now
tained in the left cavity of the

examining more
found a large empty space. After
on its lateral and
prominence
ly, we discovered an oblong
by the ul,
covered
part, hard to the touch, and
close-

supcriour

cavity
membrane, which lined the whole of this
root of the right lobe ot
This tumour was attached to the

cerated

open

At the most dependent part appeared the

that the
made by the operation; this was so situated
more in front,
could flow out without obstruction

the lungs.

ing

fluid

the sternocostal junction of

a deep caries had destroyed
seventh and eighth ribs, the consethe cartilage with the
a former injury at this part

quence, without doubt, of

and ex-

its rise here,

appeared that the disease took
to every part of its surand
tended from below upwards,
with a pellicle colined
large cavity was

It

face

AH

this

mucous matter of greater thickvered with a purulent

of the cavity, and thinner above,
ness towards the bottom
even fallen off.
where several portions of it had

MEMOIRS

404

The diaphragm was

downwards, and the me^

pressed

diastinum to the right, so that it had abandoned the ster-

num, and

had contracted adhesions with

right edge

its

the cartilages of the

pericardium, which also

The

ribs.

contained a considerable quantity of serum, was, like the

heart,

inclined- to the right

still

but

much

less since the

was

operation than before: the position of this organ

such, that instead of having

towards the

point turned

its

was turned in the oppobase was thrown upwards to the left By this disposition the circulation was
carried on with difficulty through those parts which re-

left,

forward and downwards,

site direction,

it

to the right, while

ceived their blood from the

even the heart

itself

its

branches of the aorta

first

was diminished

auricle considerably dilated, as well as the

vena cava. The cavity of the

inferiour

same

it,

was

mouth

right

of the

ventricle, of the

small,

was given off

by a single

the artery, which

and seemed

to incline

trunk towards the right lobe of the lungs

right lobe

its

appear to be proportionate to the ca-

side, did not

pacity of the auricle

from

and

in size,

was almost

obliterated.

The

that of the

left

auricle

was

almost effaced, in consequence of the retroversion which

Ihe heart had undergone, and a part of

The pulmonary

without a cavity.

it

was

solid,

and

veins of the right side

entered near the base of the heart, and opened almost im-

mediately into the

auricles

was

still

lelt

ventricle

vena cava to pass into the

the heart,

retroversion,

blood in

The

especially

left auricle.

The

had been subjected

which doubtless impeded the

this artery,

vessels

the septum between the

permit a part of the blood of the inferiour

tres, so as to

aorta, like

open, about the space of four millime-

origin of the
to a degree of

circulation of

and the branches which

it

gave

the arteria innominata, the walls of

were almost

off.

which arose from the curve were very small,

in contact

this explains the

which

deficiency q!

AND

403

CASES-

pulsation in the humeral branches, both before and after

the operation; the pulsations of the

The

paired.

peared as

was

arterial tube

still

were

also im-

partially open,

and ap-

left

side

had permitted a part of the blood to pass

from the pulmonary artery into the pectoral aorta. The
if

it

substance of the heart was whitish., and of a soft consistence, as

macerated.

if

The examination of this body

enables us to explain the

phenomena which appeared during the

far the resources of nature

disease,

may be called on

and how

for the pre^

servation of the individual.

The

following cases

bility of

Bernard

Ogne, aged

St.

perial guard,

was brought

March, 1810,

wound

more

clearly point out the possi-

curing this disease.

of the

tres long.

at

left

The

two

a chasseur of the im-

o'clock,

p.

on the 18th of

m. with a punctured

side of the thorax, about

skin,

were divided with

thirty,

to the hospital

two centime-

and a part of the pectoralis major

the

cartilage

of the fifth rib near

union with the sternal extremity of

this

its

bone. Frothy

and vermilion-coloured blood was discharged by jets synchronous with the pulsations of the heart, which were
perceived by sight and touch.
his lips blue, pulse small

He was

pallid

and

and frequent, and voice

cold,

feeble

and interrupted. His respiration was laborious, and often

impeded by sighs and sobs, and his eyes watery and
dull. He refused surgical assistance, and seemed to wish
for death.

His injured feelings had brought on a paroxysm ol

desperation. Being accused of a misdemeanour of which
he was innocent, with his left hand he plunged a knife
into the thorax, after having carefully ascertained

the pulsations of the heart were most perceptible.

where

The

MEMOIRS

406

edge of the knife was directed perpendicularly to the

axis of the fifth rib

but

at first

it

met with great

resistance,

he soon overcame by applying a greater force

this

and the instrument having a very sharp edge and

point,

entered the thorax obliquely from before, backwards,

downwards and inwards. The

had been

cartilage

di

vided quite through, the superiour and anteriour part of

the

le;t

was

pulmonary lobe was wounded, the pericardium

injured,

and the point of the knife buried

mediastinum, where

teriour

in the an-

probably met the diaphrag-

it

matick nerve: the symptoms which followed seemed

prove

to

this.

The haemorrhage and

injury of these organs

were

first

seen by the surgeon of the hospital, and Mr. Dicchc, ju-

The

nior surgeon of his regiment.

latter

being called to

him

stretched on the

give him the earliest assistance, found

with the knife remaining

floor in a state of insensibility,

in the

He would not

wound.

extract

it

lest

impetuous has

morrhage should follow and extinguish the small remain

ing flame of

The

knife

tion, the

life.

was

wound

extracted with every necessary precau-

dressed, and they conveyed

him

to the

hospital.

The house

surgeon, after examining the parts, and as

certaining the

imminent danger of the

immediately united the

straps, according to

made over
flannel,
ed.

the

of the

practice.

wound with adhesive

Dry frictions were

whole surface of the body with a

warm

and an antispasmodick draught was administer-

He was

side,

lips

my

patient's condition,

relieved, turned

voluntarily on the right

and the animal heat gradually returned.

Several hours had elapsed,

when

him very uneasy, much

agitated,

acute pain in the wound.

He

to destroy himself.

slight

the surgeon found

and complaining of

had torn

off the

dressings

haemorrhage had already

407

AfcD CASES.

detached the adhesive straps, and extreme debility and

syncope followed. The surgeon again united the

lips of

wound, he became composed, and slept part of an

hour. About ten in the evening, the pain and difficulty of

the

and increase of pulse and heat, induced the

surgeon to open a vein in his arm, which produced an
apparent calm, and he passed the night without any re-

respiration,

markable occurrence.

On

the 19th,

his debility

when

I paid

him a

visit in the

was extreme, the pulse small and

morning,
irregular,

and the respiration impaired, but not very laborious: hurried palpitations

were

felt at

the

wounded

part, the pain

was acute, the voice feeble, he sighed frequently, his eyes

were always suffused with tears, and he wished for
death.
I encouraged him, prescribed

warm

oily

camphorated

embrocations over the thorax, a cooling mucilaginous

drink, and gave him several glasses of ethereated emulsion of sweet

almonds

in the evening he

was

directed to

quantake a portion of chicken-broth, and a very small

alarmany
without
day
the
tity of good wine. He passed
the evening, I
ing symptoms, and when visiting him in
him tranquil and composed. He continued to lie

found

on

his right side.

He was

less

calm the following night,

hours of imperfect sleep, awoke

after one or two

with an intense local pain.

and

The

slightest

motion threw

His sighs were frequent, and a

of the left
tressing pain was felt on the outside

him

into syncope.

The

dis-

leg,

of
whence it
other
each
with
adhesions
the wound had now formed
near the wound below the
applied
be
to
cups
I directed
The camphorated oily
breast, which afforded him relief.

extended to the sole of the foot.

lips

other remedies. I
embrocations were continued with the
and he
enemata,
emolient
ordered some camphorated

passed several days in a

state

of calmness.

MEMOIRS

ios

On

the seventh day after the accident, the local pain

returned, and

became extremely

acute. I prescribed a

second and a third cupping, but without permanent advantage.

now

continual thirst

attended on the local

and insomnia and an evening paroxysm of

pain,

followed.
ternally,

On

fever

We persisted in the Use of antispasmodicks in

and camphorated anodyne emollients externally

was more extensive and

the ninth day, the pain

more

acute, the thirst

distressing, respiration impaired,

the pulse intermittent, small, and corded, and the pain of

were

more

A large vesicato-

the leg

and

ry was

applied to the praecordia, and the emulsions and

foot

also

He

antispasmodicks increased.

and was not able

acute.

still

The

anxiety and difficulty of respiring.

false ribs

on

lay

his right side,

to turn himself, without feeling great

was depressed, but

there

space about the

was no ecchymosis of

the posteriour part of the hypochondrium, nor any sign

of thoracick effusion on that side.

The inflammatory symptoms

abated in some measure

but the difficulty of respiration and anxiety remained

nearly the same.

The wound

cicatrized.

portion of the divided cartilage never

sternal

into appo-

with the other part, but formed a considerable

sition

projection outwards.
first

The

came

The

had been suspended,

slept imperfectly,

On

and

alvine discharges

now became

his pulsfc

which

regular.

at

But he

was small and corded.

the eleventh day, the oppression, cough, imperfect*

respiration,

and

local pain

had increased.

I applied a se*

cond vesicatory, which alleviated the symptoms. They

then appeared in a different character.
pressive, but less acute,
first

The

were very

The

pain was op-

and the palpitations which

perceptible,

now

totally

pulse lost every third or fourth stroke.

tremely feeble, and moved with

difficulty.

at

disappeared^

He was

ex-

I prescribed

chicken -broth, good wine, a pectoral drink,

gummou*

AND

4(59

CASES.

biiodyne juleps, and oily embrocations over the thorax

and abdomen.
In

this

state

he remained several days, and then the

oppression and difficulty of respiration increased.

mucous expectoration was

riot free, the

The

intermission of

pulse increased, his strength failed, emaciation

became

extreme, the alvine evacuations were colliquative, he

slept none, Was tormented with thirst, anxiety and cough,

which could no longer be supported, and

be drawing

life

seemed to

to a close.

He had heard me speak of the operation for empyema,

his thoin my clinical lectures. He begged me to open
rax, or give a quantity of opium to produce sleep. I had
several times thought of performing this operation in his

had pointed out the possibility of its success to

the
pupils, with the symptoms which characterised

case. I

my

any

collection of

fluid in the

pericardium, or a particular

of the heart. I had shown, that the

with the proper
in such cases has no communication

formed

cyst
fluid

in front

cavity of the thorax.

The

constant position of the patient

elevated;
on the right side, with the head and thorax
heart,
and an
the
of
the total absence of the pulsations
when
surgeon,
the
undulation perceived by the finger of

applied during
ribs,

above

a cough between the

the left breast, but

more

fifth

and sixth

especially this latter

of the

epiphenomenon, and the absence of the pulsations

of a dropsy of the pe*
heart were pathognomonick signs
water in the pericardiricardium. For, a collection of
the heart, must seor in a cyst, situated in front of

um,

the walls of the thorax, that

parate this drgan so far from
be no longer externally felt. Authors
its pulsations can
disappearance of pulsation, nor
have never noticed this
fluctuation of a fluid, as discovered by
this undulation and
after being setin motion by the
the finger of the surgeon,
shock given to the base ef
i*ugh, or by respiration. The

Vol n

3 F

410

memoirs

the heart, the

the

left

membranous

ventricle,

and the posteriour wall of

cyst, displaces the fluid

which

m'Tjt of

necessity undulate with greater or less force towards the

may be

opposite wall of the sac, and

felt

through the

space between the ribs^ as I have before observed.

Add

two epiphenomena, which should always

to these

exist in

dropsy of the pericardium, the intermission of

the pulse of

which authors make no mention. The

latter

took place a few days after the accident, and continued

was performed. For,

which the heart was kept, of

to increase until the operation

state of

confinement in

cessity prevented

its

would have continued

contraction,
to

and

this

the

ne-

disturbance

become more considerable

proportion to the pressure of the mass of fluid on

in

this

organ.

Authors have considered the disposition of the patient

to lie

on his

left side, as

a certain sign of hydrops peri

we have seen in the

Ogne, who always lay on the right, and
could not turn on his left side, without being threatened
cardii.*

But

case of

St.

is

it

the reverse, as

with immediate suffocation.

evident,

when we

The

reason of this will be

take into view the relative situation of

the parts.

The

pericardium and the heart are contiguous

attached on the right and

to the

mediastinum, and

to,

and

left

to the dorsal vertebrae,

to the

tendinous centre of the

diaphragm, by large vessels, by membranes, and tendinous adhesions. Still the patient should lie at ease on his
right side,

when

the fluid

is

inclosed in the pericardium,

same region. The pressure

and distension of the heart will be less when supported
by its attachments, and the tendinous planes of the meor in a cyst occupying the

diastinum or diaphragm. But

Wrk

when he

reclines

of Scnao, Structure of the Heart.

on

hi?

AND
left side,

we

might expect

411

CASES.
that the heart

would be sub-

jected to such a state of retroversion and distension,

the weight of the incumbent fluid before this

by

organ

could be supported against the ribs, that a mortal syn-

cope might occur.

In the above case, the pain of the leg and

left foot ap-

pear to have been sympathetick.

To

symptoms of hydrops periwere added, difficulty of

these pathognomonick

cardii in the case of this soldier,

oedema of the

respiration, cough,

inferiour extremities,

increasing emaciation, thirst, insomnia, and anxiety.

At

the time

when

announced the

collection of a fluid

in the pericardium, or in a separate cyst situated near

the heart, I also declared

it

as

my

opinion, that no fluid

had been effused into the proper cavity of the thorax.

The absence of the

signs

before noticed, induced

which characterise

me

Finally, seeing that this

to

advance

the latter, as

this assertion.

man must meet

a certain and

speedy death, I resolved to reduce the following operation

to practice.*

But

who

of the operation, and that

formed.

He was

edge of

his

physicians and surgeons

I first called the

of the hospital together,

it

all

agreed in the necessity

should be immediately per-

placed in a convenient posture on the

bed, and I

first

divided the skin and cel-

between the fifth and sixth ribs, below

along the inferiour edge of the pectoralis
and
the nipple,

lular substance

major muscle, then cut through

the layers of the intercos-

muscles, in a direction parallel with the ribs. Having

with great
cut down to the pleura costalis, I proceeded

tal

might not be divided,

caution, so that this last partition
* There is no well-authenticated case in which this opeprogress of the
ration has ever been performed. If the
appeared in
they
as
observed,
attentively
symptoms be
be sucthe case of St. Ogne, they will Bhow that it may

cessful.

MEMOIRS

412
if the heart

me

informed
fluid,

should be contiguous to

The want of

it.

re-

and a few drops of serum which now escaped,

sistance,

which

that the

membranous

sac containing the

mistook for the pleura, had been opened.

Without removing

my

index finger from the bottom of

the wound, I took a probe-pointed bistoury, and having

introduced

its

point into the cavity, I enlarged the open-

ing by an incision of sufficient

fluid

size.

yellow serous

immediately flowed out, mixed with some clots of

black blood, and

a pewter basin. This fluid was

filled

discharged in very copious and frequent

my

and

finger deeply into the thorax,

naked apex of the

in size,

heart, which, though

retained

still

its

conical form.

league, also perceived the same.

the patient

was

With my

finger

in great

jets.

thrust

distinctly felt the

much diminished
Mr. Sue,

During

my

col-

this operation,

agony, and ready to expire.

alternately

opened and closed this

aperture, communicating with the seat of the disease.

The
full,

first

and

basin,

in

which held about

half a

litre,

was soon

a few minutes a second, and a considerable

quantity ran

down on

the bed, so that

the whole quantity of effused fluid at

half, or three

we may compute
two pounds and a

pounds.

I closed the lips of the incision, and applied a suitable

dressing.

Generous wine and good broth revived him in

some measure. From

ral,

and

difficult,

this time, the pulse

became natuwas less

entirely ceased to intermit. Respiration

and the cough abated. During the day, the

fluid

which had not been completely evacuated, flowed out at

different times. The dressings were renewed, with the

anodyne and antispasmodick draughts. During the first

night, he slept a short time, and remained perfectly com
posed, except

During the

when
first

disturbed by the cough.

two or three days,

pijed to discharge serum,

the

wound

conti-

and then closed spontaneously,

AND
as

if

about to cicatrize.

When

this part, the action of the heart,

ceived for the

less sensible

418

CASES.
the

hand was applied

though feeble, was per-

time since the accident; but

first

to

every day, and had ceased to be

it

became

felt entirely

on the tenth day after the operation. New symptoms of

disorder, and tightness of the thorax having made their
appearance, with signs of a putrid gastrick affection, I
resolved to break open the slight adhesion of the incision,

and

to introduce a tube into the thorax.

gave egress

This operation

to three or four ounces of fluid of a serous

purulent appearance, mixed with dark coloured flocculi

He was instantly

relieved.

But when the tube came

cessive pain
to

was

an alarming

in contact

with the heart, ex-

the consequence, and he

We

state of anguish.

was thrown in-

therefore resolved

that this instrument should never be introduced, except

from absolute necessity.

A gentle emctick, which had been exhibited with a view

by the efforts to vomit produced a discharge of a considerable quantity of purulent
to evacuate the prima? via?,

matter from the

incision.

This purulent discharge dimi

nished by degrees, so that the dressings heretofore re-

newed

six or seven times in the course of the day,

now changed
pression

but twice.

became

The cough

less, sleep

able to recline on

was more

either side.

He

were

also abated, the op-

perfect,

and he was

took good diet, with

good wine, and rose every day voluntarily, to have his.

bed put in ordeg. The functions were soon in some measure re- established,

When we

were

if

we

except that of nutrition.

authorised to entertain expectations

o\

to eat
his recovery, his inordinate appetite induced him

a quantity of radishes, and other indigestible food, which

one of the nurses, through a spirit of cupidity, had procured for him.

Ho was

symptoms beyond

immediately attacked by new

our control, namely, convulsive vo-

MEMOIRS

414
miting, accompanied

by cough and acute

colick, to

which

succeeded a dysenterick flux, and colliquative diarrhoea.

His strength before diminished, was now completely

destroyed, and he gradually sunk, and died with compo-

May;

sure on the 21st of

dent, and

twenty-three

which time

the general

sixty three days after the accisince

the operation.

powers of

manner almost miraculous,

life

During

had struggled

in a

against the operation of the

most destructive causes.

Appearances of

the

foregoing Case on Dissection

In order to inspect the parts in their relative situa

tion, I

made

on both sides of the

a perpendicular incision

thorax so that

the anteriour wall of this cavity, in

all

my

which were the cicatrix of the original wound and

incision,

with a

might remain

saw

entire.

Having divided

in these directions,

we

cut

the ribs

up the trachea,

oesophagus and jugular vessels to detach the lungs and

heart with greater

The left

facility.

wounded

lobe of the lungs on the

hered firmly to the pleura

face of the lungs

was

costalis,

and the whole

of a deep reddish

flamed, and of a texture almost solid

fused

fluid in the

side ad-

sur-

brown, much

in-

was no

ef

there

proper cavity of the thorax, as I had

formerly decided.

In pursuing our dissections,

nous sac, which

at first

um, situated between

tending forward
to the spine.

we

met with a membra-

was mistaken

for the pericardi-

the mediastinum and the heart, ex-

in front of this

organ, and posteriourly

This sac or cyst was of moderate thick

415

AND CASES.
ness, and lined internally with a villous substance,

which

threw out the purulent secretion during the disease.

On the anteriour wall of the cyst, below and near the
sternum, we found the fifth true rib displaced where the

Here the internal mammary artery had been divided more outwardly was seen
and
the incision of the operation, near which the heart
was
them
between
space
the
situated:
pericardium were
much infrom ten to twelve lines. The pericardium was

point of the knife had entered.

adhering to the
flamed, gangrenous in several parts, and
a contraction
surface of the heart, a depression, or rather
of

its

own

substance

was

seen near this opening. I care

divided this coat, and dissected it up with consider

heart, which was
able difficulty from the surface of the
black
half its usual volume ; a large clot of
fully

reduced to

and the
blood was interposed between the pericardium
it,
removed
pulmonary ventricle of this organ. Having
cidiscovered a small deep furrow or groove, like a

we

towards the right curve, and near the base of the

appeared
heart, where a branch of the coronary artery
having
injection
to have passed along ; for, an

catrix,

formerly

been thrown into the

arterial system,

injured portions of these vessels.

had stopped

at the

That part of the pen

presented evident
cardium immediately contiguous also
in length, and
of a cicatrix, several millimetres

marks

made by the knife. The other

membrane were very thick, inflamed,

without doubt had been

portions of this

spots; the surface of the

and covered with gangrenous
gangrene, and as it were disheart was excoriated by
muscular fibre was black, and
solved in some parts its
was a small quantity of
appeared as if macerated. There
:

cavities of this organ the other

black liquid blood in the
abdomen presented nothing
viscera of the thorax and
:

remarkable.

416

AiEMOifcs

After reflecting on these appearances, from what part

we

can

admit the

an opinion ; but

we

were noticed

It

it

would be

difficult to

advance

an explanation

shall attempt to give

which produced the phenomena

relative to the causes

that

have been discharged by the

fluid to

operation? on this point

after the operation.

must be evident that the

which we discharged
by a membrane capable

fluid

could alone have been produced

of secreting serous fluids, as the pleura or pericardium.

If the collection had taken place in the former, the fluid

would have flowed

freely throughout the

and the small quantity of

it

taken

away

whole cavity,

could not have

produced the alarming symptoms which preceded the

But the pleura, on the contrary, was dry,

operation.

when we opened the body

Could
though

this secretion

it

adhered

after death.

be thrown out by the pericardium,

to the

circumference of the heart, with

the exception of a portion of

where the clot of blood

this

membrane

its

right anteriour surface,

was found )

at first could

Is

it

possible that

have been so

far distended

towards the mediastinum and diaphragm, without

losing
tract ?

its elasticity,

The

irritation,

totally

and could afterwards gradually con-

contact of atmospherick air, like mechanical

inflamed

it,

after

coming

in contact with the

heart,

and adhesions were gradually formed between

them.

The opening made by

dium, allowed
to retract
tion.

its

walls

the bistoury in the pericar-

first to

sink in, and

its

substance

and undergo a degree of inflammatory obstruc-

A cicatrix was the consequence, of

which no traces

could be found, except the diminution and gangrenous

affection of the contiguous portion of the heart, of

we have spoken. That the

vision of the serous

vered,

we can

cicatrix, or

membrane cannot be always

believe, as

which

evidence of a

di-

disco-

we have frequently known

the

peritoneum .unite in such a manner, after wounds had

AND

*>17

CA8E3-

penetrated into the abdomen, that no trace of them could

be seen.
It

is

in

accordance with nature's plan to admit, that

the pericardium, which

was

wards, by

left

contracting,

at first distended,

had

after,

a space or void between

itself

would be boundand the mediastinum, and

ed by the natural or diseased adhesions which had forthat this space

Thus the small quantity

this membranous sac, and the

merly taken place.

fluid effused into
air,

may have produced an

erosion of

its

of serous

contact of

walls, giving

constituting
rise immediately to a purulent secretion,

an

evacuated with
abscess or purulent collection, which was

This purulent cyst

the tube nine days after the operation.
united
was increased by the continued action of the
already
being
organs
causes of disease ; the neighbouring
degrees, and gedisordered, lost their own vitality by
neral life was of necessity destroyed.
which followed
This explanation, with the symptoms
the

wound

till

the period of the operation,

all

indicating

induce me to believe
the existence of hydrops pericardii,
mixed
pounds and a half of yellow serum,
that the

two

with small

clots of

black blood, which

we

discharged on

accident, were really conthe forty-first day after the

had supposed.
tained in the pericardium, as I
me important, as
The case of St. gne appears to
of injuries of the pencardipointing out the diagnosticks

of art by which we
urn and heart, the resources
It
consequences of such injuries
minish or prevent the
operation
an
when
may also inspire us with confidence,
in this cavity,
evacuate J collection of fluid
is required to

can

in

di-

consequence of similar wounds.

indication had been soonof opinion, that if this

eontemplated in the case of St. Ogne,
er fulfilled as I had
operation would have been comthat the success of the

am

VOL.

II.

MEMOIRS

418
plete

for

evident, that in this case

it is

piring flame of

it

revived the

fc.s>

life.

John Baptist Bernadotte, commonly

called

Cannon,

a miner of the infantry grenadiers, aged thirty -four, of an

irascible character, athletick constitution,

and uncommon

bodily power,* wishing to put a period to his existence,

in

a paroxysm of passion plunged a knife in his thorax.

The

blade of this instrument penetrated into this cavity

about two centimetres, between the third and fourth rib

of the

left

side

he

immediately after drawing out the

fell

knife with a sudden effort.

stantly followed, with

wound

of the lungs.

all

One

of his comrades closed the

wound, and conveyed him to

then on duty gave

it

profuse haemorrhage in-

symptoms of a punctured

the

the hospital.

The surgeon

a simple dressing, and applied

compress and bandage: he passed the night in great an

guish and frequent syncope.

When we
dressings

him next morning, we found

visited

filled

the

with blood, a considerable quantity of

which had

also run

lid, his lips

purple,

down
and

His face was paland watery ; blood,

into the bed.

his eyes dull

of a vermilion colour, rushed through the wound, the

circumference of which

was now

swollen, and

when

touched, a crepitation and fluctuation were evident in several parts.

The

tion laborious,

pulse

was small and corded, the respira-

and the animal heat of the extremities

scarcely perceptible.

From

these

symptoms

tercostal vessels

the opinion

it

was evident

the lungs or in

had been deeply wounded. I inclined

that the intercostal artery

had been

to
di-

vided.
* I have seen this man march before the emperour with
a cannon (four pounder) on his shoulder: hence he received
the surname of Cannon.

AND CASES
I

first

dilated the

explore with

my

wound

419

in such a

manner,

considerable collection of clotted blood

under

this

that I could

finger the aperture into the thorax; a

wound.

I sponged

out,

it

was concealed

and immediately

perceived a jet of vermilion coloured blood issuing from

the divided intercostal. I dilated the opening through the
first

layer of muscles, and with a

common

small curved

needle, succeeded in securing the artery at the

tempt, and the haemorrhage was arrested.

first

at-

But a consi-

derable effusion had taken place during the night, which

I feared could not not be entirely removed

proper to meet every indication, in order

to

I thought

evacuate this

effused blood.

I applied several cupping-glasses on the

the

first

of

which was soon

filled

I directed others to be applied on the

the lower part of the

too great, and

it

would have been more advisable

make
The calm which succeeded the

of effecting resolution, induced

This tranquil

to favour the ab-

but the quantity of

case, as I had intended, to

itself,

emphysema, and on

hypochondrium,

sorption of the effused blood

wound

with black liquid blood

it

was

in this

a counter opening
operation,

me

state continued three

and the hope

to wait the result.

days

he expectorated

some grumous blood, his urine was highly coloured, and

his pulse in some measure more natural his anxiety was
not so great, and respiration less difficult he experienced
;

considerable general improvement,

eat

some

light

an appetite, and

potage and broth.

I prescribed mucilaginous drinks,

ether,

felt

and sweetened with syrup of

ing, he took a strong

mixed with
althea.

nitrick

In the even-

anodyne and antispasmodick emul-

with small doses of antiphlogistick powders: emolwere administered, and camphorated oily
enemata
lient
embrocations applied to the abdomen. A vein in the arm
sion,

was

several times opened.

The wound was

dressed with

420

MEMOIR*

emollients,

and being of a simple character, cicatrized

in

a few days.

He

continued in this state of apparent improvement

until the seventh

day

after the accident,

when

a large

ecchymosis appeared behind the hypochondrium, and

the lowest part of his thorax.

To this

at

ecchymosis, which

Valentin has pointed out as one of the characteristicks of

sanguineous effusion,

succeeded others which

are

its

concomitants, namely, frequent cough without expectoration, difficulty of respiration, oppression, ardent thirst,

loss of

motion in the sternocostal cartilages of the same

and sinking of the

side, fixed local pain,

it

impossible to

lie

pulse.

He

found

on the side opposite the wound, and

experienced alarming symptoms of suffocation.

I immediately decided on the necessity of the opera-

empyema. The physicians and surgeons of the

and many other medical men, who attended
my lectures on clinical surgery, were collected together
in consultation on his case. They were not unanimous in
their opinion of the necessity of making the counter-opening, and the operation was deferred until the morning of
following day (the ninth.) The symptoms having consiion

for

nospital,

derably increased during the night, I no longer hesitated

as to the propriety of operating.

I selected the most dependent part opposite the

val of the fourth

and

fifth

ribs,

inter-

counting from below up-

wards The incision was made, and two litres of black

bloody serum discharged by a rapid and continuous
stream

he experienced immediate

relief.

The fluid could

not be completely evacuated, because the seat of disease

extended very

far

backwards, but

it

continued to be dis-

charged daily, during a period of five days, until

be computed

at ten or

twelve

litres

it

might

AND CASES

The symptoms
contracted in

its

421

gradually abated, the

wound very soon

dimensions, and was closed before the

ninth day after the operation.

Bernadotte considered

life

his cure as complete,

new symptoms

suddenly

when

appeared, and threatened

his

a second time.

I immediately broke up the tender union of the coun-

ter-opening, and introduced a tube into the thorax, by

which

drew

oft*

in a

fetid purulent matter.

few minutes, two porringers of

We introduced a tent, and renew-

ed the dressings two or three times a day. I prescribed

for

him

ing,

pectoral drinks, a

composing julep

and bark boiled with.milk

ed him to take some light

in the

in the even-

morning. I

articles of diet,

direct-

such as potage,

boiled rice, good broth, and wine. This plan

was

perse-

vered in for a considerable time and the dressings care

fully attended to.

The

diseased parts passed through the different stages

of suppuration. In the

or inflammatory stage, the

first,

was serous and copious, of a fetid odour, and

gray brown colour. It was then necessary to change the
discharge

dressings frequently.

The

introduction of

the tent, though covered with

cerate, produced acute pain.

heat in the thorax

he was

The

patient

felt

a burning

troubled with insomnia, and

paroxysms of fever in the evening.

After continuing the same treatment

slight

membranous

flocculi

purulent serum, and

generally preceded

several weeks,

were discharged, together with

the appearance of these eschars wa>;

by

slight accessions of fever, often ac-

companied by disorder of the stomach.

Gentle cmeticks, bark combined with mucilaginous

and ethereated anodyne draughts,

toms, and restored the

vital

powers

alleviated the

symp-

MEMOIRS

422

This second stage, which might be called the stage of

detersion, proved tedious,

and presented a variety of

changes dependent on the humidity of the atmosphere,

and on

the

regimen and passions of the

patient.

They

of-

ten gave us just cause of alarm.

Towards

the conclusion of this period, that

to say,

is

symptoms which attend

of nature by which the cavity is lessened,

after the sixtieth day, the

that

operation

viz.

the sinking in of the cartilages of the ribs on the diseased

side, the reduction of the intervals

between the

the gradual reduction or contraction of

all

ribs,

and

this side of

the thoracick cavity began to take place.

The

quantity of pus

now discharged was

every respect laudable.

The powers

re-established, the fever

small,

and

of digestion

in

were

had almost disappeared, and

every symptom predicted the completion of his cure.

This work of nature continued to go on without

ruption,

and

its

effects

became

daily

inter-

more and more

evident.

The cicatrix of the wound caused by the knife, which

was formerly opposite the space between the third and
fourth ribs was now opposite the interval of the fourth and
fifth ribs. The small nipple also descended in the same
proportion, until it was four centimetres, or more, below
a horizontal line, drawn through that on the right side.
The left shoulder also followed the descent of this side
of the thorax, and sunk down about four centimetres lower than the right. The transverse diameter of the thorax
was also evidently reduced. I have no doubt that the
growth or extension of the membranous walls of the
thoracick cavity

was

in proportion to the contraction of

these bones which surround

membranous

left

it.

The

sac (the pericardium)

heart

itself,

with

was pressed

in

its

considerable degree towards this vacant space, formerly

423

AND CASES.
occupied by the fluid

be

felt

externally.

for its pulsations could

no longer

a probe was introduced through the opening

become fistulous, its progress was confined to very

When
now

and within a very short distance from the

opening met with a resistance which could only be afforded by the growth or extension of the internal mem

narrow

limits,

branes, and their organick capillary vessels. This work

and there
of nature was carried on in a gradual manner,
will
only a small fistulous opening, which I think
the date
have closed before the expiration of a year from
survived
now
has
patient
of the operation, which the
is

now

regular,
more than eleven months. AH his functions are
and
ease,
with
he is becoming corpulent, he walks

breathes with freedom.

This cure

was
it,

is

the

more

interesting, as the subject of

it

us to expect
of an age too far advanced to authorize

for reasons before given in

ver, the disease

It will

memoir; and, moreo-

was very acute.

be observed that in

tions into t\

my

this case I

threw no

injec-

considered
ethoracick cavity. I have always

confined ourselves to the

dressings, to produce a conuse of tents and frequent
dressings were simple and
stant discharge of pus. These

them

injurious,

and hence

we

methodical.

Paul Cohanier, a

was admitted

fusileer,

into the hospital

aged twenty -three years,

on the 30th of December,

wound of the thorax,

1810, with a fistulous punctured
The sword had en
received six months before in a duel.
right
filth ribs, below the
tefed between the fourth and
discharged Irom
quantity of laudable pus was
axilla.

this fistulous

favoured

its

bed, and in

tfound

at the pleasure of the patient.

He

the
discharge by leaning over the side of
some measure inverting the thorax.

MEMOIRS

424

The

introduction of a flexible tube of gum-elastick, led

us to believe, that the disease extended perpendicularly

bottom of the hypochondriack region, where the

to the

pus collected, more especially during the night. I was

make

induced to

a counter-opening between the ribs, op-

bottom of

posite the

this sac,

which was done on the 6tb

January.

This operation was at

for success.

Through

first

attended with the wished

the counter-opening, a considera-

ble quantity of a purulent matter

some

injections of

from the

fistulous

Warm

was

discharged, and

water and honey passed freely

made by

opening, to that

the opera

tion.

We introduced a tent into the

tended

to that

was put on

inferiour

above, in order to

make

wound, and

at-

cicatrize.

He

it

the use of suitable medicines

and regimen,

and the dressings were changed twice a day.

The

suppuration having been tinged with a

immediately after the operation,

colour,

and

all

The

and diminished
his functions

now resumed

He

in quantity.

little
its

blood

natural

had no fever,

were well performed.

reduction of the disordered thoracick cavity also

appeared to go on gradually,
difficulties

for,

notwithstanding the

under which Nature laboured

tion of the pus, she

had commenced

in the evacua-

this

work of

re-

duction.

He now

appeared

to

be convalescent, and walked out

into the court of the hospital,

the 23d of the

on a clear cold evening of

same month.

with a general and distressing

to retire

immediately to bed.

He was
chill,

He

suddenly seized

which obliged him

passed the night with

and great distress. When

him next morning, the wound was dry and

rigours, acute pain of the side,

I first visited

painful

fever

he

still

had a most acure pain

was returning with

in

his side.

severe paroxysms

The

The
urine

AND CASEB.
Was diminished

in quantity,

42$

and of a reddish purple.

also experienced general pain of the thorax,

and

He

colick,

and the

least pressure on the abdomen obliged him to cry

These symptoms evidently pointed out a complete inflammation of the serous membranes of the thorax and

out.

abdomen,

arising from

no other cause than the sudden

suppression of cutaneous perspiration, and the secretion

of

pusi.

I immediately applied cups over the whole thorax,

and on the greater portion of the abdomen, prescribed

general venaesection and antiphlogisticks, and subsequently large vesicatories were applied on the parts most

These means were not sufficient to arrest the

progress of inflammation, which terminated in gangrene
and death on the night of the 4th of February, and the
affected.

seventh day after the invasion of

the

inflammatory

disease.

Appearances after Death.

Next day we opened

the body,

and found the diseased

cavity of the thorax reduced to three fourths of its former

oblong space of about twelve inches was
diameter.

An

left

extending from the superiour wound, to the counter

The

opening.

lungs of this side were contracted, and

the vertebral column, and their surface contiguous to the seat of the disease, was in a state of ganthe cyst. The
grene, as well as all the internal surface of
the act of
performed
he
that
asserted
patient had before

adhered

to

respiration with that lobe of the lungs only on the opposite side.

Vol,,

ii.

?H

MEMOItlS

426

The

ribs

had

lost

much

of their curve, had increased

and their edges were in contact. The verwere brought forwards forming a curve, the re-

in thickness,
tebrae

verse of that in the natural

num on

this side,

was

also

state.

The

portion of the stcr

pushed inwards

Finally, the

mediastinum and diaphragm had approached each other,

to unite in the obliteration of the cavity, left

charge of the

fluid.

This thorax

is

by

the dis-

now among my

col-

lection.

On
and

opening the abdomen,

intestines inflamed,

and

we found the peritoneum

many parts, in a state of

in

gangrene.

From
soldier

this

examination,

we

concluded that this young

might have been cured, but

for his exposure.

I should omit the report of the following case,

not important to

draw

true signs of effusion,

low the

were

it

the attention of practitioners to the

and the injurious

results

which

fol-

collection of blood in the cavities of the body,

provided

it

be permitted to remain there some time.

This case also demonstrates that a

clot of

blood

is insufli

cient to arrest haemorrhage.

Claude Ferret, a grenadier, entered the hospital of the

wound from

guards January 23d, 1811, with a

in the superiour

him soon

and

after his admission.

acute pain in the

wound, and

He

suffered

his pulse feeble

cold.

sword
saw

much from an

in the direction of the ax-

His respiration was laborious,

illa.

internal part of the right arm. I

his

countenance pale,

and concentrated, and

his extremities

These symptoms, and the direction of the Wound,

which was

obliquely from the insertion of the tendon of

the deltoid muscles upwards, and inwards towards the

posteriour space between the

me

to suspect that

first

and second

ribs, led

an important artery of the thoracick

AND

427

CASES.

wall had been injured, and that a considerable internal

haemorrhage and effusion had taken place.

I

first

wards the
finger.
it

to

wound

dilated the

to a considerable extent to-

but could not reach

axilla,

limit

its

my

with

Without making further examination, I ordered

be simply dressed, and directed cupping-glasses to be

was

applied on the thorax wherever there

The

pearance of emphysema.

pain or an ap

patient used sweetened,

mucilaginous drinks, with the addition ot nitrick ether,

and

we

On

awaited the

result.

the 24th, the restoration of animal heat, elevation

me

of the pulse, and colour of the skin, led

haemorrhage had ceased spontaneously, or

been arrested

arm

had

same day, and a porringer

of blood was taken at each operation

to this treatment the fever
ditional severity

but in opposition

came on the same day with ad-

he complained of a burning and insup-

portable heat in the

wounded

side of the thorax,

tormented by an ardent and insatiable

was

at least

for a time. I prescribed venaesection in the

several times during the

lie in

to believe the

was

could not

thirst;

a horizontal posture, and the labour of respiration

great.

Venisection was
glasses

were

now repeated several times;

applied,

and

cupping-

the antiphlogistick articles con-

means appeared to calm

some time, but they re-appeared on the

tinued with regularity. These

the

symptoms

for

with the ec
31st January, with increased violence, and
pathognomonick
chymosis described by Valentin, as the
of effusion.
for
I then resolved to perform the operation

between the fifth and

upwards. About two

sixth ribs,
litres

empyema,

reckoning from below

of black thick blood

immediately discharged, and about the same

some hours afterwards, when

were

quantity

the dressings were changed;

MEMOIRS

428

was of the same consistence, and a portion of it was

mixed with small clots of blood.
This operation afforded him great relief, and he passed

it

the five succeeding days in calmness; but on the seventh,

symptoms of inflammation again

in the ascendant, until the

returned, and continued

evening of the eighth, and

then terminated suddenly in gangrene.

He

expired on

the 8th night after the operation.

On

opening his body,

we

found the right division of

the lungs, and the sac of the pleura in a state of gan-

grene.

blood

The

still

considerable

quantity of black

coagulated

occupied the bottom of the thoracick cavity.

viscera of the

abdomen were

also inflamed as in the

preceding case.

we dismammary

After having emptied and washed the thorax,

covered a transverse opening of the internal

artery, near the place

clavian,

and hence

where

it is

given off from the sub-

that haemorrhage

was poured, which

the thick clot of blood surrounding this artery had not

been
if

it

sufficient to arrest

and indeed this

had surrounded the artery,

soldier

was

The

quite exhausted.

clot

appeared as

until the strength of this

great quantity of

fused blood of necessity rendered this

wound

ef-

mortal

the operation then could only prove a palliative.

Many
were

cases

came under our

superficially injured,

care, in

which the lungs

and emphysema had taken

place to a greater or less extent about the wound.

After

wounds, and procuring the discharge of

the blood effused under the muscles, and of the air which
dilating such

had insinuated

itself

into the cellular

plying cups over the

diate neighbourhood,

wound and

we

membrane, by ap
its imme-

the parts in

passed a roller over the wound,

with compresses dipped in

warm

camphorated

wine,,

429

AND CASES.
and a supporting bandage,
the wounds.

after first closing the edges of

This treatment, with cooling drinks and rest, generally restored the patients in a time proportionate to the
extent of the injury.

In the case of Despagne, a chasseur, symptoms of thoracick effusion supervened, after an apparent cure of five
or six weeks cupping and vesicatories produced no fa;

vourable change

in his condition

I resolved to

make an

into the thorax at that part nearest the seat of

opening
disease.

My

did not meet the cyst,

incision

first

but next

with pus, which

now con-

tinued to be discharged through this opening,

until the

day the

wound was

was

patient

in the

filled

way

of recovery.

The

cartilages of

on the same side had already sunk in, as was

evident on inspection, and the thorax was diminished in
capacity. He was discharged from the ho'spital, in perfect

the ribs

health on the 15th of

Yung, brigadier

November.

of dragoons, received a punctured

of the thorax, between the sixth and seventh ribs

diaphragm on
of the right side, which passed along the
direction of the
the convex surface of the liver. The
the probe
which
to
distance
the
its depth, and

wound

wound,

entered before

it

arrived at

its

termination, the charac-

jaundice which succeeded

ter of the pain, the general
oleaginous
almost immediately, the discharge of yellow
pain of the
blood through the wound, the sympathclick
rio-ht

shoulder,

and

difficulty of

respiration,

were

all

signs of an injury of this organ.

The same
in

wounds of

this case.

plan of treatment generally adopted by us

was successfully adhered to in

depended more particularly on tearifica-

the thorax,

We

MEMOIRS

430
and cupping, on

tions

diluting Irinks,

with the addition of

acetick ether, and mild laxatives.

This brigadier

The

heath.

left

the hospital perfectly restored to

case shows, that

wounds of

the liver are not

always mortal.

Nicodemus Joseph Michaud, a chasseur, was admitted into the hospital on the 30th of December, with a

wound on

the right side of the thqrax: a sword, after di-

viding the external soft parts, pierced deeply into the tho
racick cavity, between the sixth and seventh ribs, the
latter

of which had two thirds

o its

bony substance

di-

vided, and the point of the instrument had passed inwards

and downwards

The

inferiour

edge of the lungs was merely touched, but

a part of the tendinous centre of the diaphragm

bably wounded

was prowound,

the direction and depth of the

and the symptoms which succeeded, pointed out the

in-

jury of this parf.

The pain was intolerably acute, and extended from the

wound to the xiphoid cartilage; the features of the face
were strongly contracted, more especially the eye lids
and

lips,

the teeth

was

sardonicus

were exposed, and a complete

the consequence.

tinue in a sitting posture,

difficulty,

from

He was

and could be understood with

his imperfect

pronunciation

while his

respiration

his pulse

feeble,

was laborious and hurried,

and accelerated: he was in a

state of

distress

and mos.t imminent danger.

glasses over the

tense,

extreme

We applied cupping-

wound, and thus extracted a considera-

ble quantity of coagulated blood

the cellular substance

The edges

risus

obliged to con-

of the

and

which was

effused in

in the thorax.

wound were

then brought into a state

of approximation, and thus retained by means of adhesive straps.

Scarifications

and cupping-glasses were used

AND

431

CASES.

on the most painful parts of the thorax, and venisection

was performed twice in the twenty -four hours. I prescribed mucilaginous cooling

antispasmodick

drinks,

draughts, with milk of sweet almonds, emollient ene-

mata, and camphorated oily embrocations over the ab

domen.
All these means had but little effect, and next day the
symptoms were more alarming; he could no longer
speak, but he understood
correctly by

were more

The

signs.

violent,

when spoken

and the oppression and pain extreme;

the functions of the brain were not at

introduction of the tube through the

rax, satisfied

me

that

no

was no ecchymosis on
chondrium.

effusion

impaired

all

wound

the

into the tho-

had taken place;

thei*e

the posteriour part of the hypo-

Indeed a collection of

place, because the

and answered

to,

tetanick contractions of the face

wound was

fluid could

not take

situated at the lowest pail

of the thoracick cavity.

I increased the doses of the antispasmodicks, and directed the cupping-glasses to be applied on the part opposite

the injured

rated

diaphragm: the symptoms were mode

by these means, and from

this

time gradually

abated, the convulsive laugh disappeared, he

lie

horizontally,

and

was able to
was now

deglutition, before difficult,

performed naturally.

Several hours sleep brought out a

copious perspiration, and effected a great and general im-

provement
at

in his condition

he

now

felt

no pain except

the xiphoid cartilage, and that yielded to a vesicatory

the lips of the wound were soon united, the features of

the face resumed their natural appearance, the functions

were

re-established in succession, and he

tal in perfect health on the 10th of

left

the hospi-

November.

This case proves

That the risus sardonicus is not always aecomnu,nied by delirium, or loss of reason, as authors assert.
1st,

432

MEMOIRS

2dly.

phragm

That wounds of the tendinous centre of the

3dly. It

makes us acquainted with the manner

the risus sardonicus

is

irregular action of the

produced; for

mouth and

it

is

lids

common

which

generally un-

lips, as is

of the face which partook of contraction, as

also

in

not simply an

were not the only

derstood, for in this case the lips

in the

dia-

are not always mortal.

is

parts

observed

or natural laugh; but the eye brows were

drawn towards

the middle of the forehead, the eye-

considerably opened, giving the eye a frightful aspect;

the muscles of the jaw, of the larynx, pharynx, and

oesophagus, participated in this tetanick contraction

he

lost his voice,

tion

was

4thly.

swallowed with

for

and degluti

difficulty,

frequently interrupted with sighs or hiccough.

This case enables us to appreciate the immense

advantages to be derived from the use of cupping-glassfes

and

scarifications.

The

irritation

produced by them on

the parts to which they are applied, removes the

tion

irrita-

produced by the wounding cause on the internal

nerves and contiguous parts, and thus prevents inflammation.

they

By

disgorging the capillary vessels of the skin,

facilitate

the general circulation, and the obstruction

and pain of the disordered parts

be preferred

to

common

the whole system,

in the disease.

is

removed. Cups are to

venisection, which debilitates

and often

effects

no favourable change

I have often seen an acute phlegmasia

yield suddenly to the abstraction of blood,

cups from the contiguous pails,

when

petition of general venisection. I

vation

more

it

by means of

had

resisted a re-

have made

this obser-

particularly in partial inflammation of the-

pleura costalis or pulmonalis, the consequence of wound:

of the thorax. *

* If

we admit

the theory of inflammation advanced

by-

Lubbock and Mr. Allen, and allow that the vessels are
rendered weak by inflammation, and that there exists a
Dr.

And

The
fects in

433

cases.
produces surprising

application of cups also

emphysema which

follows complicated

ef-

injuries

scarifications or orifices

com-

municate with the cellular substance in which the

air is

of the lungs:

if

one of the

diffused this fluid will

be instantly absorbed by the cup.

The wound may be dilated,

are applied, and

and

so retained

its lips

when

if

necessary, before the cups

should be brought into contact,

the cup

is

removed,

in

order to ex-

clude the introduction of the atmospherick air into the

thorax, and to prevent the inflammation of the internal

organs. I

am

of opinion that this chasseur

may

attribute

his safety principally to cupping, and the use of vesicatories.

Having now given a view

in military surgery,

of the most important facts

which have

fallen

under

during one voyage and twenty campaigns, I

mitted for a

moment

to call the attention

my

notice

may be per-

of the reader to

in
the loss which the surgery of France has sustained
practitioners.
the death of two of our most celebrated

of these, Mr. Sabatier, my preceptor and

through the most difficult paths of the science of

The
guide

first

at the end of his

.ureery, sunk under a chronick disease,
and comdestiny,
his
year, after having fulfilled

80th

pleted his career of glory.

The

vast accession of matter

inflamed vessels and

of relative power between the
we should endeavour
circulation),
of
engine
(the
the heart
or balance of power between
to re-establish a due relation
effected by directing
them This indication then cannot be
part; the heart
inflamed
the
to
exclusively
our attention
to prevent
remedies,
general
by
calmed
subdued or

want

must be

being more injected, and

the vessels, already weak, from
the same time we relieve the
at
while
gangrene;
into
falling;
giving them tone, and
inflamed vessels by unloading them,
With this view cupping
restoring them to a healthy state.
advantageously used as an auxiliary. Tb
is

Vol.

ii.

3 l

MEMOIRS

44

with which he enriched the temple of science, will reader dear to posterity the homage justly paid to

his

me-

mory by Messrs. Pelletan and Percy. His virtues have

always commanded my admiration, aod his friendship
shall live in

The

my remembrance.

second, Mr.

Mark Anthony

geon of the Hotel Dieu,

students,

was

was about
fices.

at

Petit, late chief sur-

Lyons, and one of my fellow-

cut off in the vigour of his days, as

to reap the fruits of his labours

and

he

his sacri-

Professour Desgenettes, in a learned eulogium, has

assigned him the rank that he shall henceforth hold

the distinguished surgeons

who have

among

preceded him.

His admirable " Essay on the Medicine of the Heart,"

speaks his noble sensibility. As a surgeon and philosopher, he has there, with the greatest delicacy, defined
the reciprocal duties

appear
son,

which unite the

His precepts may serve as

cian.

to

have been intended

who was

and physi-

patient

rules of conduct, and

for the instruction of his

educated to the profession of surgery un-

der his parental care.

Though

me

the tender age of

deprives

of the happiness of directing his professional studies

in the

same manner, yet while presenting

my-surgeons the
I

my son at present

may

fruits

to

young

ar-

of iny observations and practice,

also hope, that hereafter the perusal of

them will

make him emulous to excel. Should he be discouraged

by the difficulties I have encountered, and the dangers to
which

I have been exposed, he will also be cheered

the success which has attended

nificence of the hero

my

who presides

TE END.

by

labours,

and the mu-

over our

destinies,

PL. 13

PL X

r.ja.

mm

H
Am J

IB

AiH