509 to the " Medical Student," it is in reality addressed to all who are engaged in the pursuit of science, to whom it will afford a full and clear explanation of all the French and German terms which they meet with, along with the Greek and Latin synonymes. The breaking down of Dr. Palmer’s health from the undermining influence of incessant mental labour, in the first instance, and subsequently, delays which originated with the publishers’ account for the long space of time which has elapsed between the publication of the two first parts and that of the present, the third and last. Dr. Pal- mer’s unwearied exertions, although exercised on so appa- rently dry a subject, have evidently been a " labour of love," for we find him nearly promising to add various Latin, Italian, and English indexes to his dictionary. This we sincerely hope he may live to do, and if the universal ap- probation of his professional brethren should prove a sti- mulus to his labour, we feel sure that he will have it. BRITISH MEDICAL JOURNALS. ON THE PATHOLOGY AND TREATMENT OF FRACTURE OF THE NECK OF THE THIGH BONE. MR. CoopER commences by saying, that his observations are limi- ted to fracture occurring within the capsular ligament. As to the manner in which such accidents should be treated, there are two classes of opinions. Practitioners who hold the one believe that such injuries can be repaired as injuries of other long bones; and, accordingly, take means, by mechanical restraints, &c., to secure such a result. Other practitioners, of a different opinion, believe that such reparation rarely ever occurs; and, when it does, that it is by the slow process by which the bones of the skull, when in- jured, are repaired. If the latter opinion-it was that maintained by Sir A. Cooper-is correct, the practice of those who entertain the first must be wrong, as by it no useful result can be obtained; whilst the aged patient’s health becomes impaired by the me- chanical restraint imposed. To support the opinion entertained by his uncle is the object of Mr. Cooper’s present essay. Some attention to the meaning of the words which he makes use of, and to the arrangement of his sentences, would wonderfully facilitate the object which he has in view. In many portions of a not very long essay, the meaning is totally obscured. He believes " that nature has ordained that these fractures are not to be united by ,, bone;" and he states the causes which render such an union difficult, if not impossible. They are referred to those which are mechanical and those which are vital. The mechanical are :-The difficulty of producing coaptation of the fractured extremities; the distention of the synovial membrane; the fractured extremities also cannot be kept together, in consequence of the muscles being at- tached to one fragment only, to these may be added, the peculiar relation of the neck to the shaft of the bone, and to the trunk of the body; and the difficulty of keeping the parts at rest. Among the vital causes, Mr. Cooper places:- 1. The low condition of the reparative powers, generally con- sequent on the advanced period of life at which this accident occurs. 2. The remarkable changes peculiar to the hip-joint from age, especially to the portion of the femur implicated in this injury. 3. The peculiarities of original structure. Those vital causes being powerful inversely in the order in which he places them. The first two are generally recognized and understood. Mr. Cooper, under the third, describes some pe- culiarity founded on the source and distribution of the blood-vessels which are engaged in the first formation of the neck, as an epiphysis. He says :- " There appear, therefore, to be three sources by which the epiphyses are nourished, although hardly to be said actually to be supplied with blood-vessels. At the osseous extremity’ nutrition is derived from the capillary vessels of the extremity f the shaft of the bone : the fringed and distinct arrange- ment of these capillaries form the apparatus, by which the nutrient matter of the blood is appropriated to the cartilage. The articular extremity of the epiphysis is in a similar manner nourished qy the synovial capillary arrangement through the articular car- tilage itself, while the central part of the epiphysis is supplied by direct vessels from the surrounding fibrous tissues. " May it not happen, therefore, that the differences which exist between articular and epiphyseal cartilage depend upon the synovial nutriment apparatus, which seems to produce that per- manent condition which the articular cartilage inherits, while that of the epiphysis is only temporary? Such an opinion seems some- what corroborated by the comparison between the epiphysis of joints and those of apophyses. In the latter we find they become rapidly converted into bone, and almost simultaneously over their whole surface, not leaving themselves tipped with a surface of cartilage, because they do not at any part derive nourishment from synovial membrane. Mr. Cooper concludes-and the conclusion is, perhaps, as difficult to prove as to disprove, " that it is the result of organiza- tion which leads to ligamentous union, and it is not the applica- tion of the most complicated mechanical contrivance which can lead to ossification." Some experiments were also made to ascertain, if any, and what, chemical changes -took place in the neck of the thigh bone. The average results of those experiments are shown in the following table :- " From this it appears, that although the neck of middle- aged bone contains fifty per cent. of bone earth, yet the recent neck of the old bone contains only thirty-one per cent.; whereas, the difference between the shafts is by no means so great, being fifty-six for middle-aged bone and fifty-three for old bone. In all cases, however, the shafts contain more bone earth than the neck. " Aware that these results differ entirely from the received opinion that the liability to fracture in old age arises from an excess of bone earth, I have not hastily arrived at an opposite conclusion; nor should I have trusted to actual experiment as the basis upon which to found an argument militating so strongly against an established aphorism; but reflecting on the mode in which the reparation of bone takes place in ordinary cases of fracture, it appeared to me little short of ridiculous to expect, in old age, an excess of bony matter, in a part which is so imper- fectly vitalized, and which, indeed, in common with all the epi- physes, is so many years consolidating into bone." Hence, argues Mr. Cooper, the groundlessness of the hope which anticipates bony union of the fractured neck of the aged femur, and the impropriety of the practice which would attempt it. For our own part, aware that such a union does occasionally take place, and satisfied that, by judicious management, the ill-effects of a restrained position, by which it may be secured, may be modified; we should adopt still that practice which might pre- vent the sufferer from being for life a cripple, subject by his in- firmity to a restraint little more than that which, if applied for a limited period, might have secured for him a useful limb. The preceding, and the essays referred to at p. 453, with a case of poisoning by arsenic, detailed by MR. TAYLOR, in which the poison was detected as a sulphuret, twenty-eight days after death-A case of popliteal aneurism, with ligature of the femoral artery, by DR. NOTTINGHAM—A statistical report of the Clinical Society-Two cases of extra-uterine fœtation, by DR. OLDHAM, together with some cases and observations by DR. BARLOW, con- stitute the principal contents of the last number of Guy’s Hospital Report. The following observations of Dr. AjLDRiDGB are deserving the attention of those who are not already acquainted with those effects of mercury :- ON THE INFLUENCE OF MERCURY IN PRODUCING NEPHRITIS. "The effect of mercurial preparations in causing salivation is only a particular instance of their tendency to stimulate glandular
Transcript
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to the " Medical Student," it is in reality addressed to allwho are engaged in the pursuit of science, to whom it willafford a full and clear explanation of all the French andGerman terms which they meet with, along with the Greekand Latin synonymes.The breaking down of Dr. Palmer’s health from theundermining influence of incessant mental labour, in thefirst instance, and subsequently, delays which originatedwith the publishers’ account for the long space of timewhich has elapsed between the publication of the two first
parts and that of the present, the third and last. Dr. Pal-mer’s unwearied exertions, although exercised on so appa-rently dry a subject, have evidently been a " labour of love,"for we find him nearly promising to add various Latin,Italian, and English indexes to his dictionary. This we
sincerely hope he may live to do, and if the universal ap-probation of his professional brethren should prove a sti-mulus to his labour, we feel sure that he will have it.
BRITISH MEDICAL JOURNALS.ON THE PATHOLOGY AND TREATMENT OF FRACTURE OF THE
NECK OF THE THIGH BONE.
MR. CoopER commences by saying, that his observations are limi-ted to fracture occurring within the capsular ligament. As to themanner in which such accidents should be treated, there are twoclasses of opinions. Practitioners who hold the one believe that
such injuries can be repaired as injuries of other long bones; and,accordingly, take means, by mechanical restraints, &c., to secure such
a result. Other practitioners, of a different opinion, believe thatsuch reparation rarely ever occurs; and, when it does, that it isby the slow process by which the bones of the skull, when in-jured, are repaired. If the latter opinion-it was that maintainedby Sir A. Cooper-is correct, the practice of those who entertainthe first must be wrong, as by it no useful result can be obtained;whilst the aged patient’s health becomes impaired by the me-chanical restraint imposed. To support the opinion entertainedby his uncle is the object of Mr. Cooper’s present essay. Someattention to the meaning of the words which he makes use of, andto the arrangement of his sentences, would wonderfully facilitatethe object which he has in view. In many portions of a not verylong essay, the meaning is totally obscured. He believes " thatnature has ordained that these fractures are not to be united by ,,
bone;" and he states the causes which render such an union
difficult, if not impossible. They are referred to those which aremechanical and those which are vital. The mechanical are :-The
difficulty of producing coaptation of the fractured extremities; thedistention of the synovial membrane; the fractured extremities alsocannot be kept together, in consequence of the muscles being at-tached to one fragment only, to these may be added, the peculiarrelation of the neck to the shaft of the bone, and to the trunk ofthe body; and the difficulty of keeping the parts at rest. Amongthe vital causes, Mr. Cooper places:-
1. The low condition of the reparative powers, generally con-sequent on the advanced period of life at which this accidentoccurs.
2. The remarkable changes peculiar to the hip-joint from age,especially to the portion of the femur implicated in this injury.
3. The peculiarities of original structure.Those vital causes being powerful inversely in the order in
which he places them. The first two are generally recognized andunderstood. Mr. Cooper, under the third, describes some pe-culiarity founded on the source and distribution of the blood-vesselswhich are engaged in the first formation of the neck, as an
epiphysis. He says :-" There appear, therefore, to be three sources by which
the epiphyses are nourished, although hardly to be said actuallyto be supplied with blood-vessels. At the osseous extremity’nutrition is derived from the capillary vessels of the extremityf the shaft of the bone : the fringed and distinct arrange-ment of these capillaries form the apparatus, by which thenutrient matter of the blood is appropriated to the cartilage. Thearticular extremity of the epiphysis is in a similar manner nourished
qy the synovial capillary arrangement through the articular car-tilage itself, while the central part of the epiphysis is supplied bydirect vessels from the surrounding fibrous tissues.
" May it not happen, therefore, that the differences which existbetween articular and epiphyseal cartilage depend upon thesynovial nutriment apparatus, which seems to produce that per-manent condition which the articular cartilage inherits, while thatof the epiphysis is only temporary? Such an opinion seems some-what corroborated by the comparison between the epiphysis ofjoints and those of apophyses. In the latter we find they becomerapidly converted into bone, and almost simultaneously over theirwhole surface, not leaving themselves tipped with a surface ofcartilage, because they do not at any part derive nourishmentfrom synovial membrane.
Mr. Cooper concludes-and the conclusion is, perhaps, asdifficult to prove as to disprove, " that it is the result of organiza-tion which leads to ligamentous union, and it is not the applica-tion of the most complicated mechanical contrivance which canlead to ossification."Some experiments were also made to ascertain, if any, and
what, chemical changes -took place in the neck of the thighbone. The average results of those experiments are shown inthe following table :-
" From this it appears, that although the neck of middle-aged bone contains fifty per cent. of bone earth, yet the recentneck of the old bone contains only thirty-one per cent.; whereas,the difference between the shafts is by no means so great,being fifty-six for middle-aged bone and fifty-three for old bone.In all cases, however, the shafts contain more bone earth thanthe neck.
" Aware that these results differ entirely from the receivedopinion that the liability to fracture in old age arises from anexcess of bone earth, I have not hastily arrived at an oppositeconclusion; nor should I have trusted to actual experiment asthe basis upon which to found an argument militating so stronglyagainst an established aphorism; but reflecting on the mode inwhich the reparation of bone takes place in ordinary cases offracture, it appeared to me little short of ridiculous to expect, inold age, an excess of bony matter, in a part which is so imper-fectly vitalized, and which, indeed, in common with all the epi-physes, is so many years consolidating into bone."
Hence, argues Mr. Cooper, the groundlessness of the hope whichanticipates bony union of the fractured neck of the aged femur,and the impropriety of the practice which would attempt it. Forour own part, aware that such a union does occasionally takeplace, and satisfied that, by judicious management, the ill-effectsof a restrained position, by which it may be secured, may bemodified; we should adopt still that practice which might pre-vent the sufferer from being for life a cripple, subject by his in-firmity to a restraint little more than that which, if applied for alimited period, might have secured for him a useful limb.The preceding, and the essays referred to at p. 453, with a
case of poisoning by arsenic, detailed by MR. TAYLOR, in whichthe poison was detected as a sulphuret, twenty-eight days afterdeath-A case of popliteal aneurism, with ligature of the femoralartery, by DR. NOTTINGHAM—A statistical report of the ClinicalSociety-Two cases of extra-uterine fœtation, by DR. OLDHAM,together with some cases and observations by DR. BARLOW, con-stitute the principal contents of the last number of Guy’s HospitalReport.The following observations of Dr. AjLDRiDGB are deserving the
attention of those who are not already acquainted with those effectsof mercury :-
ON THE INFLUENCE OF MERCURY IN PRODUCING NEPHRITIS.
"The effect of mercurial preparations in causing salivation isonly a particular instance of their tendency to stimulate glandular
510
organs. This tendency sometimes displays itself in the productionof bilious diarrhoea, and sometimes in an excited condition of thekidneys, verging towards inflammation.
"In a great many instances I have observed the urine to becomeneutral or alcaline under the employment of mercurial medicines.It was particularly noted that these patients had passed acid urinepreviously to being placed under mercurial medication; that theurine had become acid again after the mercury had been discon- I,tinued for a variable length of time; and that no alcalie nor alcaline salt had been taken, such as might by its elimination from Ithe kidneys have given rise to this reaction. Neither was there any !,retention of urine in these cases, nor organic matters present whichcould have originated a rapid putrefaction; so that it could onlybe concluded that the diminished acidity, neutrality, or alcalinityof the urine of persons under the influence of mercury, results froma vice of secretion produced by the action of this metal on thekidneys. Now, it has been shown, that alcalinity of the urineresulting from a vice of secretion, is a symptom of simple nephritis,
- whether acute or chronic; and a symptom of such importance, as,in the opinion of some, to warrant by itself the diagnosis of thedisease.
11 In a case which I lately had an opportunity of seeing, thereeould be no doubt, however, of the existence of nephritis; and thatit resulted from the effects of mercury appeared much morethan probable. There was pain and deep-seated tendernessin the regions of the kidneys, frequent rigors, and vomiting, aswell as alcalinity of the urine. These symptoms arose under thethe use of mercury, but required active antiphlogistic treatment fortheir removal."-Dublin Hospital Gazette.Under the circumstances indicated, we have frequently found
albumen a constituent of the urine.
CHEMISTRY, PHARMACY, ANDMATERIA MEDICA.
ON THE FORMATION OF A NATIONAL PHAR- MACOPŒIA.
By MR. SQUIRE.THE attention of the medical profession has for many yearspast been directed to the impolta,nce of forming a NationalPharmacopoeia for Great Britain and Ireland. This object was,I believe, contemplated previous to the publication of the lastLondon Pharmacopoeia. The evils likely to result from thediscrepancies which exist in the formulae of the three Collegesof London, Edinburgh, and Dublin, for preparations bearingthe same name, must be apparent to every one. Some of thesepreparations differ so widely in composition and properties, thatthe quantity constituting an ordinary dose of a compound, madeaccording to one of the British Pharmacopoeias, may be sufficientto prove highly injurious, if not fatal, were the compoundprepared from the formula of another of the Colleges. Thenames of the compounds prescribed by medicalmen in England,Scotland, andlreland, are for the most part alike-prescriptionsare written in the same language; and similar characters areemployed for designating the quantities of the ingredientsordered. There is, in fact, nothing to indicate in what part ofthe kingdom a prescription has been written; yet such are theincreased and daily increasing facilities for locomotion whichcharacterize the present age, that patients are constantly travel-ling from one capital to another with prescriptions, which, ifpresented to the Pharmaceutist without explanation, would bedispensed in a manner contrary to the intention of the pre-scriber.
In bringing this subject under the notice of the Pharma-ceutical Society, I propose pointing out some of the principaldiscrepancies which have occurred to me as existing between thethree British Pharmacopaeias, and I hope that the reading of thepaper here, and its subsequent publication among the Transac-tions of the Society, may elicit the expression of opinions fromother practical men, with reference to the points alluded to.
In the remarks I am about to make, I shall follow theorder in which the preparations to be noticed occur in the Lon-don Pharmacopoeia.Acidum Aceticum.-This name is applied in the London
Pharmacopoeia to an acid consisting of 30.8 parts of anhydrousacetic acid, and 69.2 parts of water. In the Edinburgh Phar-macopoeia, the same name indicates the strongest acetic acidthat can be obtained, namely, that containing only one atom, orabout fifteen per cent. of water. The acetic acid of the DublinCollege contains about 35 per cent. of water. The composi-tion of these three acids, all bearing the same name, may bethus represented:-
Acidum Hydrochloricum Dilutum.-There are considerablediscrepancies in the strength of this, as well as of the otherdiluted mineral acids as prepared according to the instructionsof the three Colleges, as the following statements will show -.-
Acidum Hydrochloricum Dilutum.-This acid, made accordingto the London Pharmacopoeia, contains 2 per cent. of realhydrocyanic acid; that of the Edinburgh Pharmacopoeia containsrather more than 3 per cent.; while that of the Dublin Phar-macopœia is necessarily of variable and uncertain strength.In this country Scheele’s acid, which contains from 4 to 5 percent. of real acid, is very frequently prescribed by medical men.These differences in a medicine of such energy and importanceare much to be regretted. The strength of the London Phar-macopœia, is undoubtedly preferable to the others.Among the ethereal preparations, there is ordered in the
London Pharmacopoeia, a compound called oleum cethereum.There is no formula for the preparation of this oil in either ofthe other Pharmacopoeias, and the process given by the LondonCollege is said by some practical men to be impracticable, or atleast to be so uncertain in the product afforded, as to renderit very expensive; and it is doubtfQl whether the substancegenerally met with under the name of oleum sethereum, is reallythat which the London College have described.
Spiritus IEtheris Nitrici.-There is a great difference betweenthe strength of the sweet spirit of nitre made according to theLondon, and that made according to the Edinburgh Pharmaco-poeia. The latter directs a pure hyponitrous ether to be firstmade, and then one part of this by measure to be mixed withfour parts of rectified spirit. The resulting spirit thereforecontains one-fifth of its volume of hyponitrous ether. Theprocess of the London College yields a product which variesconsiderably in strength, the proportion of ether present de-pending upon the quantity of ingredients operated upon, andthe rapidity with which the distillation is conducted. I have,however, never met with a specimen made according to theLondon process, that contained half as much ether as thatmade by the Edinburgh process.
Aconitina is directed in the London Pharmacopoeia, to bemade from Aconitum paniculatum; in the Edinburgh, fromAeonitum napellus. Dr. Fleming states that the Aconitumpaniculatum contains very little of the alkaloid, and otherauthors have represented it as being much less active thanthe species ordered by the Edinburgh College. I believe theAconitum napellus is generally used.
Liquor Ammoniœ of the London and Edinburgh Pharma-copoeias, has a specific gravity .960, and contains ten percent. of ammonia; that of the Dublin Pharmacopoeia, has aspecific gravity ’950, and contains 12.5 per cent. of ammonia.
Aquce Destillatœ.—Several of our members have attestedto the fact that the distilled waters keep better without theaddition of the small quantity of spirit which is directed tobe added by each of the Colleges. Mr. R. Phillips manyyears ago, in his Notes on the Pharmacopoeia, pointed outthe injurious effect of the spirit in causing the waters tobecome acid, the spirit being converted into acetic acid. Thishas also been recently noticed by Mr. Warrington in a paperread before the Chemical Society. In the London and Edin-burgh Pharmacopœias, the spirit is directed to be added to theingredients previously to distillation, and it has been stated
that the effect of this is to improve the flavour of the product.*The Dublin College, however, orders the spirit to be added afterthe water has been distilled (as did a previous London Phar-macopeeia), the object being, no doubt, the preservation of the
water, but the contrary effect is certainly produced.
