607one contraction <romhe fundus to’the os’uteri. ’The-etrictureDt the cervix is, however, anexception; it must be overcome, inthe same manner as strictures7i-u other places, by direct dilatation.Another cause of retained placenta is adhesion, either partial orgeneral; but this, like uterine inertia, is so constantly accompa-nied with hemorrhage, that we must defer its consideration to thatpart of our subject.,

When none of these causes operate, and the placenta is ex-

pelled in the usual -time, the uterus does not altogether eease itscontraction for some time afterwards. If left altogether to itselfwithout being properly supported, there is a danger that there4may be too great relaxation of the uterus ; consequently, hemor-Thage and severe after-pains, from the attempts made by the:uterus to discharge the eoagula formed in its cavity. This is oneef the most frequent causes of after-pains. You have abundantevidence that it arises from the circumstance stated, because theseafter-pains occur far more frequently with women who ’have hadmany children, -than with those who are only -pregnant for the:first time. In the latter case, the abdominal parietes being only.once distended, retain a certain degree of tonic contractile power,which is altogether destroyed by frequent pregnancies.

If we have succeeded in placing before you in a clear manner,the phenomena which take plaee in parturition, the contrivanceemployed by nature for the safe delivery of the child, and theprinciple which she seems to follow for the accomplishment of.her purpose, you will be better prepared to enter upon the con-sideration of the management of -labour, and will-have but littledifficulty in determining the value of those rules which are laiddown for your guidance. The management of labours, therefore,shall form the next subject of our attention.

(To be continued.)

FOREIGN DEPARTMENT.

M. GENDRIN ON THE PRESERVATION OF THE HEALTH OF THOSE

WHO WORK LEAD, AND ITS PREPARATIONS.

M. GENDRIN has recently published in -a -Frcnch journal (LaPresse) an article on the preservation of the health of those whowork lead, and its various preparations, whichwe think sufficiently,important to warrant our laying it in full before our readerts.

11 The morbid symptoms which ruin the health and endangerthe life of those who-labour-in manufactories of carbonate of lead.and of minium, are-shared," says M. Gendrin, by all whose occu-pations lead them to employ lead and its preparations. More.than forty professions are attended with danger to those who ’,follow them, from -this source. Among them the-most dangerous ’,are those in which are prepared the chemical products, of which ’,lead is the basis; -such as manufactories of litharge, of carbonateof lead, of minium, of oxide of lead; establishments in which ’,lead in the metallic state is worked, (those -for the fusion of lead ifor the manufacture of shot, -and of printing types;) works for Ithe vitrification of the oxide of lead, (potteries, china and .crystalworks;) trades in which the salts of lead are used, (house paint- z,ing, black dying of horsehair stuffs, -glazing of visiting cards ;) ’,&c. &e. In all the establishments devoted to these purposes, ’,most of which are on a very extensive footing, a large number of

iworkmen are exposed to the action of a great quantity of poison-,ous matter, volatilized in a state .of impalpable dust, or vaporized, ’,or dissolved in fluids."Thus brought in contact -with the absorbing SMrfaees of the

economy, the poison acts with the greatest possible- energy, owing ito the activity of the tegumentary functions, exaggerated by Ilabour and by the elevated state of the temperature. Thence it Iis that we see the unfortunate beings whom want of work in other professions throws into these, obliged to cease their labours aftera few weeks, and forced to enter the hospitals -suffering from themost serious symptoms. Unfortunately for them, the violent- abdominal pains which constitute the principal symptom of .poisoning by lead, are always followed by extreme debiiity, and Ioften by incurable paralysis. In some instances, happily rare Iones, those who work at the preparation of minium are attackedwith epileptic symptoms, which either terminate in death orleave the patients in a state of insanity, or of cachectic debility,which, generally speaking, our art cannot remedy.

" In the presence of so great an evil, it becomes a duty for allmedical practitioners to unite their efforts to attenuate and toprevent the disastrous effects of poisoning by lead. It is thisduty which I -accomplish," continues M. Gendrin, " in makingknown the result of fourteen years’ experiments respecting thetreatment of saturnine diseases, continued without interruption inthe medical divisions of the hospitals, the Hotel Dieu, Cochin, andLa Pitie, entrusted to -my care. I do not hesitate to say, with afeeling of deep conviction, that nearly allsaturnine diseases may

be cured, rapidly and securely, by an ieasyand cheap remedy;and, the most important point of all, that the occurrence ofsaturnine affections may be prevented.

" Whatever may be its gravity, unless it be complicated bycerebral symptoms, lead colic may be always cured by the inges-tion alone of sulphuric acid, in the dose of from a drachm and ahalf to two drachms, mixed with about three pints of water, forthe four and twenty hours. The cure takes place in six days, onan average, if the disease is extreme; in three days, if it isslight.

" Whenever the skin of the patient is covered with a layer oflead, as’&Iacute;s the ease with nearly all the workmen who come out ofworkshops in which large masses of the metal are operated upon,to the sulphuric acid, administered internally, must be added theexternal use of sulphurous and soap baths, the cleansing action ofwhich is increased by the detersive action of frictions performedwith a brush." The -nervous and cerebral symptoms only occur, generally

speaking, when the patient has already -suffered from severalsaturnine affections inefficiently treated. If they manifest them-selves at the first attack, it is because the skin is covered by alayer of metallic powder which keeps up permanent poisoningof the system. Even in these cases, which are the most difficultto manage, if the disease is attacked in time, by insisting longeron the sulphurous and soap baths, a cure is effected in from eightto ten days on an average. The constant efficacy of -this simpletreatment is to be explained by the conversion into an insoluble,’harmless salt, (the sulphate of lead,) of the mineral poison ab-sorbed, and by the ablation of the particles of lead deposited onthe tegumentary surface.

" The preservative treatment is based on the same principle.In order to -preserve workmen from saturnine affections, the-following precautions must be adopted :-Two glasses of thesulphuric lemonade must be drank each day; the parts of thebody which are uncovered during labour must be washed withsoap and water at each cessation from wotk; the workman musthave clothes on purpose-to work in. Those who are employedin .localities where the_atmosphere is loaded with a great quan-tity of metallic dust, or poisonous vapour, ought, also, to take twogeneral soap baths each week, scrubbing the body with a flesh-brush. The omission of these precautions during six or eightdays, or even during two or three, if the workman commits ex-cesses in drinking, is often sufficient to allow the symptoms ofpoisoning to appear. Thence the necessity of continuing forsome time the use of the sulphuric lemonadeand the soap lotions,even after ceasing to work at lead. Sulphuric lemonade maybe thus taken without any injury to the health. The workpeople of -the manufactory of carbonate of lead of Clichy havetaken it during two years and a half, without experiencing anyill,effects whatever." No one need be surprised," says M. Gendrin, " that Ishould

speak with conndence, even with authority, on the’subject. What I,have above stated is merely the interpretation of facts. Sinceits31, have thus treated between four and five hundred eases, allof which have been carefully taken down by my house physicians,nearly all of whom are now in practice, and have adopted mypractice, as have also many other enlightened physicians athome and abroad. M. Roard, the learned chemist, who is at thehead of the manufactory of Clichy, (the principal manufactoryin Paris for the carbonate of lead,) has made his workpeople usethe sulphuric lemonade during two years and a half. This pre-caution alone has enabled some of them who had previously beenattacked several times by lead colic, to work during six monthswithout intermission, and without experiencing the slightest in-disposition. The inspectors and workpeople of various otherestablishments have likewise owed the preservation of theirhealth to the adoption of these precautionary measures."The general adoption of the treatment which I recommend

would be attended with great advantages. It would, firstly,preserve the health of men whom poverty alone, generallyspeaking, compels, in order to give bread to their families, todevote themselves to occupations which only reward them withdisease, infirmities, or death ; secondly, the manufacturers wouldfind as many labourers as they wished, who, being able to remainfor a considerable length of time at their occupations, wouldacquire a thorough knowledge of the manipulations in whichthey are engaged, a knowledge which they now seldom, if ever,possess. How is it possible to have workpeople well acquaintedwith the various manipulations required in establishments of thiskind, when, either from actual disease, or from the fear of it, theyseldom remain in them more than a fortnight? If the workshopswere to cease to be unhealthy, the work would be better executed,the price of labour would diminish, and the products would bemore abundant. The preservative measures which I havepointed out are attended with but very trifling expense. Sul-

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phuric acid and soft soap are so cheap, that an exceedingly smalloutlay would meet the expense incurred. In large establish-ments, the water furnished by the steam-engine, which is

generally wasted, might be used for baths."In addition to the remedial and preservative measures which

I have recommended, there is still much to be done to preservethose who work lead and its preparations, by mechanical pre-cautions. Is it not deplorable, for instance, that the sieves forminium, and the mills for the carbonate of lead, should still, inmany establishments, be moved by hand ?- My task is now fulfilled. I have proved that we possess the

means of putting a stop to a great evil. A general administrativelaw is wanted; and it is the duty of a government to adopt thosemeasures which are calculated to preserve the health of thepopulation entrusted to its care."

REMARKS ON SOME OF THE INJURIES OF BONESARISING FROM ACCIDENTS.

By JAMES PRIOR, Esq. M.R.I.A., F.S.A., Deputy-Inspectorof Hospitals and Fleets.

(Continued from p. 583.)THE following is a severer case. Whether unfavourable idio-syncrasy, neglect of general bleeding, or peculiar strain upon thelimb at the moment of injury, aggravated the symptoms, may bea question. It was treated by a good surgeon.A medical officer of this hospital, when hotanizing, as a student,

with some companions, in the vicinity of London, slipped downa bank, his right foot being caught in a hole, and remainingfixed, while his body fell backward, thus throwing a severe

strain upon the leg. The effect was a very oblique fracture ofthe fibula, about two inches above the malleolus, and dislocationof the tibia inward.

Reduction was accomplished, on the spot, by his brotherstudents, and removal homeward rendered as easy as possible,though excessive pain was experienced in the limb. Leeches,and the other usual means of subduing inflammation, exceptinggeneral bleeding, were freely used. For a month, the agony ex-ceeded, he says, anything he has ever seen since produced byinfinitely worse accidents in other persons. During a fortnightor three weeks he could not suffer the application of a splint,and even afterwards was frequently obliged to remove themwhen applied in the easiest manner; while the whole limb, to thehip, soon presented one mass of ecchymosis. The spasmodicaction of muscles, particularly at night, starting from sleep, withviolent tremor, and shooting pain in the seats of injury, ren-dered the hours which should have been passed in repose onlysources of misery. During the day there was less distress,arising, as he conjectured, from the mind being more occupied inreading, the visits of friends, and by passing objects. Opiumand hyoscyamus, from forty to sixty minims of each, and these ’,;

proportions sometimes doubled, seemed to have little or no effectin abating pain or procuring sleep; neither did confinement of ’,the muscles, by sufficiently tight bandaging, or any other means ithought of, subdue the spasmodic twitching.

All positions became painful soon, so that constant change wasnecessary to enjoy ease. The most agreeable proved at lengthto he a kind of swinging apparatus, on which the limb beg placed, could be raised or lowered at pleasure; the easiest posi-tion, and that which could be longest maintained, being with theheel raised above the level of the body. For three months hewas compelled to remain in bed; for three more he was uponcrutches; and at the present day, though ten years have elapsed,the leg is always weak, occasionally swells, and soon gives wayunder more than moderate exercise.*

Fractures of the clavicle are generally found to unite so irre-gularly, that surgeons are induced prudentially to intimate theprobability of the fact beforehand to the patient, lest, afterwards,

* Varieties of temperament furnish continual matter for remark tothe practitioner; nor must he look for anything like regularity inthe symptoms o disease. Just as this paper was being forwarded for pub-lication to THE LANCET, a case of fractured tibia was brought into theho,3pi, al, where there is no peculiarity of pulse, being only 76; no startingsfiorn sleep, no spasmodic twitchings, no heat of skin, or any constitutionaldisturbance whatever. He is a seaman, (Daniel S-, A.B., aged thirty,)of her Majesty’s occasional yacht, Black Eagle, which, in proceeding toPortsmouth to embark the Queen and H.R.H. Prince Albert, for the Isle ofWight, was run into off the Foreland. at night, by a strange vessel, and cutdown to the water’s edge by the collision. He is not himself aware fromwhvr his injury proceeded, but the crew say it was caused by the fall of thesteam-pipe, in consequence of the shock. It occurred about eighto’clock, P.M, 27th March, and the vessel did not reach Woolwich tillfive P.m. the following day; twenty-one hours had therefore elapsed,and much tumetaction was present before he was seen by a medical officer.There wa- no displacement, no wound of the skin, no injury to the fibula,but there is obvious solution of continuity about the middle of the tibia.The swelling has now (April 3rd) subsided.

there should be imputations thrown on their professional skill.Few called to treat many such cases, but have been teased byrepeated displacements of the ends, or rather the scapular end, ofthe bone, from the difficulty of keeping the arm and shoulder inthe most advantageous position, so that even constant surgicalsuperintendence, and reasonable care on the part of the patient,will not always succeed. Occasionally I have been induced tovary the form of bandage, in order to discover that which mosteffectually performs its work. The common stellate roller, orfigure of 8 form, however well applied, appears rarely to accom-plish its purpose in a manner quite satisfactory; but will alwaysbe in use from being available in spots where better machinerycannot be procured. The stuffed leather clavicle bandage of theshops, with its arrangement of pads, buckles, and straps, savesmuch trouble, and is more speedy in application than the other;but on the whole, perhaps, scarcely more effectual, and not un-frequently gives more uneasiness to the patient. Neither is italtogether perfect in construction, for very frequently the strapthat passes over the shoulder happens to press unduly andexactly upon that scapular portion of clavicle already depressedbelow the other fractured extremity, and which, in fact, it is theaim of surgical appliances to raise. The clavicle apparatus ofAmesbury, with some modifications, sold by Weiss, is, if more

complex, certainly on the whole better adapted for the purposeof procuring truer apposition in the ends of the bone, which,though a matter of less consequence to men, is of more import-ance to women, whose dress leaves any irregularity there moreopen to observation. Union, and of a satisfactory character,.will, however, take place under the application of either, so as togive sufficient power, to the limb.On 25th April, 1844, Lieutenant-Colonel P-, Royal Marines,

in proceeding from barracks to Woolwich-common, where thetroops were assembled to celebrate the Queen’s birthday, had hishorse fall under, and partly upon, him, by which the left collar-bone was fractured, several contusions of the left side, thigh,and leg, sustained ; and he was so stunned as to experience some-confusion of mind for an hour or two afterwards.

Being in a different part of the field, I was not aware of theoccurrence until half an hour afterwards, when the ceremonies ofthe day had concluded, and then the stellate bandage had beenapplied by my assistants. In the evening, the patient beinguneasy at the seat of fracture, as well as generally, the pulsefuller and quicker, he was bled to ten ounces, cold lotion applied,and an opiate, with a diaphoretic, given at bedtime. These werecontinued till the 30th, when the leather clavicle bandage of theshops was applied, the other having become displaced anduneasy. This, however, produced more uneasiness than its pre-decessor, and I was thence induced, two days afterwards, to re-commend that of Weiss, which answered its purpose most satis-

factorily. On the thirtieth day after the accident, it was left off,a sling being substituted.June 3rd.-The latter was disused, excepting occasionally,

when the hand seemed disposed to swell.The union of the fractured bone is perfect, not the slightest

trace of irregularity on its surface being perceptible; and as thepatient has passed the meridian of life, it must likewise be cons’i-dered quicker than might be expected.The olecranon, when fractured-one case only of which I have

seen in the better class of society,-seems to do well with verymoderate precautions. Bony union, I believe, very rarely takesplace, and then only when the disjunction occurs close to theshaft of the ulna ; nor do I remember a case where that reputedfact of union by bone has been proved by dissection, though suchmay have appeared to be the case in the living subject. Butwith ordinary care on the part of the patient, a very efficientjoint, through the medium of ligament, and fit for all the purposesof life, will be secured.

Lieutenant H-., Royal Marines, in riding out of Tenby,Pembrokeshire, on the evening of May 7th, 1836, was thrownfrom his horse, and lighted partly on his left elbow, which occa-sioned considerable pain in prosecuting his journey to Pembroke,ten miles distant. As he was then two miles from barracks, andthe hour.late, Mr. Mansel, of Pembroke, was called in, who,discovering fracture of the olecranon amid considerable tume-faction of parts, judiciously directed leeching and the other usualmeans for reducing inflammation. I saw him on the followingmorning, and afterwards daily, when these remedies were conti-nued.On the llth. finding the swelling sufficiently reduced, the

fracture situated about the middle of the olecranon, and thetriceps drawing up the detached portion of bone, I applied a rollerabove and below the joint, over two strips of calico, one oneach side of it, placed longitudinally, and of such length as toadmit of their ends being tied over the circular bandage, bywhich means a purchase was procured sufficient to overcome