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be lodged on the external fossa iliaca, Iresting on the bone, and displacing the ’,three gluteal muscles; in all probabilitythe ligamentum teres, as well as the cap-sular ligament, is ruptured.Should the luxation not be reduced, a B

new articulation would be formed in thepoint where the bone now rests ; the gin- ! It2eus minimns, clothing the head of thefemur, would be transformed into a fibroustissue, and serve as a kind of new cap- Bsule ; the fossa iliaca would become soft-ened, and a little excavated to receive thehead of the bone, and an imperfect jointwould be formed; the patient would re-main lame for life from the shortening ofthe limb, which would be constantly turn-ed inwards.

Luxation of the femur may be con-founded with fracture of the neck; but alittle attention is sufficient to establish the Idifferences; dislocation occurs in theyoungsubject; fracture of the neck is rarely seenbefore the fiftieth year; besides, in thelatter accident, the foot is almost always , ’,rotated outwards; finally, the length ofthe limb is readily restored by extensionin cases of fracture.Having thus spoken briefly of the diffe-

rential diagnosis of fracture and luxation,M. BERARD recurred again to false articu-lations, spoke of fracture of the cotyloidcavity, and indicated the manner in whichextension and coutiter-extension should bemade {after the English method). In at-

tempting reduction, he prefers exercisingextension in the direction given to the limbby the luxation, without explaining thereason of this preference.Second Patient.—PHLEBITIS AFTER AM-

PUTATION OF THE FINGER.

The second patient was a lock-smith,fifty-four years of age, of a good constitu-tion, who had the little-finger of the lefthand smashed against a wall by the shaftof a cabriolet ; a few days after, the fingerwas removed in totality, by the single flap ;since that time the wound has gone on

badly; some portions of bone have comeaway; the edges have become disunited;violent inflammation has set in; four orfive days after the operation, the patientwas seized with severe shivering fits, andsome delirium ; the flap became flabbyand grayish; the pus ill-conditioned, andhe vomited several times ; there is nocough or diarrhoea, but the patient’s skinis of a dirty-yellow colour; the thumband three fingers are considerably en-gorged and cedematoas ; but no fluctua-tion can he felt ; the forearm, up to it!middle, is slightly tumefied and red; thecoloration of the skin disappears underpressure; there are no red lines ascend

I ing along the track of the lymphatic ves-sels, nor swelling of the glands in theaxilla..

The general symptoms are very unfa-vourable; although the lungs are sound,, ! there is excessive prostration of strength ;;’, tongue dry and dirty; low fever; great. thirst; some pain in the left lumbar re-gion; belly tympanitic ; incontinence of

i urine, &c. Hence M. BERARD concluded- that purulent absorption had taken place;- that abscess by metastasis was formed insome internal viscus, and that the patientt ! must of necessity die; for, with the ex-- ception of two individuals treated by M.

SANSON, all the other cases of this kindhave been mortal. Here M. BERARD tookoccasion to enter on the question of puru-lent absorption at some length, and gavea good resumé of our knowledge on thispoint, passing in review the opinions ofBARRY, DANCE, CRUVEILHIER, DuPUY-TREN, and others. We regret our spacedoes not permit us to notice at length’this doctrine, as it differs essentially fromthat followed in England. The treatmentis confined to palliatives, for a radical curecannot be hoped for. However, tartaremetic, in strong doses, seems to havedone more good in cases of this kind thanany other medicine.

LECTURE BY M. SANSON.

(July 3rd.)First Patient.—SPOTS ON THE COItNEA..-

FRACTURE OF THE LOWER EXTREMITYOF THE RADIUS.-VARICOSE VEINS.

M. SANSON’S two patients are at theHotel Dieu, No. 8, Salle St. Jean, andNo. 41, Salle St. Marthe. The first is aman, fifty-seven years of age, of sanguine-ous temperament; he has generally eti

joyed good health ; at present he exhibitsthree different affections.

’

lst. Spots on the Cornea.-About twentyyears ago he first perceived that his sightbegan to get weak; he was obliged tci

employ very strong spectacles when heread, and at last vision remained, thoughimperfectly, in the left eye only. Thepalpebral conjunctiva is now red andvillous ; the edges of the eyelid are red,but not ulcerated; the ocular conjunctivais unaffected. Both transparent corneæexhibit examples of an ephelium, withslight opacity. On the left side the opa-city is not extensive, but, on the right, itinterrupts the vision. The iris is but littlesensible to the action of light. The lengthof time which this affection has alreadyexisted, renders it difficult to treat it withany hopes of success; the chief meanswhich M. SANSON indicated were, local

664

bleeding by leeches, astringent collyria,. laudanum dropped upon the spots, and

foot-baths.2nd. Fracture of the Radius.-The next

affection which the patient exhibits ismuch more worthy of attention than theformer. When a child, he fell from anelevated position on the left side of thebody, the weight being thrown on thewrist-joint, the radius was fractured bythe fall, but a charlatan who was con-

sulted left the accident to itself, as he pro-bably was ignorant of its nature. Inflam-mation of the fore-arm, with great tume-faction, set in; an abscess formed in the

neighbouring cellular tissue, and openedspontaneously in three different places;after a long continuation of suffering,these abscesses healed, but the fracturealways remained unconsolidated. Thehand is now inclined at a right angle onits radial side, and the extremity of theradius projects internally on the externalside, there is a well-marked angular de-pression. The existence of a false articu-lation in the present case is very curious,and rare, and much better for the patientthan if consolidation had taken place in thevicious position of the hand occasionedby a neglect of all treatment. In fact, thepatient can make a very good use of hiswrist, and has even served as a volunteer,without being impeded in his duties bythe state of his hand. When desired torotate the hand, he executes the motionin the shoulder-joint, but he can pronateand supinate the member even when thearm is fixed.

Until within a very short time ago, saidM. SANSON, cases of this kind were de-scribed as belonging to luxation of thewrist-joint, forwards, backwards, or late-rally. I fell into the error, and describedthe accident as a luxation in my work onoperative surgery, and in a dictionary ofmedicine ; in this respect I followed thedoctrine and authority of BOYER. Notlong ago M. DUPUYTREN called intodoubt the possibility of these luxations,and demonstrated that what surgeonsgenerally denominated dislocation of thewrist-joint, was nothing but a fracture ofthe inferior extremity of the radius; sincethen more careful dissections have shown,that such luxations were nearly impossi-ble. In fact, the swelling of the radius atthe exterior of its anterior surface below,produces such a disposition of parts,that the axis falls on the -.Here, then, is one reason for fracture tak-

ing place ; besides, on examining the su-perior range of the corpus, we see thatbehind there is a gliding motion, which isalmost incompatible with luxation; finally,the motion of flexion and extension takes

place between the second and first rangeof carpal bones; if to these reasons weadd the resistance of the ligaments, ten-dons, &c., we shall have little reason toadmit luxation of the wrist-joint.M. SANSON now described in a masterlv

manner the symptoms attending fractureof the lower extremity of the radius, andobserved that the most frequent effect ofthis accident, especially if neglected or ill-treated, was to impede more or less themotion of rotation ; however, in the pre-sent case, in consequence of the falsejoint formed, the patient executes rotationin a most extensive degree, and has gooduse of his wrist.

3rd. Varicose Veins.—But the disease forwhich the patient was received into thehospital yet remains to be noticed. Manyyears ago there were formed over the leftankle, and on the thigh, knotty chordsalong the tract of the veins, depressible,and bluish in colour. A varicose masssoon formed at these two spots; the tu-

mours were soft, irregular, and livid, re-sembling much, except as to colour, a massof leeches.The patient is a wine merchant, and in

the habit of remaining a long time in theupright posture. Some time back the vari-cose tumours began to occasion inconve-nience ; the veins above the ankle becamepainful; phlyctenæ were formed, and thenulceration took place ; the ulcers healedand opened frequently, and, finally, haveremained open for the last month. Belowthe right ankle there is an ulcer, a littleelevated at the edges, superficial, and aslarge as a piece of thirty sous ; the integu-ments surrounding it are smooth and tense,excoriated, and of a bluish tint; the dis-charge from the ulcerated surface is verymoderate. About eight days back he ex-perienced a sensation of heat in the vari-cose mass, situated on the right thigh;this part became also tumefied and red;the veins here were very dilated andflexuous, the integuments brownish, anddisposed to ulcerate. The internal sur-

face of the left thigh presents nearly thesame appearances; there is a round tu-mour, elevated about an inch above theskin, and two or three inches in circum-ference ; the integuments are tense andglistening, and several hard compact septamay be felt here and there.What is the state of the veins in an af-

fection of this kind? (Here M. SANSONtraced a concise but perfect history of va-ricose tumours.)The disease may be distinguished into

three stages :-1st. In the first it is confined to a sim-

ple dilatation of the veins, which are tenseand a little painful, occasioning some in.

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convenience when the patient observesthe upright posture for any time. If youemploy pressure in this case, and on theliving subject, there remains sufficientcontractility of the vessel to restore it toits original dimensions; and should youhave an opportunity of examining theveins by the patient’s death, you do notfind any alteration of tissue; the texturemerely appears a little more dry than isnatural.

2nd. In a more advanced stage of thedisease, the pain is more pronounced;there is difficulty, or at least fatigue andimpediment in walking; the limbs becomenumbed, &c. If. the blood be artificiallyexpelled from the veins, we find their pa-rietes thickened, transformed into tensehard chords ; the elasticity is completelylost. In case the patient should die, theinternal tunic of the vessels does not pre-sent any alteration worthy of notice; butthe external coat is found resembling thefibrous tissue which constitutes the mid-dle tunic of an artery, and when the veinis divided across, its mouth remains per-manently open.

3rd. If the disease be permitted to goon, the veins become flexuous and knotty;they are much increased in thickness andlength; the dilatation is irregular, and thefibres of the middle tunic form a herniathrough the external one, as sometimeshappens in the intestines.The cellular tissue which surrounds and v

joins together these masses of varicose c

veins, becomes itself altered : it is en- a

gorged and hardened; it assumes a larda- Cceous aspect, and is very apt to take on t

inflammation and to ulcerate. tThe consequences of an affection of this

kind are very various ; sometimes slight,at other times very dangerous or evenfatal. When the inflammation extendsfrom the cellular tissue to the veins, a

phlebitis ensues, which may terminatein death. In ordinary cases the tumourmerely inflames, and terminates in suppu-ration ; the abscess opens spontaneously,or is opened by the surgeon, and pus,mixed with grumous blood is discharged.These abscesses may heal up, but the va-ricose mass is never completely removed,or the disease radically cured. In almostall cases there remains an induration ofthe cellular tissue, which is extremely dif-ficult to dissipate; but when this indura-tion is seated in the interior of the varicesthemselves, a hardened knot remains,until a new inflammation supervenes, bywhich it may be more or less dissipated.In the case before us, the inflammation

has been arrested, and there is no appear-ance of the patient’s being threatened byphlebitis ; indeed it is not probable that

the veins have ever been inflamed, for thepatient has not experienced any shivering,low fever, delirium, or pain and redness,along the vessels, &c. The ’prognosis istherefore favourable ; under any treat-ment there will be some suppuration, butof a good kind, and some fibrinous massesmaybe expelled, but little blood; there isno danger of hemorrhage coming on, andwe may dispense to treat of this accident,especially as the time presses.

It cannot be expected that the patient, will be cured of all the varicose masses,for the inflammation has not extended tothem all ; however, a cure in some rarecases may be obtained by spontaneous ob-- literationofthevein. Of this M. SANSON

quoted an example, and took occasion tof notice the numerous cases of success ob-? tained by M. BRESCHET in varicose dila- tation of the scrotal and spermatic veins.t The treatment may be comprised in ae few words -leeches to prevent the inflam-.- mation from extending further; and, in a

n few days, when the fluctuation which al-ready exists is more marked, the tumourmay be opened with the lancet or allowed

o to open itself, after which, resolution willtake place, and the patient’s state be muchd ameliorated.

Second Patient.—HARE-LIP.

M. SAN SON (having spoken of incision ofvaricose veins, excision, the treatment ofvaricose ulcer, &c.) turned to his se-

cond patient, a little girl two years of age,affected with a congenital hare-lip. Itdoes not, however, present at the edges ofthe division that kind of reddish projec-tion which commonly distinguishes thismalformation. The affection is simple,situated, as usual, on one side of the upperlip ; this is almost universally the case,and depends on the manner by which theupper lip is developed in the faetus bythree pieces, one median, the other twolateral ; hence, when development is ar-

rested, a lateral portion does not unitewith the median, and hare-lip is produced.If there be such a disease as median hare-lip, it is extremely rare, and most modernauthors have denied its existence; how-ever, M. SANSON cited a case from Mos-

CATI, which he seemed to consider as

authentic. The bones, in the present case,are not divided; there is merely a slightinequality between the incisors, depend-5 ing on a want of perfect consolidation., The division of the soft parts is not re-y markable; the superior angle adheres to

the gums, as well as a portion of the up-n per lip itself. Here M. SANSON, havingremarked that theory had little to do withy a clinical lecture, gave an excellent his-it tory of the causes producing hare-lip and

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, division of the maxillary bone and palate;described its different species and compli-cations, and entered into a considerationof the theory of development as applied tothis malformation. In speaking of thetreatment, M.SANSON also observed, thatit was less the duty of a clinical lecturerto describe what had been proposed anddone by others, than to detail his ownmethod of operating, which he proceededto do in a very clear manner. It differsnothing from the ordinary method of ex-cising the edges with scissors, and employ-ing the ordinary silver-bodied needles ofSHARP. As to the uniting bandage firstproposed by Louis, he rejects it as use-less, except in cases of double hare-lip, orwhere an osseous tubercle has been re-moved.

LECTURE BY M. GUERBOIS.

(July 5th.)WE can only indicate the titles of

the subjects on which M. GuERsois

lectured. Unaccustomed to his voice or

very peculiar manner of speaking, wewere barely able to comprehend a wordhere and there, and if we were rightly in-formed by those who did understand him,the matter was by no means worthy of re-porting.

NECROSIS.—The first patient had gan-grene of the foot with necrosis. M.GUERBOIS gave some common-place ge-neralities on gangrene, caries, and ne-

crosis, and described their causes andtreatment every now and then recurringto his patient, and repeating each pro-position laid down, at least twice.GUNSHOT WOUNDS.—The second pa-

tient was a young man, 25 years of age,who had shot himself with a pistol, inconsequence of some disappointment inlove. The ball remained embedded in the Isuperior maxillary bone; excessive inflam- Imation with suppuration came on, &c.He spoke of gun-shot wounds in general,the accidents which supervene, purulentabsorption, tetanus, &c. This subject wastreated by the speaker moderately well,and he succeeded in filling up his time ofan hour without any of the repetitionswhich disfigured his lecture during theformer trial.

Dr. TYTLER authorizes us to state, that

during the few weeks he is to remain inEngland, he will, on an application fromhis medical hrethren, inspect any cases ofcholera, of the existence of which he mayreceive timely notice.

THE LANCET.

London, Saturday, Aug. 2, 1834.

THE introduction of a BILL into our

Legislature for " amending" the "poorlaws " of England, has given rise to a dis-cussion,-an incidental one certainly,=on the state of our public charities, when

amongst others, the Medical Eleemosy-nary Institutions fell in for their share of

notice. It is not our purpose to write a

criticism on the new B ILL,—a document

which has excited an extraordinary sen-sation from one end of the country to theother, although we must declare that ifthis Journal were devoted to the consi-

deration of political questions, it is impos-sible that we could have remained silentrelative to this vastly important nationalmeasure, and even now we may per-

haps be permitted to observe, that hav-

ing for many years past taken an ac-

tive part in parochial affairs-having wit-nessed the condition of the labouring poorin aristocratic towns,-in places devotedto manufactures, - and in strictly agri-cultural districts,-we conscientiously be-lieve the parties who are engaged in

pushing this Bill through Parliament, arenot only ignorant of the links which bindtogether the various members of societyin this country,—are not only incapable of

catching even a distant glimpse of whatmust be the deplorable effects of this Bill,if it should ever be enacted into a law;but that they have not the remotest con-

ception or knowledge of those funda-

mental principles on which a legal pro-vision for the poor is secured in that con-

dition of society which is denominated

civilized. The principle which has beenadvocated in Parliament by the supportersof this measure, is neither more nor less

than this,-that the present generationbeing the owners of the soil, have it in