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chest. The age of a third child, nineteen months; the lobes ofgland reduced in thickness to the size of two ordinary quills;cause of death, hooping-cough with pneumonia ; this child wasvery greatly emaciated.

These few cases seem to indicate that there is no certaincorrespondence between the ages of children and the size ofthe thymus gland. The author had just examined the bodiesof twin children dying within six days of each other withsymptoms of inflammation of the lungs; ages respectively, tenand eleven weeks. The thyroid and thymus glands in thelarger and elder child weighed three drachms; the thyroid andthymus glands in the smaller and younger child weighed twodrachms and a half.

Provincial Hospital Reports.NEWCASTLE-UPON-TYNE INFIRMARY.

CASE OF EXCISION OF THE ELBOW-JOINT, PERFORMED BY MR.HEATH, M. B., &c., Surgeon to the Infirmary.

(Reported by J. T. MILBURN.)

GEORGE R-, a boy aged eleven, was admitted on the10th of May, 1855, from the workhouse, where he was bornand has resided all his life. He is an orphan. He has hadscrofulous disease of the right elbow-joint for upwards of a year,and he fell down a day or two ago and hurt his bad elbow,which caused it to swell and ulcerate a good deal. The elbowis at present much enlarged, there is a sore over the outer con-dyle, and ulceration over the inner one, extending an inch anda half above the joint, in which there is very little motion.About three inches below the joint there is a fistulous opening,through which a probe can be passed down to the ulna, whichs carious. The surrounding integuments are much discoloured.A probe can be passed quite into the joint, which seems to betotally disorganized. To have a little castor oil in the morning,and to have a bread poultice applied to the elbow.May llth.-To take plenty of milk.14th.—Notwithstanding its being a very unfavourable case,

on account of the caries in the ulna below the joint, whichcould not be removed, Mr. Heath determined to make an

attempt to save the limb by performing the operation forexcision of the elbow-joint.15th.-The boy having been put under the influence of

chloroform, Mr. Heath made an incision from about two inchesabove the elbow-joint to a little below it, and another incisionat right angles to the first, forming together the letter T. The

flaps being carefully dissected back and the joint opened, theends of the humerus and ulna were found to be greatly ulceratedand softened. The radius was unaffected. The articular sur-faces of the humerus and ulna, with the olecranon process ofthe latter, were removed, a few sutures put in, and the ladsent to bed.

16th.—The lad looks very well; no feverishness; bowelsopen.

19th.-The arm was opened out to-day, and looked as wellas could be expected. To be dressed with warm water, and abandage cut into lengths of about nine inches each, so as toobviate the necessity of moving the arm when it is dressed.25th.-Since the operation the lad has been doing very well,

without any symptoms worthy of remark. There is a slightdischarge from the wounds, which are granulating. Ordered,bismuth and carbonate of iron with sugar, of each a quarter ofa grain, twice a day.June 4th.-Very little discharge, and swelling much dimi-

nished. To continue water dressing, with a leather splint to beapplied to the under surface of the elbow. Continue medicine.

24th.-Doing extremely well. The arm to be put in a largerand more bent leather splint. Continue the medicine.

Aug. 14th.—Doing well. He can raise his arm a little with-out help. About a month ago, he was ordered to take a table-spoonful of cod-liver oil with syrup of iodide of iron, whichhe has done; but as the syrup purges him, he is to omit it.Ordered, carbonate of iron with sugar, a quarter of a grain;sulphate of quina, two grains.

Dec. 5th.-The wound of the long incision is now nearlyhealed, and the transverse one is healing gradually, and has avery healthy appearance. The original sore over the internalcondyle is about the size of a sixpence, and is quite healthy,as is also the original sore on the forearm, which is much dimi-nished in size, and the whole of them are secreting a smallquantity of laudable pus. The sores are dressed with strips of

linen dipped in cold water, and pretty tightly strapped aroundthe arm. A bandage is then applied to keep them in position,and the whole confined in two stout leather splints, which arebent at an obtuse angle, and quite encase the arm. Thistreatment has been made use of now for the last six weeks;the arm has steadily improved under it, and he is now able toraise a light weight to his head. He has been taking a glassof wine daily for the last six weeks, and his general health isvery good.’ Jan. 15th, 1856.-The arm is now in pretty much the samecondition as when the last observations were made, not havingmade so much progress during the last month as could havebeen wished. The patient has taken cod-liver oil for the last sixmonths, with the best effects. When he came in he had everyappearance of being a weak scrofulous boy, whereas now he isquite robust and healthy-looking; he can now flex the forearmupon the humerus to a slight extent; he carries articles oflight weight about the ward with the arm with the greatestease, and there is every prospect of its being a useful limb tohim in after life, which from his being an orphan is of vital im-portance to him. The elbow is at present still dressed withthe linen straps.

Feb. 6th.-Since the last report the elbow has been going onvery favourably. The fistulous opening which communicatedwith the ulna is quite healed up; and as Mr. Heath thinks achange of air will do him good, he is to leave the hospital

I shortly.

Reviews and Notices of Books.Lettsomian Lecturers on the Physiological Constitution, Diseases,

and Pructures of Bones. By JOHN BISHOP, F.R.S., Fellowand Member of the Council of the Royal College of Surgeonsof England. Svo, pp. ’0. London: Samuel Highley.A DEBT of gratitude is due to those eminent men who have

in former times founded courses of lectures in our Colleges andSocieties, which, unlike the elementary courses delivered tostudents, are intended to convey to the more advanced mem-bers of the profession the most recent and important discoveriesin one or other of the departments of science, or to advance theoriginal views of the author. By this means, indeed, the dis-covery of the circulation of the blood was promulgated byHunter in his prelections at the College of Physicians long beforethe publication of his treatise, " De Motu Cordis;" and by theprofessorships of the College of Surgeons the profession is an-nually made acquainted with some of the most recent disco-veries in surgery, comparative anatomy, and histology.For this reason we ivelcome the appearance of the Lettsomian

Lectures, and we shall now enter on a brief notice of those onSurgery, delivered last year before the Medical Society of Lon-don by Mr. Bishop. The lectures are three in number-thefirst comprising an examination of the physical properties ofbones, their elasticity, strength, and flexibility in relationto their inorganic and organic constituents, rickets, mollitiesossium, caries, and psoas abscess; the second comprises theorganic changes, producing necrosis and the formation of newbone, the necessity for the removal of dead portions, exostosis,soft tumours of bone, and the difficulty of their diagnosis; thethird lecture is devoted to fractures and their reparation, frac-tures of difficult reunion and of difficult diagnosis. Such beingthe subjects, it is our intention to touch lightly, as our briefspace will alone permit, on a few of the more interesting pointspresented for our consideration.The author has long devoted great attention to the relation

which subsists between the physical properties of bones and theirchemical constituents, and he has proved by well-directed ex.periments that, while the elasticity and strength of bone de-pend on the inorganic, the flexibility and cohesion are con-

ferred by the organic constituents, and that an intimaterelation exists between their physical properties and theirnormal composition.

If the inorganic matter be deficient, as is very often the casein the first few years of life, the flexibility of the bone is in-

319

creased, while its elasticity undergoes a corresponding diminu- cases of similar re-union have occurred in the practice of Mr.tion, and as a consequence of the diminution of elasticity, the Hodgson. The author remarks on this subject, that a know-bone being unable to regain its normal form, it becomes dis- ledge of the occasional occurrence of osseous union is of greattorted; and if a subsequent deposit of earthy matter takes importance, inasmuch as it teaches us not to relax in our effortsplace while the bone is thus distorted, permanent deformity to insure such union; whereas, if Sir A. Cooper’s opinion wereoccurs. Consequently it is at this particular period, and acted on, we should be inclined to leave the case as hopeless,before the bone regains its healthy proportion of inorganic and neglect the precautions necessary to insure a perfectconstituents, that artificial support is required. restoration of the bone.

"It is in this state of the bones that some mechanical support In treating of the vexed question as to the proper position of

is desirable, inasmuch as if, during the curvature of the bones, the limb in fractures of the neck and shaft of the femur, the

they acquire the proportion of earthy matter sufficient to confer author strongly advocates the double flexure of the inclinedon them the elastic property common to normal bone, they plane, in preference to the long, straight splint. We entirelyremain distorted during life, and no mechanical contrivance aa-ree with him in opinion, as the flexed position is clearly inthat can be borne by the patient seems adequate to restore thebone to its normal figure. The re-hardening of the bones of Accordance with physiological principles; and whie maintainingthe lower extremities, when there is no organic disease, appears the fractured ends of the bones more closely and accurately into take place in children about the age of four years." apposition, clearly adds very considerably to the comfort of the

The influence of position in the production and restoration patient during a protracted, tedious, and painful confinement

of lateral curvatures 0 f tl’ 1e spine, unattended by caries or other in a fixed position. Even in the primary setting of the frac-

organic disease of the vertebræ, is well treated in the succeed- ture, when the limb is placed in the straight position, consider-

ing pages. able force is required to bring the ends of the bone in exactThe organic changes of bone in rickets and mollities ossium apposition; and from the constant and powerful action of the

and caries are next treated of in detail, followed by a discussion muscles, a constant tendency to override each other is produced,of the propriety or impropriety of opening psoas abscess, which which requires great pressure to overcome-so great, indeed,concludes the first lecture.

that in some instances sloughing of the periæum has been m-

I the second lecture, the author gives an excellent descrip- duced. On the other hand, when the limb is flexed, the endstion of the causes and phenomena of necrosis, entering minutely

of the bone are kept in apposition by the action of the muscles,

into the histological and chemical changes which occur in the and no resistance has to be overcome, so that little more

dead bone and the surrounding parts ; but we must t t are 1 ex- pressure is required than what is simply necessary to preventception to a statement which the author acknowledges to be the limb from altering its position. The time required for firm

hypothetical-we allude to the solution of dead bone by the re-union of the neck of the femur may be considered as double

living solids or fluids surrounding it, so far as relates to the that for the shaft; and it is influenced by other circumstances,

dense structure of the shaft of bones; for we have seen saw- especially by the age of the patient, varying, in cases recordedby Dupuytren and Hodgson, from 54 to 103 daysmarks on a necrosed portion of the shaft of the femur as perfect, The other fractures that unite with difficulty are those of

after seven years’ contact with the surrounding soft parts and the coronoid process and olecranon, and of the patella. These,pus, as on the hrst day they were made. We apprehend that theirregularities on the surface of the sequestrum are rather to m

almost all cases, unite by fibrous tissue; but the authormegularities on the surface of the sequestrum, are rather to beattributed to the unequal depth to which the bone has lost its states that the late Mr. Ulitt had in his possession a, fractured.

vitality, and the subsequent removal i the still living portions oleoranon process in which true osseous reunion had taken

of the bone, than to the solution or eating away of the necrosed place. With some brief remarks on fractures of doubtful diagnosis,parts. the author closes this course of lectures, and we have risenExostosis, osteophytes, hypertrophy, and atrophy oi bone,with some allusions to tumours 0 f bone of difficult diagnosis, ’ from the perusal of them with a full appreciation of the clear

complete this lecture. and concise form in which he has placed opinions and factsbefore his auditors and readers. His original researches andThe concluding lecture is devoted to a detailed consideration remarks on some points, to which we have bneily adverted,of some of the more important points in the pathology and are of no mean value, and they place him in the rank oftreatment of fractures. In reference to the production of irac- original observers and reflectors. We cordially recommendture by apparently trivial violence, the author remarks- this little treatise—for such we must designate it—to the care-

"That there are great differences in the nature and qualities ful perusal of the profession.of the ground, and this difference seems generally to produce

___________

corresponding effects on the softer tissues, as well as on thebones; and moreover, we must bear in mind that the percussion A Treatise on Electricity, in Theory and Practice. By A. DEon reaching the ground is much greater than that due simply LA RIVE, late Professor in the Academy of Geneva. Into the velocity which the body has acquired in falling, it being three Volumes. Vol. II. Translated by CHARLES V.proportional to the weight of the body, multiplied by the WALKER, F.R.S. London: Longman and Co. pp. 912.square of its velocity. Such being the case, we must no longerbe surprised that fractures of the bones sometimes result merely THAT the name of the professor of Geneva will be honourablyfrom tripping on the feet in walking, and falling on the ground, and permanently connected with the history of electricalmore especially when the surface on which the body falls is science is a prophecy which it does not need much acute-composed of compact and rigid materials." ness to make, as the half of it is already accomplished.The discussion of the reparation of those fractures which are Three years since, the first volume of the present treatise made

of " difficult or otherwise uncertain re-union" is of great inte- its appearance, and another volume is yet required to completerest, because the author differs in some respects from established it. When thus finished, it will form the most perfectopinion in England. It was laid down as an axiom by the late manual of electricity in any language. To those who have aSir Astley Cooper, that fracture of the neck of the femur is taste for the abstruse and more mathematical development ofnever repaired by osseous union; and he has placed on record, this branch of natural science, who are not content with thethat in the whole course of his very extensive practice he had surface, but love to search the matter to its foundations-tonever met with a case of such re-union, nor with anyone who those, that is, to whom Oken’s formula is no mystery, and whohad witnessed perfect bony union; and that union within the are not terrified by the various theories of electric and voltaiccapsular ligament, when union of any kind occurs, is always by induction-we recommend this work with confidence. It is

membrane. A preparation, however, illustrative of osseous re- not by any means a _pol-)ula2, treatise, or one to be lightlyunion, was sent to Sir Astlev Cooler bv Mr. Swan. and other skimmed over, but it enters into the subject, and considers it

320

in all its bearings, in a very full and satisfactory manner. IWe hope soon to see the third volume, which will be occupiedwith the Applications of Electricity, and its Manifestations inNature. ’

Obscure Nen’ous Diseases popularly explained: being SixLetters addressed to a Physician. By J. L. LEVISON.London: Effingham Wilson.MR. LEVISON’S brochure consists of a series of letters, written

in an agreeable style, addressed to Dr. Conolly. The author

endeavours to show that many obscure and anomalous nervousaffections depend upon influences affecting the branches of thetrifacial nerve, especially derangements and diseases of thedental apparatus; and several cases are given in illustration,where a cnre was established by careful attention to the stateof the teeth. Although written for the public, it may be con-sulted with advantage by the medical practitioner. It con-tains much useful information in a small compass.

Practical Hints for Investing Money in the Funds. By FRANCISPLAYFORD. Second Edition. 12mo. London: Smith andElder.

SEVERAL members of our profession having thanked us forhaving drawn their attention to this very useful little work, atthe publication of the first edition, we think it right to statethat a second edition has just appeared; and its publication sosoon after the former proves sufficiently that our good opinionof its merits was not misplaced.We fear that not a vast number of our professional brethren

have an opportunity of investing a considerable amount of

capital realized by the onerous labours which they undergo,but when they have floating funds to invest, the valuablelittle treatise before us points out to them the means bywhich they may dispose of the same to the best advantage.In the Preface to this second edition will be found remarks onthe operation of the Limited Liability Act; and the Appendixcontains important additions, bringing down the statement ofthe fluctuations of consols to the latest available period. Sucha treatise as this was undoubtedly required; and we heartilywish it all the success it deserves.

The Entomologist’s Annual for 1856. pp. 174. London:JohnVan Voorst.

THIs little book contains, besides much valuable scientificand amusing information, a good reference to all the ento-mological publications now on sale; and also a list of livingentomologists.

MILITIA SURGEONS.yo the Editor of THE LANCET.

SIR,—Your journal of the Sth inst. contains a letter signed"A Militia Surgeon," reminding his professional brethren oftheir " present unsatisfactory position." I trust the hintthrown out will stimulate them from their dormant state of in-activity to a consideration for their future welfare. They aredifferent in many respects from other officers ; on being ga-zetted, they (surgeons) are required to join the regiment, andgive their services for two months without receiving any pay,which goes to the mess and band funds, and twenty days an-nually are stopped for the same funds; while the other officersare allowed two months’ leave of absence to pay these expenses,and three months every year, which is not allowed to medicalofficers. Again, captains, lieutenants, and ensigns enter theservice either for a standing in society, or to spend a few hoursin a day (which time hangs heavily on them), or to get intothe army without purchase: but it is not so with medical men;their profession gives them a standing in society, and theirmind and time are absorbed and taken up with the study ofhuman nature, which noble calling makes them welcome guestsin every family. What eallipg is there that receives lessthanks and less remuneration for the services it renders than

the medical profession ?-a profession that abounds with me-dical talent, that does no small credit to the age in whichthey live, and. a calling that requires as much learning asthe other professions; yet we do not receive the same pro.tection from the State. And why? Because it is our own

fault; we are not sufficiently united; and until we do comeforward in a body (and there is not a better time thanthe present), so long will the present evils rest upon us. I

hope the surgeons and assistant-surgeons of militia regimentswill come forward at once, before it is too late, and demandfrom Government something hereafter, when our services areno longer required, as an acknowledgment of our worth; for"we can never hope to return to our old positions; they havelong since been filled."-I am, Sir, your obedient servant,

llaroh, 1856. _____

SUCH IS LIFE.

To the Editor of THE LANCET.SIR,—The letter of " A Militia Surgeon" in THE LANCET of

the 8th inst. is well timed. Numbers of militia surgeons havequitted well-established practices at the urgent solicitations ofofficers, and in the expectation that the war would be of someyears’ duration, at the end of which period a pension or half-pay would be given, if not a permanent post on the staff. Nowis the time to bestir ourselves, and earnestly put forth our claims,or nothing will be got but a "Thank you, " in General Orders."There are other mess stoppages made monthly, and subscrip-tion lists are constantly being pushed under officers’ eyes whichcannot be avoided; so that pay, when cut down by innume-rable clippings, becomes a mere shadow of the nominal sum,and if the outfit is paid for the shade itself even hath departed.Should the war terminate now, militia surgeons will, I fear,,have only their loyalty and patriotism for their reward, andmany will have cause to regret leaving a comfortable homeand safe practice for the honour of mounting a cocked-hat.

I am, Sir, your obedient servant,London, March 12th, 1856- ANOTHER MILITIA SURGEON.

CHLOROFORM.To the Editor of THE LANCET.

SIR,—The following case, in which chloroform was admi-nistered, may be interesting to your readers, and not withoutsome utility, as illustrating the unfavourable symptoms thatmay supervene during its administration, and the means tobe used to prevent any fatal consequences when they do occur.

I was requested by Mr. Tuson to administer chloroform to a,lady on whom he was about to operate for cancer in the breast.The patient, aged thirty-six, was of a lympathic temperamentand an unhealthy diathesis, which had been increased by theuse of stimulants to allay pain. The pulse before the operationwas low and feebie, with general prostration.On the exhibition of the chloroform, the patient immediately

evinced great distress, followed by strugglings, spasmodic con-tractions of the limbs, and such symptoms as generally occurin the administration of ether. Indeed, when anaesthesia wascomplete, there was not at any time that quiet, placid uncon-sciousness that usually characterises the effects of chloroform.

The tumour was quietly removed by Mr. Tuson, the ligaturestied, and the inhalation discontinued. During the operation,the pulse did not vary. Upon a minute inspection of theparts before closing the wound, Mr. Tuson discovered a secondthough very small induration, which he considered necessaryto remove. As consciousness was fast returning, I poured asmall quantity of chloroform on a sponge and administered it,requesting Dr. Bell, who was present, to be kind enough towatch the pulse. Anaesthesia, was not complete during themomentary removal of the tumour, and much struggling andpain were evinced. Scarcely was this completed, than thepulse suddenly fell, followed by spasm of the jaw, and otheralarming symptoms. The application of the strongest ammoniato the nostrils failed for a minute to relieve the spasm, andrepeated doses of stimulants were necessary to restore thepatient. The practical conclusions I would draw from theabove case, are these-First, that whenever the patient is ofan unhealthy diathesis, or accustomed to take stimulants, theintensity of the inhalation should never be increased afteranesthesia is complete, but the effect kept at a uniform rate.Secondly, to avoid, in all similar cases, a second inhalation;but where, as in the above case, from unforeseen causes, thiscannot be avoided, then to keep a vigilant watch over thepulse, as there will seldom be any other indication of theeffects about to supervene.—I remain, Sir, yours, &c.,

W. H. MORTIMER.