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-No. 4.] LONDON, SATURDAY, JAN. 29, 1825. [Price 6d. SURGICAL LECTURES, DELIVERED BY MR. ABERNETHY. Theatre, St. Bartholomew’s Hospital. LECTURE 16. On the union of Wounds by Adhesion. GENTLEMEN, IN the latter part of my last lec- ture I was speaking of the injuries done to the living body by mechanical causes, and I said, that parts very much torn and injured by violence being done to them might, by approx- imating their surfaces, be made to unite. This union by adhesion, or union by the first intention, as the old surgeons named it, is a subject of great importance in the practice of surgery. Even parts that are com- pletely divided may be made to ad- here again, and to grow, but such parts never properly recover the feel- ing and functions which they possessed before. I am satisfied that the de- gree of sensibility in such parts is always imperfect, and the power of motion, if the part divided were mus- cular, is not restored to the extent which it before possessed- So well convinced are surgeons that parts will unite, and not only that the severed part naturally connected to the other parts will unite, but also that portions of skin taken from dis- tant parts of the body will unite to each other, that they have been in- duced to manufacture new noses, in the way which TALIACOTIus recom- mended ; but I never saw one of them yet, that could be said to be equal to a pasteboard nose. I remember a man who came to this hospital, whilst I was an apprentice, who had chop- ped off the top of his finger; he brought the part which had been di- vided in his pocket; the surface of it was washed very nicely and was- placed accurately upon the part from which it was removed; it adhered, the circulation was restored in it, but it was a very long time before the sensibility, or power of moving it, returned. The parts newly united have an unpleasant, jarring feel for a long time afterwards ; if rubbed or struck, there is great uneasiness, and frequent pain produced; the parts do not ap- pear to possess that share of the dis- tribution of the nervous energy as the other parts of the body. I once tried the experiment upon myself : I was cutting a piece of cheese, the knife slipped, and I sliced off a piece of my thumb : I went out of the room, and thought I would try what could be done by replacing it; I replaced it very nicely, bound it up with a piece of string, and it united-united per- fectly, but I almost regretted after- wards that I had attempted it, for there were such unpleasant sensations in the part, produced by such trifling causes, that I would rather have been without it almost than with it. The part shrivelled and contracted in wrinkles, and I have the mark of it to this day. Still, however, it is very usefully applied in the practice of sur- gery, is this power of uniting parts by adhesion. A new lip may be formed from the skin under the chin, and really this is a very important and useful substitution, both in the pro- cess of mastication and for the pur- poses of speech. A gentleman of this town cut out a piece of the integu- ment from beneath the chin, just of the size he thought would do for the lip; he fitted it very nicely iuto a
Transcript

-No. 4.] LONDON, SATURDAY, JAN. 29, 1825. [Price 6d.

SURGICAL LECTURES,DELIVERED BY

MR. ABERNETHY.

Theatre, St. Bartholomew’s Hospital.

LECTURE 16.

On the union of Wounds by Adhesion.

GENTLEMEN,IN the latter part of my last lec-

ture I was speaking of the injuriesdone to the living body by mechanicalcauses, and I said, that parts verymuch torn and injured by violencebeing done to them might, by approx-imating their surfaces, be made tounite. This union by adhesion, or

union by the first intention, as the oldsurgeons named it, is a subject of

great importance in the practice ofsurgery. Even parts that are com-

pletely divided may be made to ad-here again, and to grow, but suchparts never properly recover the feel-ing and functions which they possessedbefore. I am satisfied that the de-

gree of sensibility in such parts is

always imperfect, and the power ofmotion, if the part divided were mus-cular, is not restored to the extentwhich it before possessed-So well convinced are surgeons that

parts will unite, and not only that thesevered part naturally connected tothe other parts will unite, but alsothat portions of skin taken from dis-tant parts of the body will unite to

each other, that they have been in-duced to manufacture new noses, inthe way which TALIACOTIus recom-mended ; but I never saw one of themyet, that could be said to be equal to

a pasteboard nose. I remember aman who came to this hospital, whilstI was an apprentice, who had chop-ped off the top of his finger; hebrought the part which had been di-vided in his pocket; the surface of itwas washed very nicely and was-

placed accurately upon the part fromwhich it was removed; it adhered,the circulation was restored in it, butit was a very long time before thesensibility, or power of moving it,returned.The parts newly united have an

unpleasant, jarring feel for a longtime afterwards ; if rubbed or struck,there is great uneasiness, and frequentpain produced; the parts do not ap-pear to possess that share of the dis-tribution of the nervous energy as theother parts of the body. I once triedthe experiment upon myself : I wascutting a piece of cheese, the knife

slipped, and I sliced off a piece of mythumb : I went out of the room, andthought I would try what could bedone by replacing it; I replaced it

very nicely, bound it up with a pieceof string, and it united-united per-fectly, but I almost regretted after-wards that I had attempted it, forthere were such unpleasant sensationsin the part, produced by such triflingcauses, that I would rather have beenwithout it almost than with it. The

part shrivelled and contracted inwrinkles, and I have the mark of it tothis day. Still, however, it is veryusefully applied in the practice of sur-gery, is this power of uniting parts byadhesion. A new lip may be formedfrom the skin under the chin, andreally this is a very important anduseful substitution, both in the pro-cess of mastication and for the pur-poses of speech. A gentleman of thistown cut out a piece of the integu-ment from beneath the chin, just ofthe size he thought would do for thelip; he fitted it very nicely iuto a

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grooved edge which he had cut to re-ceive it, twisted it about, and it unitedperfectly, although it was a long timebefore the sensation returned in thepart.Now the consideration of this sub-

ject shows the advantage which maybe taken of it in the treatment of in-juries done to the soft parts. Youshould bring the part; into their na-tural situations as near as you can,and if there be any hollow left, it willfill up by the second mode of union,namely, by granulation. I cannot

say that I like sutures, I would ratherbring the parts together by sticking-plaster, it appears to be the best modeof assisting the union of the parts.The extent to which parts will uniteby the adhesive process is really some-times surprising; I can give you aninstance of this : I removed a largeadipose tumour from the thigh of a

lady ; the length of the incision re-

quired for the removal of it, was fulla foot in length ; I brought the edgesof the wound together by sticking-plaster, but left an opening above antbelow for the exit of any blood whiclmight escape from the minute vesselsI placed the limb in that position irthe bed in which it might be retainecfor any length of time-gave direc.tions to the nurse that she shouldsponge the limb now and then with alittle water, whenever it felt hotterthan it should do, and gave her a

little aperient medicine, and so on, toregulate her bowels. There was nohæmorrhage, no feverish irritation,no swelling ; there was a sort of scabwhich formed over the edges of thewound; in less than a week I touchedthis scab over with a little mitd oint-ment, softened it a little, and it cameu-ff; I found that the wound had unit-ed throughout its whole length, ex-

cept in two places where there were

two little openings, about the size ofa pin’s head, but in a day or two morethese were closed as completely as theother part.

Hæmorrhage from Wounds.

You frequently have bleeding fromwounded surfaces, and the bleedingmay be considerable, although thevessels from whicli the blood proceedsare very small. It is of no use to put

up wounds, or to bandage wounds, ifthe bleeding continue, because you’ would have to open them again to

secure the vessels, and then you wouldbe placed just in the same circum-

stances as when you began. It often

happens that, after a trifling opera-’, tion, several vessels will require to besecured; the parts are brought into

contact, the patient is put into bed,haemorrhage occurs from the small

vessels, the wound is distended withcoagulusn, the straps of plaster give, way, and out it comes. Now the coa-

gulum of blood confined in this wayinvariably proves an irritant to the

part and tends to keep up the hæmor-rhage. Well, what is to be done?Thereis really very little to do ; youshould remove all the dressings, wipeaway the c-oa-ulum carefully, and ifyou see a vessel bleeding, secure it bya ligature. There are many vessels

which will not bleed on the surfaceof a stump at the time of an opera-, tion, but will afterwards cause great, trouble. I could tell, by putting myfinger over the surface of a wound,when I touched an artery, for thereis something peculiarly hard and re-sisting in the structure of an artery,when compared with the other parts.Wash the surface with a sponge anda little warm water, and if it willbleed at ail it will then. Patients aregenerally cold and chilly for some

time after an operation, therefore youshould apply some warm water to thesurface of the wound to see if anyvessels there are disposed to bleed,for after the patient is put to bed andgets warm, redaction is established,and then you might have troublesomehaemorrhage. Surgeons are greatwound-makers, and therefore,theyshould be very careful and anxious topromote the healing of wounds also.I will tell you what the German sur-geons do ; they think so little of hæ-morrhae, that they say they hardlyever need to put a ligature on a ves-

sel ; they stop the haemorrhage byapplying’ could ; they often put ice tothe surface of a stump to check thehaemorrhage, but there is somethingin that which I do not like; I do notsee that we have any right to take thelaw in our own hands and reduceparts below their natural temperature.They leave the stump naked, exposed

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to the air, after the haemorrhage hasceased, for ten or twelve hours, oruntil the face of it becomes coveredwith a gelatinous matter, and then theybring the parts together, and theyunite; there is no fear of haemorrhageafterwards ; there is a natural gluealready prepared to unite the parts.But I do not see why we should leavethe parts exposed so long ; it may be;said that the exposure prevents thehaemorrhage, but I will undertake tosay, that if the following practicewere adopted there would be no suchdanger.

I should secure, certainly, the largerarteries with ligatures ; I should let thesmall ones bleed a little, and then theywould stop, but I would not dress thewound, and then carry the patient tobed; I consider this a very objection-able thing, for the mere movementnecessary to take him there would de-range the situation of the things onthe wound, and perhaps be the causeof producing haemorrhage. I wouldsecure the wound after I had put thepatient in bed and placed the limbjust in that position in which I intend-ed it to remain. I would put on thestraps of sticking-plaster so as to

bring the edges of the wound properlytogether, but I would leave opening’sabove and below for the escape of anyblood, if it should be effused. I havealso used a varnish over the adhesive

plaster, a solution of sealing wax inalcohol, and the mode of applying thisI have described in the 11 SurgicalObservations." If you do not allowthe blood to find its way out, the coa-gulum separates the sides of the wound,and keeps up an irritation and pre-vents the union of the parts bv ad-hesion. If you do this, and take carethat there be no accumulation of heatabout the part, by the proper regu-lation of temparature, and avoid anycauses of irritation to the system, Iwould engage that the wound shouldheal very well.

This reminds me of a subject whichI should have spoken of when con-sidering Ulcers, namely,

Hæmorrhage from Ulcers.Hæmorrhage may take place from

ulcers as well a’9 from wounds, and itis produced by two causes; a sort of

; increased action is established, whichproduces a haemorrhagic dispositionin the newly-formed vessels of thepart; and bleeding also occurs fromthe complete relaxation, or weaknessof the vessels. Various methods havebeen recommended for the purpose ofrestraining such hssmorrhage ; theyhave advised the use of styptics andpressure, and so on; but as to styp-tics, I do not like them, they are irri-tating applications, and frequently domore harm than good. When it arisesfrom the first cause, lessening thetemperature of the part wilt generallysucceed, and give at the same timesomething to act on the bowels; youwill fit;d that the hæmorrhage willcease. Mr. HUNTER relates a case inwhich there was hæmorrhage froman ulcer ; he thought the sore had anirritable appearance, and that if itwere soothed, and the irritation allay-ed, that the bleeding would cease ; onthis principle he applied a poultice tothe wound, and the bleeding did cease.Then as to pressure; 1 do not likethe idea of pushing a foreign bodyinto a wound to suppress the bleed-ing, but if it should arise from someinjury done to a large vessel at thebottom of the wound, I should allowit to be very necessary to secure it.There is a haemorrhagic disposi-

tion, and I dare say many of you willsmile at what I am going to say; thereis a hæmorrhagic disposition connect-ed with, and dependent upon, thestate of the digestive organs; I’ll behang’d if it be not so. (A laugh.) Youall know what a great influence thestomach has on the heart and largevessels ; well, it also exerts a very greatiufluence on the capillaries. An irri-tation in the stomach will excite theheart’s action, and that again exertsitself on the minute vessels. A ladyconsulted Mr. HUNTER for a vomitingof blood ; she had frequent returns ofthis complaint, and she was deter-mined to hear what he had to say;she described the nature of the com-

piaint, which was merely that whichI tell you. He asked her if she hada sort of premonition, or had any pe-culiar sensation about the stomach, bywhich she could tell when this vomit-ing of blood was to happen; she saidshe had; that she felt an uneasinessand fulness, accompanied with irri-

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tation of the stomach. He consideredthis, and advised her to drink, when-ever she thought the complaint comingon, a tumbler of tepid water. Tepidwater, you may say, was a very sin-gular remedy; (he did not mentionthat he advised her to do any thingelse, but I take it for granted that heordered something to keep her bowelsregular;) it produced the effect whichMr. HUNTER intended; it allayed theirritability of the stomach, and shenever had another return of the dis-ease.

There is a case recorded in theMedical Journal, by a man who hadno theory to support ; it is the case ofwhat is called 11 The Bleeding Family."The gentleman states, that if one ofthem pricked a finger he could notstop the haemorrhage, nor from a

slight bruise or injury. At last hefound out, that nothing answered sowell as giving them a purgative, andhe said, that he afterwards alwayssucceeded in stopping it by this mea-sure. Does not this show that it isa state of the capillaries very muchdependent on the state of the nervoussystem, which is influenced very muchby the condition of the digestive or-gans. I am convinced of the truth ofwhat I tell you, but I do not wishyou implicitly to credit any thing which II may say, but exert your own un-derstandings, and if you think thatwhat has been said is not reasonable,then do not believe it. I wish thisClass, and every member composingit, to be,-" Nullius addictus jurare in verba

magistri,"but to exercise their own judgments,and have what I say either confirmedor refuted by their observation andexperience. So much for haemorrhagefrom ulcers ; I have pointed out thefrequent cause of this disease ; andI have told you frequently how to re-medy it.Here again is a great chasm pro-

duced in the series of subjects whichare usually treated of in a surgicalcourse, but the diseases and accidentsof the larger arteries, and the modeof securing them under different cir-cumstances, are considered in the ana-tomical course, with the diseases of

many other parts; therefore little ornothing remains for me to say of themhere.

Reverting to the injuries producedin the body by mechanical agency,I may next speak of the accidents towhich bones are liable, and shalltherefore say something about

Fractures.

Bones, like other parts of the body,are frequently injured; the earthymatter is often broken through, andthe soft parts of the bones, the sentientand vital parts, suffer laceration ;there is, in fact, in every fracture alacerated wound produced; but fromthe vitality of the part being low,much less inflammation and constitu-tional re-action follow than in lace-rated wounds of other parts. You

bring the divided parts together asneatly as you can, and the woundunites as any other wound would do;if the parts are lying in contact theybecome united by an organised me-dium, and after a time the earthy mat-ter is deposited in this uniting medium,and the strength of the former struc-ture is restored; but if the parts benot lying in contact, the space is filledup with granulations, a deposit of

earthy matter takes place, and theunion is accomplished in the sameway.

But there is a peculiarity in thebones of young’ people ; there is littleearthy matter in them in proportionto the soft matter ; the lime consti-tuting the solidity of the structure

may be broken through and yet thesoft parts not divided. You may bendthe bones of children very much with-out fracturing them ; and this inducesme to state a case which may be use-ful for you to attend to as young’ men :A child may be running, across a car-pet and fall down, with his thigh bentunder him ; he is taken up by hismother, or nurse, but it is found thathe cannot stand ; you may be sent forto examine the leg; you feel it over,but you do not detect the usual signsof fracture ; there is no crepitusproduced on twisting’ the limb about,and perhaps it is not much displaced.Well, you are asked what you thinkof it, and perhaps you may say, (11 1

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think it is only’ a sprain, madam, andI will send you some Goulard wash,and you are to wet some linen ragsand apply to the part." The childbecomes restless and uneasy, andtosses himself about; the thigh be-comes painful and swollen ; it is clearthat your Goulard’s wash is not doingall that should be done. The friends,perhaps, are dissatisfied, and call inanother person, and he being betteracquainted with these sort of thingssays, " Whether the limb lie brokenor not, a state of rest is necessary forthe recovery of the part, and the childmust be kept in bed." He very pro-perly applies a splint to steady thelimb, and gives strict injunctions thatthe child shall be kept quiet in bed ;he may direct the wash to be kept onthe part, and now it does good. The

swelling subsides, the pain goes away,and in about a week there is nothingleft of the swelling.

I mention this to you to put you onyour guard when you are called toinju-ries received by the limbs of children ;for a case like that which I have justrelated would operate very much to thedisadvantage of a young practitioner.A state of rest is necessary for therestoration of the part; the union of afracture can never take place unlessthe parts be kept perfectly quiet, andtherefore you should never in anyway" aid, assist, or abet" in removingthe patient from one place to another,or sanction any such proposals. I re-member once I was fool enough my-self to be overcome by the importuni-ties of a patient who had a compoundfracture of the leg ; he had been inbed about six weeks ; but stilt the leg,he said, felt very weak, and he wascontinually saying to me, " Oh ! Sir,if you would only allow me to get onthat sofa, (pointing to one near hisbed,) I should be much more comforta-ble than 1 am here, I have been in bednow six weeks. " I was prevailedupon, I say, to " aid, assist, and abet,"in removing him from the bed to thesofa, and I never regretted doing sobut once; the leg became uneasy, in-flamed, the fracture again disunited, i

and he had to go through the sameconfinement again.

Fractures will unite if the parts beput in their proper places, without

pain, without swelling, or any un-

easiness ; of course I am speakingof the simplest form of these accidents ; ;and if you will only let these aloneyou will find that they will go on verycomfortably. The older surgeonswould never allow a limb to be open-ed after the fracture had been onceset; Mr. POTT would say very often,in going round this hospital, to a pa-tient who had fracture of the leg, ‘ Isthe limb easy to you ?" If the man saidyes, then he would reply, do not letit be disturbed ; and he never allowedhis patients to be looked at under amonth, provided the limb remainedeasy. But I do not see the necessityfor this ; I see no harm in looking ata limb, and satisfying ourselves that itis all right.Nothing appears more absurd to

me than the rules and directions whichwere formerly given in surgical booksabout the setting of fractures ; theyspoke of extension, counter extension,coaptation, deligation, and so on, andof the various powers to be used forthe accomplishment of all this non-sense. I say it is absurd and nonsen-sical, for if you only treat the injuredpart with kindness you may do whatyou will with it. It was said, thatgreat force was necessary to overcomethe power of the muscles, but I saythere is no such necessity; the resist-ance which they are capable of mak-ing has only a determinate existence,and then you may do what you please ; ;it is seldom a difficulty of more thantwenty four hours’ duration. Spasmsof limbs are sometimes very severe,that I own; and it is said, that, tocounteract these you must give opium ;I do not coincide with this exactly,for the patient after having takenopium, will awake with violent twitch-ings very frequently, and disturb thefracture more than if he had takenno opium. 1 have known these thingsto happen so severely, that I have beenobliged to sit all night at the bed-sideof the patient to keep him from sleep-ing. There is a state of imperfectsomnolency induced by opium, whichhas a considerable effect upon thenervous and muscular power, and thespasms into which a limb is thrownafter awaking from the sleep procuredby opium is often very severe. Themanner iu which I should treat a frac-

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ture would be just this : I should havethe patient laid in bed, and the limb,resting on a splint, should be placedin that position in which it might re-main for any length of time. I shouldmake a gentle effort or two to replacethe limb, or at least to bring it as nearas I could into the natural positionwithout much effort. If I found themuscles pulling obstinately, I wouldlet it alone, place the limb on a splint,and then on a pillow, so that it mayrest easily. 1 should, in addition, justgive a little something to open thebowels. The resistance made by themuscles is, I say, seldom longer thanthe’period of twenty-four hours, andthen you may manage it as you please.When once you have got the limb intoits proper shape, the muscles will pre-serve it as pertinaciously in that po-sition as they before resisted your at-tempts at doing so. Nay, sometimesthey even assist in briuging the frac-tured ends of the bone into their pro-per situations. I have known manysuch cases, but I will tell you thefollowing :A medical gentleman was walkingacross the radm, he tripped over thecarpet, fell down, and broke his leg;he contrived to get -to bed, and withthe help of his assistant, he placed itin a tolerably easy position for the

night, and in the morning sent for me.I could trace the boundaries of thefracture very distinctly, it was a badfracture, a very oblique fracture of thetibia, and I tried gently to replace it; II brought it a little nearer to its pro-per situation than before, but therewas such a jerk made by the musclesof the calf of the leg, that I could notsucceed in putting it exactly as I

wished ; I said to the gentleman, yousee, Sir, that it would be no use to at-tempt to do any more to it now, letit remain as it is, as it does not give youmuch pain, and I will see you againto-morrow. I saw him the next morn-

ing, but the limb was so swollen thatI could not feel tltP edges of the frac-ture so well defined as before ; I feltit over however, and tried to restoreit to its natural position, and I found 4no difficulty in moving the limb thenfrom any resistance of the muscles, Ibut yet I did not get it exactly into 1

its place, of that am quite sure ; but Ias the swelling went down, I found

the leg was as nicely set as could, have been wished ; I am sure thel muscles did it, for I will swear I did

not. The fracture was united so

nicely that I would defy any man evento say that the leg had been frac-tured.

You are told that fractures are tounite at a certain time, that you mayknow to a day when to take off the

splints, and so on ; but nothing ismore ridiculous, in my mind, than to

attempt to say any such thing. Whattime do they allow for a fracture ofthe leg’ to unite in ? Four weeks; andwhat time is allowed for a frfléture ofthe thigh to unite in ? Six weeks. Oh !this is all fully, you cannot say whena fracture shall unite, for the rapidityor tardiness with which it is accom-

pIished depends on the constitution ofthe patient. I might tell you a casewhich will show you that it is so. A

gentleman of fortune happened to

break his leg when in the country, andthe surgeon who usually visited the

e house visited him ; he seemed to havedone every thing that could be done

in the management of the fracture,he applied the splints and bandages; very properly ; but the only fault inhis treatment was, that he was overt solicitous that the limb should be re-markably straight, and perhaps hemoved it a little too often. The’ gentleman remained in bed six weeks,but was satisfied that he had no power; in the limb, and in a short time afterhe came to Londan. He sent for meto see him at his town house, and thentold me the history of his case; hewas limping about on crutches, andcould not put that foot to the ground.I examined the fracture, and found ithad not united. Now, said he, " Sir,what is your opinion, what would youadvise me to do !" Really, Sir, said 1,it may appear very cruel advice to

say that you should go to bed againafter being there for so long a time,but upon my honour it is the best ad:vice I call give you. He objected tothis, and I said I was willing to see

what good could be done with thecrutches. I told him that the limbmust be kept perfectly steady, and ifhe moved about on his crutches to bevery careful of his leg. I secured thelimb as neatly as I could, I bandagedit, and put on Sharpe’s splints. H.

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went about six weeks after this to ahouse which he had at Clapham, andthere, unfortunately, in going into thegardeu, slipped his foot, and snap wentthe leg again ; he had, of course, thesame sort of routine to go through

again. ,

The bones of children, on the con- itrary, unite with surprising rapidity;sometimes a large bone will unite in aweek or ten days, aye I have evenknown them to do so in five. If achild break his leg, for example, orhis arm, you place him in bed, andput on splints to steady the limb, andthen the child lies as quiet as possible,and the nurse and muther are conti-nually saying, " Little dear, see howgood he is, he never moves, Sir, fromthe position in which we place him,from one end of the day to the other."Ah, certainly he is a very good littleboy to lie so quiet. This state of

things continues perhaps for about aweek, and then the tune is altered." There is no such thing, Sir, as keep-ing this child quiet," they will say, "heis continually moving about; we puthim at the upper part of the bed in themorning, and you see where he is now.The little rogue, what shall we do byhim?" (A laugh.) Do by him? why lethim alone; if he has crawled fromone part of the bed to the other, whatdoes this show but that he finds him-self able to get there. Now I saythat this shows a degree of intuitiveconfidence in the power of the partwhich had been injured. I may saythat it is a sort of animal consciousness,which enables a person to tell whenthe injured part is in a state fitted

again for use.Supposing that a man should have

broken his leg, and at the end of threeor four weeks he should ask you toexamine it and tell him whether thefracture had united or not : Why, youmight feel the part gently, and if therewere no motion, you might say it isnot worth while for me to break yourleg in trying if it be united, but I 1will tell you what you may do; you isay you feel the part strong, leave off 4

the splints, but keep yourself still inbed, and it cannot be any great pu-nishment for you to amuse yourself a i

week more by rubbing your leg upand down with your hand, and restorethe vigour of the circulation in it, i

’ draw it up and down a little everyday in the same place, and if it give; you no uneasiness, gradually increasethe extent of its motion, but do notput it to the gronnd. The time thatyou will employ in this way will notbe lost, for you will find that the

strength of the limb will be muchmore restored in a week’s disciplineof this kind than if you were to use

your crutches prematurely. I can tellyou a very curious case in proof of thepower of this animal consciousness ;I was told it by the gentleman himselfwho attended the patient. A ladysent for an eminent surgeon to visit apatient at her house that had brokenan arm ; the surgeon, nothing loth,for he knew he should be well paidfor his visit, went ; he found that thelady’s favourite monkey had fracturedhis arm, and at the particular solicita-tions of the lady, was induced to setthe arm, which he did very accu-rately ; he was one of the most expertmen in applying splints and bandagesthat I ever saw. The arm was thenplaced in one of the lady’s silk hand-kerchiefs, which was passed over theneck,and thus the arm was supported ina sling. Whilst the surgeon was doingall this, the monkey eyed him veryattentively, aye, egad! as if he weretaking lessons on the treatment offractures like a surgical pupil (a longlaugh), and when it was finished, offhe scampered on his three legs or

arms, or what you please, and nei.ther maid, mistress, or surgeon couldcatch him again for three weeks. Hewas seen every now and then holdingit up close to his side, and adjustingthe sling to make it comfortable; andas soon as the three weeks were over,he fancied that he could use his pawagain, and began to scratch the silkhandkerchief, and scratch he did tillhe got it quite off, and then rari aboutupon his four legs as before. I knowthat I do not always express to youvery clearly what is in my own mind,but I think that this is a very goodillustration of the feeling which I havecalled animal consciousness.There are many causes which pre-

vent the union of fractures, but I amafraid you will not be inclined to hearwhat I have to say on this subject to-night, and I shall therefore postponeit until my next lecture.


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