Dislocation of the elbow, if attended to quickly after the accident, may often be easily reduced by seating the person in a chair, carrying the arm well behind the back, and pulling, not very forcibly, from the fore-arm.

Both these dislocations of the wrist and elbow-may be suspected, when, after violence-particularly such as is calculated to push either the hand or lower arm upwards-inability to use the limb below the seat of the injury, and distortion and impaired motion of the joint, are unaccompanied with any grating sensation, such as occurs when bone is fractured.

Dislocation of the shoulder is most generally occasioned by violence applied to the elbow, or by falls, whilst the arm is not close down to the side of the body. Sometimes the exact discrimination of an injury to the shoulder joint is a matter of much difficulty, for fracture alone, or fractures with dislocation, may occur. At other times, particularly in thin persons, it is tolerably easily made out, more so if the examination is made before swelling comes on. In addition to the general symptoms of dislocation already enumerated, the injured shoulder will be perceptibly altered in shape; it will appear more depressed and flatter than the sound one, and if the hand is placed upon the spot which ought to be occupied with the round head of the armbone-and this may be discovered by examination of the uninjured shoulder-it will be found hollow, and further, if the arm be now gently moved about, and its bone traced up towards the shoulder, it will be found moving in some unusual position, most probably in the arm-pit. Supposing, therefore, that the case is sufficiently clear, and that the sufferer from the accident, in the absence of proper surgical assistance, is content to risk the matter upon non-professional judgment, or that from having been the subject of the accident on some previous occasion, he is tolerably certain of its present nature;、 the means for the reduction ought to be set about as speedily as possible, if it can be, whilst faintness from the injuries continues. These means vary considerably; hanging over doors or gates, the arm-pit being placed on the edge, have been employed and recommended; and in persons who have been the subjects of frequent dislocations in the same shoulder, may be efficient, but in a first dislocation should never be resorted to. One frequently-used method of reducing dislocation of the arm-bone into the arm-pit, is for both patient and surgeon to lie down upon the ground side by side, but with their

heads different ways, and so that the surgeon having previously taken off his boot, can place his heel in the arm-pit of the patient, whilst he grasps the hand, or a towel fixed to the arm of the affected side; in this way, whilst the heel is used to push against the displaced bone in the arm-pit, it, combined with the traction exerted by the surgeon upon the limb of the patient, tends to give a leverage by which the bone is so placed, that it can be drawn into the socket by the muscles. This method may be a convenient one, when only one person is in company with the individual to whom the accident has happened. The following is the most generally useful and most resorted to mode of reducing dislocation of the shoulder: The patient being seated on a chair, a large towel or a table cloth, folded broad, is to be passed round the chest, close under the arm-pit of the affected side, crossed over the opposite shoulder, and held either by a strong assistant or fastened to some fixed point. By this application, the shoulder blade is fixed, the arm itself is then to be pulled, chiefly in the direction in which it has been fixed, firmly, steadily, and slowly; this being done, either directly by the hands of assistants, or by a towel fastened round the arm by the hitch-noose-fig. B. If when this steady pull has been persevered in for some time, the displaced bone does not get into place, the effect of suddenly taking off the attention of the patient may be tried, either by some sudden exclamation, or by dashing a little cold water in the face. By such a proceeding, the muscles which resist the reducing or pulling force applied to the arm, are for a moment, so to speak, thrown off their guard, and that moment may suffice to permit the bone to pass into its socket.

Dislocation of the lower jaw is not a very unfrequent occurrence, and happens from persons opening the mouth very wide, either in laughing or gaping; the jaw slips, and its joint portions or articulations on both sides are drawn forward; the person cannot close the jaws, but remains with the mouth wide open, a most inconvenient position should skilled assistance be far distant; the accident, however, can scarcely be mistaken, and may be rectified without much difficulty by a bystander. For this purpose, the thumb or thumbs, according to whether the joint is entirely dislocated or only on one side, are to be placed by the acting party upon the upper portions of the back teeth, and strong pressure exerted downwards, whilst the chin is drawn upwards by the fingers at the same time. As the jaw returns to its place, its powerful

muscles draw it upwards with a sudden snap, and if the fingers of the operator are not covered with a handkerchief or some other material, they may get smartly bitten. After dislocation of any part has occurred and been reduced, a bandage or some application which will confine the injured members should be worn for some days, not simply from fear of the accident recurring at the time, but to keep the parts, which must have been more or less lacerated, quiet, and to permit the internal traces of the injury to be as much as possible obliterated. In conclusion, although the subject of dislocation has been dwelt upon at some length, it is chiefly for the reason that these accidents, painful at the time, and, if unremedied, productive of deformity and impaired usefulness for the future, are often overlooked, or are apt to occur at great distances from skilled assistance. In such cases, the information given in the foregoing article, may, either by directing attention to the importance of the injury and of its speedy rectification, or, if acted upon with care and prudence, by pointing out the most effective treatment, prove a useful guide.

Refer to Joints-Muscles, &c., &c.

DISORDERED FUNCTION,-a term very frequently used in medical language, means departure from the usual healthy action of any portion of the body, either unaccompanied with perceptible change of structure, or as a consequence of altered structure of the part.

author has found the two first on the listbroom and dandelion-as certain, or more so than any others, and, as domestic remedies, they have the advantage of being easily procurable in this country, and of being perfectly safe. Fluids should be given freely during the action of diuretic remedies. It sometimes happens, that diuretics which would not act before, act after the administration of an active purgative. Similar effects are found in the hands of medical men, before and after bleeding. As mentioned under the article Coffee, the infusion of the raw berry is diuretic. Mental emotion such as fear, and nervous disorders such as hysteria, it is well known, give rise to great increase in the flow or urine.

Refer to the various separate' articles, for the uses, &c., of the diuretics mentioned. DOVER'S POWDER-is a compound of one grain of opium, one of ipecacuanha, and eight grains of sulphate of potass, powdered well together: ten grains consequently contain one of opium. It is much used as a remedy to produce perspirationin which, however, it often fails-and in cases generally where opium is requisite. The ipecacuanha may occasion sickness. Refer to-Opium.

DOUCHE-is a stream of water directed

upon a part of the body, and "is most fre quently performed while the patient is in the bath. Douches are of various kinds, as the descending, the lateral, and the ascending-the water in the first kind falling from a reservoir, at a greater or lesser height upon the patient in a single or divided stream, the size of which may be varied according to circumstances. The lateral douche is produced by a man's pressing the water through a tube, as with a fire-engine, the stream being directed against any part of the body that is indicated. The strength of this can be regulated by the attendants pumping with a greater or less degree of force, and also by a finger placed over the aperture by which the stream is divided. In the ascending douche, the column of water is directed upwards, and is usually taken in a sitting posture; this douche being almost exclusively employed in complaints of the organs contained within the pelvis.

"Douches are directly exciting remedies, and are mostly used to produce a greater degree of vitality and activity in parts, as in cases of local debility, scrofulous swelling, muscular rigidity, paralysis, contracted joints, neuralgic pains, &c. They are mostly administered while the patient is in the bath, and are often advantageously com

There is always some degree of uncertainty in the action of diuretic medicines, but with some more than others. The

DRAINAGE-is the important process by which superfluous moisture is removed from the soil, through the soil itself, or by means of channels made in or through the earth. It may be either natural or artificial; to carry off the simple excess of fluid resulting from atmospheric moisture, such as rain, or to remove the impure and deteriorated fluids, which more or less result where man and the domestic animals are congregated.

The salubrity of a district is always closely connected with its natural drainage; whenever moisture accumulates, either from position, that is, want of inclination or lope to run it off, or from the nature of the soil, disease is apt to prevail. Professor Ansted* remarks, "There can be no doubt that the district where sand and gravel allow the water to drain off at once beneath the surface, and that where hard and impermeable rock permits the rain to escape readily into the nearest running stream, will be on the whole the most healthy; while, on the other hand, that in which the tough clays retain the water in ponds on the surface will be exposed to marsh fevers and various disorders affecting the throat and lungs. These remarks apply chiefly to temperate climates, but when the conditions of vegetation are taken into account, they are no less true than important for warm countries, where the rankness of the vegetation must no doubt be connected with the nature of the sub-soil over which it grows."

Britain in which it formerly prevailed, a circumstance which can only be accounted for, by the increased attention to the drainage of those districts. As might be expected, low situations are not likely to be so well drained as those situated on elevated ground; the latter does not, alone, however, suffice in all cases if the drainage is improperly managed, and some of the worst local forms of typhus have been known to prevail in such places.

The drainage of houses or collections of houses, where day by day there must be removed the excretions, both solid and fluid, of man and animals, is one of the most important points connected with the preservation of health, it might almost be added, and one of the most neglected ones. Both in town and country, the necessity for sufficient drainage, whether of the natural moisture of the soil, of the results of animal life, or of domestic habits, has been, if not entirely overlooked, most insufficiently provided for. It might shame the boasted civilization of our era, to learn that in Mr. Layard's researches in Nineveh, he found the buildings-of an age estimated at 1200 years before Christ-provided with a complete system of sewerage. Each room had a drain connected with a main sewer.

It is generally thought, that in the country less necessity exists for perfect drainage than there does in large towns, and to some extent the idea may be correct, in so far, as the less number of individuals collected in a given spot, and the freer circulation of air, must tend to preserve greater purity of atmosphere; but the idea, by lulling suspicion has proved a dangerous one, and the single homestead, or small isolated hamlet, has been desolated by the scourge of fever, which a little precaution might have prevented. One most striking instance has been recorded by Dr. Christison, which occurred in and close round a farm-house occupied by an extensive farmer, in “a thinly-peopled rural district in Peebleshire.' With respect to situation, Dr. Christison, after describing it, concludes with, "a healthier locality could not well be chosen; and yet, in and close to this healthily-situated house, and in no other in the district, fifteen cases of a severe and peculiar form of fever occurred within the space of a few weeks, and three proved fatal. Such a well-marked visitation could not well escape searching investigation, which brought to light the fact, that the house was completely surrounded by drains, which had, in the course of time, become filled up with the drainage of the farm-yard, of the necessaries, &c., &c. Such cases are

These considerations are important for all, and especially for the emigrant and settler in new districts, who ought always to fix, if possible, upon a site for his dwelling, where the water has or may be made to have an efficient drainage in every direction and way, and to exercise caution also, that the dwelling of himself and family is not so placed that any generally prevailing wind can blow upon it from a marshy or badly drained tract of country. The effect of draining the soil, in rendering a country more salubrious, and in removing disease, is well exemplified in the disappearance of ague from many parts of

* Professor of Geology, King's College, London.

by no means uncommon, even in country situations which would be at a first glance esteemed most salubrious, and indeed would be, but for the shameful neglect of the inhabitants. The author cannot recollect during ten years' practice in a rural district, any invasion of fever going through a house or collection of houses, which has not been traceable to deficient drainage, and neglect of sanitary measures generally. It is not fever, however, as generally so called, which alone occurs in consequence of deficient drainage, but bad health generally; and whatever case of disease or accident may remain within the tainted locality, acquires a certain unfavourable tendency and type; even recovery from child-bed is affected by it, and perhaps more cases of child-bed fever and death than would be imagined, might be traced to the unhealthy influences originated by habitations situated in a badlydrained locality. Surely this last consideration, if no other, might rouse men to act: the point touches the wealthy citizen as well as the poor one.

Inflammation of the eye, or rather of its covering membrane, the "conjunctiva," has been found occurring commonly in particular localities, no cause being assignable beyond that of stagnant and putrefying ditches or unwholesome drains. The contamination of wells which supply water used for drinking and cooking, by badlyarranged or imperfect drainage, is a very fertile source of disease; many of the worst invasions of fever, and cholera also, have been traced to this disgusting source.

Whatever has been said respecting drainage in country places, applies with increased force to the provision in towns, with their dense populations. On this head, Mr. Grainger, in his pamphlet published by the "Health of Towns Association," remarks, "The most prolific source of disease in towns is, certainly, defective drainage and sewerage. Where large numbers of human beings are collected together, it is apparent that there must result a vast amount of refuse matter of every description, to which must be added, the solid and fluid excretions of the body, the former of which alone, amount, in a town like Liverpool, to nearly six thousand tons annually.'

The first essentials for proper drainage are, well-constructed sewers, that is such as will not promote the deposition of solid matter in their interior. That the majority of the old sewers and drains do this has been proved before the Health of Towns Commission. It was shewn, that "by their unnecessary size and defective form, most of the old sewers being flat at the bottom,

they cause a retardation in the flow of their muddy contents, and thus, of necessity, produce a lodgment of putrefying animal and vegetable matter. Another source of deposit is the improper direction of these conduits, the sharp angles and curves of which, especially where the smaller sewers enter the main trunks, lead to obstruction, and to these must be added the various irregularities of surface connected with the masonry.' Again, drains are frequently placed too near the surface, and leave the under-ground premises either undrained, or, what is worse, receptacles for their leakages should they get out of order; then the most superficial drains of all, the gutters, are full of holes and crevices; the entire system, including the gratings over the under-ground drains, being calculated rather to foster disease than to remove the causes of it. In addition, however, to construction, a full supply of water is requisite, one that can thoroughly and periodically, at not too distant intervals, be sent in full volume "flushed"-through the passages so as to sweep everything before it.

;

One gentleman, Mr. Guthrie, examined before the Health of Towns Commission, gives the following important points of evidence: he says, "My attention has been more especially directed to private drainage, or the sewerage of individual tenements for I am satisfied the public health is more deleteriously influenced by the exhalations which arise from pent-up matter in them, than by those which issue from the great main or common sewer. I hold every system of flushing to be imperfect which merely hurries along the contents of the principal or main sewers, while the putrefying débris of inhabited tenements is left undisturbed in house drains. The reason why house drains act so imperfectly, that they frequently get entirely choked up, is simply because their too limited supply of water is spread over so great a surface that its power to carry along matter in suspension is lost.

Choking from accumulation seldom takes place in the small iron or lead soil pipe, neither would such a circumstance ever take place if the calibre of the tube or drains intended to carry off the soil, were not made so great, that the usual allowance of water is unequal to the task of washing out its interior. "The tubes made for housedrains should be circular, and not more for any ordinary tenement than from three to six inches in diameter. The form of main sewer most recommended by those who have paid much attention to the subject, is the oval-fig. A-or with a lesser curve at

It is calcu

bottom than at top-fig. A 2. lated that this latter form "gives full action to the water at the time it is most needed, namely, when the quantity is smallest. Drain tiles or bricks may be used to form these oval sewers; but tubes in moderate lengths are most strongly recommended. In addition, it is advised that whatever materials are used for drains should be glazed in the inside, as tending less to promote deposition of solid matter, and also being more easily cleansed. Sufficient fall for the fluid is of course requisite for a complete drain.

Effluvia are very apt to escape from drains "by the improper position of the gully gratings, and from these not being trapped. By improper position is meant the top of an eminence, where no surface water can properly accumulate." Gratings and gullies are therefore injurious in such situations; and, indeed, should only be placed where absolutely necessary to carry off surface water, which will clear them out; and they should be trapped. The inmates of houses close to gully holes have been known to be attacked with fever which could in no way be accounted for, except by the emanations proceeding from the sewers through the gratings.

Lastly, all those parts of a house which are connected with sewers and drains, such as water-closets, sinks, &c., ought to be so constructed that they do not allow effluvia to escape. This may be simply and cheaply done by means of earthenware soil-pans, with syphon-pipes, as represented-fig. Bin which the stratum of water-fig. B. 1.which always must remain in the lowest part of the pan, acts as a valve against all effluvium from the pipe-2. Where a sink is not attainable, a simple funnel-like pipe, with a cover-fig. C.-may be fitted into the floor, and made to lead into the drain. The subject of drainage generally, is so important, and its connection with health is so intimate, that it might be extended to

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a much greater length than the limits of this work will admit of. Enough, it is trusted, has been said to direct attention to it, and those in whom a spirit of inquiry has been excited, and who desire more extended information, cannot do better than seek it in the valuable and cheap publications of the Health of Towns Association.

DREAMING is the wakeful and sentient condition of some of the faculties of the mind, whilst the others are asleep. The whole subject of dreaming is highly interesting in a psychological point of view; but it is only in its connection with the body that we have here to do with it. Some persons naturally dream more than others; but there is no question, that the occurrence and more particularly the nature of dreams are both much influenced by the condition of the body. Few are so fortunate as to have escaped an attack of incubus, or nightmare, arising from disordered digestion; and all who have been much with children, know well how liable they are to suffer from disturbing dreams, whenever the stomach and bowels are disordered. It may be safely asserted, that a large proportion of uncomfortable dreams are connected with disorder of the digestive functions generally over