trochanter major, combined with fracture of the cervix femoris, often bears a strong resemblance to dislocation of the caput femoris.

"Whenever the fractured portions of the trochanter can be brought into contact, a crepitus will be produced which may enable the surgeon to ascertain the precise nature of the injury. But when, from the direction of the fracture, one portion of the trochanter has been drawn by the action of the muscles towards the great ischiatic notch, no crepitus may then be discoverable, a direct source of mistake will then arise from the positive resemblance of the fractured portion of the trochanter to the head of the femur, the former occupying the same place which the latter would do in dislocation; and if, with these circumstances, there should happen to be an inversion of the injured limb, the difficulty of the diagnosis must be considerably increased. This obscurity, while it affords a strong motive for extreme caution in such cases in our own practice, should at the same time teach us to be slow in citing a mistake in the practice of others, as proving either ignorance or inattention."

Mr. Stanley is nearly five years behind the level of professional feeling on this point. The fashion now is, to condemn the practice of your contemporaries, whether it is good or bad-and the more skilful they are, the more copiously you must pour on them the epithets of dolts, ninny-hammers, &c. This is the way to get on in the world. Mr. Stanley's ethics will never do for the 19th century! But to return to injuries of another kind.

Case. A woman, aged 60 years, fell on her right hip in the street. The limb was found slightly everted and shortened three quarters of an inch; yet it was moveable in all directions. The extremity of the shaft of the bone was in its natural situation, but behind the femur, and at a little distance from it, a bony prominence was discovered resting upon the ilium, towards the great ischiatic notch, strongly resembling the head of the femur. Various opinions were entertain. ed as to the nature of the accident-some considering it a dislocation, others a fracture. After a confinement of some months to her bed, the woman recovered sufficiently to walk with the assistance of a

crutch, and in this state continued till her death, three years afterwards. On dissection, Mr. Stanley found that there had been a fracture extending obliquely through the trochanter major, and through the basis of the neck into the shaft of the bone. The prominence mistaken for the head of the bone, was occasioned by the posterior and larger portion of the trochanter drawn backwards towards the ischiatic notch.

Several other cases are related from Mr. Stanley's practice, and some from that of others. He concludes by observing that, in many cases where the nature of the injury is doubtful, we ought to impose on the patient a strict confinement to his bed, for as great a length of time as if the fracture had been ascertained. The circumstances attendant on the accident should also be carefully investigated, as these are often our only guides.

5. ON THE NATURE AND TREATMENT OF TRAUMATIC TETANUS.

[By M. Le Pelletier, Chief Surgeon of the Hospital of Mans.]

The author of this Memoir appears to have been placed in circumstances favourable for the observation of facts and the investigation of phenomena-and he thinks he can offer something more positive, as to the nature and treatment of tetanus, than has hitherto been given to the public. M. Pelletier takes a course opposite to those who consider tetanus as an affection of the nervous system, and consequently as affording no appreciable physical lesions as the cause of the symptoms. He looks to the material and palpable alterations in the organs of the body, as the basis of our investigations. He asserts that, in all the dissections that have been made of well-marked traumatic tetanus in the Hospital of Mans, there were unequivocal traces of inflammation in the vertebral meninges, especially at the origins of the nerves, and during their course in the spinal column. Two cases are narrated as a preliminary step, the bearings of which will be readily seen.

Case 1. Nourri, aged 17 years, was seized, on the 16th October, with headach, fever, and pains in his joints, espe cially the hip-joints. After being a fort

night ill in this way, without any medical treatment, erysipelas came on the lower extremities. A physician was called in, and ordered leeches and blisters to the inflamed parts and cinchona internally. By these means the patient's disorder was increased, and he was sent to the hospital on the 2d December. He was now in a desperate condition, with symptoms of engorgement in the head-chronic peritonitis-and a kind of engorgement and 'induration of the cellular tissue of the lower extremities. We need not detail the treatment. The symptoms were meliorated, but, as the patient passed his urine and stools in bed, he became excoriated about the sacral region, ending in ulceration which ultimately destroyed life. But the most curious part of the history is the supervention of trismus, which made progress with the sacro-coccygeal ulceration, till complete opisthotonos was established. It was concluded, and perhaps with reason, that the disease was traumatic tetanus, from the extension of inflammation along the sacral nerves to the coverings of the spinal marrow. Our author had found copious general bleeding the most effectual treatment in other cases of traumatic tetanus; but here the patient was almost worn out with preceding diseases. Nevertheless, he ventured on venesection, which mitigated the symptoms, but did not arrest the fatal course of the tetanus.

Case 2. Pazon, aged 33 years, was much bruised by the falling in of a quantity of wood upon him, on the 18th May. He was immediately carried to the hos pital, and the bone of one humerus was found broken in two or three places, with a flesh wound above the elbow, produced by the broken bone, which there protruded. There was great pain and irritation at this part. High fever and inflammation followed, and the usual antiphlogistic measures were employed. Suppuration and partial gangrene took place, and, on the 26th, tetanus supervened. It is remarkable, if it be strictly true, that the tetanic contraction of the muscles commenced in the lacerated and fractured arm

extended thence to the pectoral muscles to the muscles of the jaw-and quickly destroyed life.

The

Dissection. The nerves of the brachial plexus were carefully examined. neurilema of the cubital and median vein was red and inflamed, and this inflammation was unequivocal in the envelopes of the spinal marrow and brain. It was remarkable that the inflammation was entirely confined to the left side of these envelopes, namely, to the side correspond. ing with the fractured arm.

Without indulging in extracts from our author's reasonings, we may observe that he comes to the conclusion, from the above and many other dissections, that tetanus is the result of inflammation-and that the inflammation has its seat in the neurilema of the nerves, and of the spinal marrow-particularly in the pia matral covering of this last organ.

From the above it will not be difficult to come to the therapeutical indications of M. Pelletier. If inflammation be the pathological character of tetanus, it follows, of course, that depletion, in its widest sense, must be the rational mode of treatment. Unfortunately, the depletive plan has too generally failed-but this failure does not disprove the pathology of the disease maintained by our author, and by several others, especially Drs. Sanders and Reid, in this country. It is wise to accumulate all the facts we can, upon such abstruse points of pathology as that now before us. It is on this account we have given a brief analysis of M. Pelletier's paper.-Revue Med. Nov.

1. ED. MED. & SURG. JOURNAL.

The race of medical periodicals cannot boast of high pedigree. But what they want in genealogy they make up in fecundity. There was a time, ('tis sixty years since,) when our grandfathers brought forth much less frequently than our grand-mothers-and when the sun paid a visit to all the signs in the zodiac, during each term of literary pregnancy! It was in that peaceful period the dynasty in question commenced, under the modest appellation of "MEDICAL COMMENTATORS"-for critics were not then known in medical literature. The ostensible object of our forefathers was precisely what is now alleged by their numerous progeny. "A scheme, better calculated for saving time in reading, and expense in purchasing books, is a concise view of the books themselves."Introd. to vol. i. Jan. 1773. Thus we see that our Caledonian ancestors had an eye to economy, even in those days.*

The dynasty of COMMENTATORS lasted 20 years and upwards, when, without any very apparent cause, it changed its title to ANNALISTS, (ANNALS of MEDICINE,) but still pursued its slow annual phases, returning with Christmas, or the new year, to add to the enjoyments of those festive epochs. The ANNALS continued from 1796 to 1805, when an impulse was evinced, that might well be deemed prophetic of what is now taking place, after a lapse of 20 years. Again the family name was changed-the publication was made QUARTERLY, instead of ANNUAL, and the Journal at the head of this article started into existence. It appears that, even then, it was customary to declaim against "the multitude of similar publi

* The Edinburgh Journal has sadly diverged from its original purpose. No one now expects any thing like an account of the medical literature of the day in the review department of that work.

+ Let those who startle at changes in the mode of publication, look back at the history of periodicals, and they will find changes enough. They will find that, in almost every instance, the change has been for the better, when the periods of publication were shortened.

VOL. VIII. No. 16.

57

cations." Where are the records of this multitude? The following sentence will explain. "All such periodical works, from the very nature and origin of them, have their periods of vigour and decay. They flourish, and they fade. They terminate, abruptly; or, after reaching a respectable old age, they are suspended. New ones arise. Their powers are rapidly developed, &c." And, we may add, they follow the fate of their predecessors, sooner or later! Gibbon tells us that, in the Byzantine empire, although the grave was dug at the very foot of the throne, the LATTER never wanted a tenant, however soon he was destined to descend into the gloomy habitation below! The dynasty of the Duncans has had a long and honorable career. The three series, spread over a space of half a century, have maintained a more uniform character, dignity, and respectability, than any work of the kind, in this or any other country. The cause of this uniformity was, doubtless, owing to the government of the journal being patriarchal, and, therefore, not subjected to perpetual vicissitudes in its editoria! management. The innumerable contributions to this work varied with the contributors-and although many able and erudite reviews are scattered through its volumes, we cannot say that the work, as a whole, has evinced any very powerful talent, or exuberant principle of vitality. Its original conductors have, we believe resigned-and how far its present Editors may enhance, maintain, or diminish the fame of this father of British periodicals, in an age when all the energies of the human mind are called forth, it is not for us to predicate.

No. 94.-JAN. 1st, 1828.

This Number of our Edinburgh cotemporary contains 13 original papers, occupying 118 pages of the work, and evincing various degrees of merit. The first on the list is that which we shall notice in the present fasciculus of our Journal.

Treatment of Caries. By Dr. J. J. NICOL.

After some desultory remarks on the

diseases of bone generally, Dr. N. comes to the pith of the communication-the TREATMENT, by the application of lunar caustic to the bone or its periosteum, aided or not by the internal use of sarsaparilla, and general constitutional remedies. Dr. N. modestly premises, that he offers these cases to the profession, "without the least pretensions to novelty, in so far as regards the remedies employed." What, then, it may be asked, was the object of publication? "The success of their application alone has a claim on its attention." Here the modesty is not quite so striking as in the preceding sentence. If the remedies are not novel, but only the success of their application remarkable, then the operator has the credit. Be this as it may, a single case will illustrate the mode of treatment pursued by our author, as well as a whole sheet of didactic precepts.

"Case 2.-A young gentleman, about 16 years of age, having over-exerted himself in running, was seized with inflammation along the right shin, extending towards the knee. The surgeon who attended leeched and applied evaporating sedative lotions, by which the inflammatory process was in a great measure subdued. Ulceration however followed, some time after along the flat upper part of the tibia; and the integuments gave way in two places, about the distance of an inch and a half from each other. The discharge became limited and unhealthy; the upper end of the tibia enlarged; the knee excessively pained; and the general health bad. Leeches and evaporating lotions were again applied over the knee without any benefit, and diaphoretics were also freely administered without any relief. The case becoming alarmingly retrograde, and the parents anxious, I was called in. The knee was much swollen, and the leech-bites had become vesicated, presenting the appearance of pemphigus. The whole upper end of the tibia, and for some inches downwards, was evidently enlarged; its anterior tubercle projected unusually, and was soft, but not tender to the touch. The orifices of the ulcerations previously described had enlarged to nearly an inch in diameter, communicating freely with each other, and exposing the periosteum, which was glairy, and discharged a thin

sero-gelatinous rather than sero-purulent matter. Hectic had existed for some time, and the strength was much exhausted. The tibia was now pronounced in a state of extensive disease internally, and the treatment completely reversed. An incision with a scalpel was made on the outside of the enlarged tuberosity, and a rod of caustic introduced close to the bone. One single point of the periosteum at each of the ulcerations below was touched in a similar manner. Fomentations of poppy capsule were applied two or three times daily; four ounces of Decoct. Sarsaparilla comp. were given morning, noon, and night; and from half a grain to a grain of opium exhibited two hours after each dose of the decoction.

"In twenty-four hours tranquillity was restored to the limb. In three days the hectic fell off. This plan of treatment was continued, substituting for the opium as many tea spoonfuls of the following mixture as the stomach could bear without sickness or nausea.

"R Antim. tarlarizat. gr. iv. Solv. in aq. cinnam. 3 viij. Tinc. opii, 3j. M."

The swelling of the knee disappeared -that in the bone diminished-and two thin circular films (evidently separations from the outer lamina of the tibia) were discharged at the openings. The ulcers then turned healthy, and in about four months from the time Dr. N. first saw the patient, a cure was effected, and the young gentleman is now a useful limb of the profession himself.

Dr. N. makes several judicious observations on individual remedies, employed in these diseases of the bones and their coverings. General blood-letting can only be resorted to in the acute stages, where the inflammation partakes of the gouty or rheumatic character. Instead of antimony, opium, and calomel, and other remedies, formerly much employed, onr author now depends greatly on colchicum, with Battley's liq. opii sedativus. These he uses in the proportion of two or three parts of the former to one of the latter thus, giving to an adult 30 drops, or more, (of the combination,) every three or four hours, according to the urgency of the symptoms, continuing the medicine till the stomach or bowels become affected, or copious perspiration is excited.

a

When, by these means, aided by sarsaparilla, and proper local treatment, the disease has been arrested, but the bone still continues enlarged and the periosteum thickened, then the establishment of a caustic issue becomes necessary. "When the most prominent part can be easily reached, I have invariably made an incision with the point of a scalpel, down to the bone, and not larger than was sufficient to admit a pointed rod of lunar caustic, of the usual size, which was immediately introduced, twirled round two or three times, and instantly withdrawn." A poultice was then applied, till the eschar separated, and a purulent discharge was established. Dr. N. affirms that-" short of the actual excision of the parts, he considers the lunar caustic to be the sheet anchor in the treatment of affections of the bones."

We shall notice the other articles in succession-at least all those which we deem practically useful or theoretically interesting. And we take this opportunity of observing, that our Periscope of Journals will always partake of the char acter which we have endeavoured to establish for our Analytical Review of Books. We shall not give a bare catalogue-or a meagre skeleton of papers, divested of blood, nerve, and flesh. Of those articles which we do notice, we shall aim at giving a concise, but intelligible view of their import and bearing, not a tantalizing glimpse, conveying no definite ideas to the minds of our readers. Let this be borne in mind.

2. THE LONDON MEDICAL REPOSTORY.

This journal started on a flood-tide of popularity that promised to carry it to immortality. It was presented to the public as the SURGEON-APOTHECARIES' and APOTHECARIES' JOURNAL and REVIEW," in the year 1814, when a strong excitement and impulse existed throughout that wide and respectable class of medical society, to distinguish itself by science, art, and literature. The journal was conducted by three eminent GENERAL PRACTITIONERS-Messrs. Burrows, Royston, and Thomson-so that every thing conspired to the success of the work.

This success was great-but it was aston ishingly over-rated. The first number circulated to the extent of 1250, and this point was never afterwards over stepped. Four years later, (1818,) when the property was sold to Messrs. Underwood, the circulation had dropped to 1000. One of its professed objects was-" to bring within the reach of the country practitioner whatever of novelty arises in theory or practice"--and to "assist in the amelioration of medical literature, by inciting to the practice of composition." In respect to their REVIEW DEPARTMENT, the editors were inclined to think--" that analysis, which gives a faithful view of facts to be more useful to the public, than that criticism which aims to exalt the critic above the author." Most people are now of the same opinion.

The LONDON MEDICAL REPOSITORY has passed through many hands during the last ten years, and consequently taken its hue and intellectual character from its

reigning master or masters.* While, originally, the organ of the GENERAL PRACTITIONERS, it strenuously advocated the interests of that body, but never insulted any other class of medical society The consequence was, that it had the support and respect of every designation of the profession.

No. 31. JANUARY 1, 1828.

The

The first article is the commencement of an hospital report from Dr. Carter, of the Kent and Canterbury Hospital. Dr. C. informs us that, for several years, intermittents were almost unknown in his neighbourhood-even in Faversham and the marshy lands of its vicinity. foul fiend was supposed to be extinctor to have taken his departure for Walcheren or Batavia. But no such thing. Within the last two years, ague has reinstances turned-prevailed-in many been extremely obstinate--and, in some, bas laid the foundation for irremediable disease. It is hardly necessary to say that these effects of protracted ague are chiefly felt in the liver and spleen, leading ulti

It has vacillated between aristocracy and democracy--it has been on the verge of free-thinking--and it has been downright methodistical.