We shall here introduce a case which Occurred at St. George's Hospital, and is illustrative of the difficulty which exists in ascertaining the exact nature of the injury which the brain has received.

A boy was brought into the hospital, Aug. 22d, at half past one, P.M in a state of total insensibility, having fallen from a height of 30 feet. There were two extensive scalp-wounds upon the right side, but the pericranium was entire, and no fracture of the bone could be discovered.

The pupils were rather contracted and sluggish-pulse almost natural-surface cool-breathing much like that of a person asleep, and without stertor. When his name was halloo'd loudly in his ear, he was perfectly unconscious of it, but, whilst some bleeding vessels were being

when we received No. 233 of the Lancet, containing a most abusive tirade against Mr. Earle, for the practice which he pursued. There is so large an admixture

of slang, "cock-sparrows"-" bats""vampires," &c. &c. that, for some time, we could not persuade ourselves but that we were perusing the account of a mill, at Monlsey Hurst, between "Barney Aaron" and the "Chelsea Snob," or some such celebrated personages. The sapient critic in the Lancet sports we know not how many notes of admiration, at Mr. Earle's considering the symptoms enumerated above as those of compression. Now we have said, and we do maintain it, that the symptoms were those of compression, almost from the very commencement of the case, exasperated certainly, at last, by the inflammation going on in the substance of the brain. If the symptoms did not indicate compression, what, in Heaven's name, did they indicate? Concussion? The man in the mask must be even a greater goose than we take him for, if he asserts that difficulty of articulalation-paralysis of one side--and involuntary discharge of fæces and urine, are evidences only of concussion. Whether the trephine should have been applied earlier than it actually was, may admit of doubt; but the man who can rate a surgeon, as Mr. Earle is rated, for applying that instrument in a case, where dissection shewed "three or four ounces" of blood over the dura mater, and a considerable quantity under it, ought to be ashamed of himself.

secured upon the scalp, he struggled violently, and moaned.

In the evening, he grew restless and fidgetty, and slight re-action came on. He was still insensible, and the pupils were dilated, particularly that of the right eye, but without any strabismus, or convulsive affection, in any of the muscles. V.S. ad 3 viij.

23d. Evidently sinking. The surface is cold-the pulse scarcely to be feltpupils act on the approach of a candle, but the right is still dilated. Towards evening he became rather convulsed, and, at 6, P.M. quietly expired.

Sectio Cadaveris. Mr. Brodie, under whose care the patient was, imagined that the symptoms depended upon extravasation beneath the dura mater. On raising the calvarium, no blood whatever was found, either above or below this membrane, and the hemispheres were sliced down to the level of the corpus callosum, without any extravasation making its appearance. In the substance of the cerebrum, a little to the left of the septum lucidum, was a small spot, softened, and containing a little blood. This was also the case with the left optic thalamus, and in the lower part of the posterior lobe of the cerebrum, was a cavity about the size of an almond, enclosing extravasated blood. A fissure was found running across the optic fossa of the sphenoidal bone, and the liver was of that granular texture found in dram-drinkers.

It would be difficult to say how far the symptoms, in this case, were owing to compression, and how far to concussion. The want of stertor-the coldness of the

surface, and the almost natural state of the pulse, would seem to evidence the latter, whilst the unequal dilatation of the pupils, and the general intensity of the symptoms, might rather be referred to the former. These are the mixed cases which occur in practice, and bother the student, who has got by rote all the pretty little distinctions, so clearly pointed out in his elementary books.

5. ST. GEORGE'S HOSPITAL.

PECULIAR AFFECTIONS OF THE CRANIAL BONES.

At page 489 of our last Fasciculus we

6. ST. THOMAS'S HOSPITAL.

ON NON-UNION OF FRACTURED BONE. By MR. AMESBURY.

A very interesting paper upon this subject was read before the Medical Society, at Bolt-court, on Monday night, by Mr. Amesbury. He detailed at length, a case, which had occurred under the care of Mr. Green at St. Thomas's Hospital in which several methods of treatment had been unsuccesfully employed, and the patient ultimately had the limb ampu tated.

A strong, healthy sailor, æt. 36, was admitted March 11th, 1827, with fracture of the thigh about its middle third, which had existed for twenty-four weeks, and been treated in a very ineffectual manner at a Portuguese hospital. The fracture was oblique, very loose, and the lower portion of the bone was drawn up along the inner side of the upper one, to the extent of two inches and a half, but extension restored the limb to its natural length. By the politeness of Mr. Green, Mr. Amesbury was allowed to apply his apparatus, so as "to retain the limb of its proper length, and press the fractured surfaces strongly together." Much pain followed the application of the apparatus, and continued more or less for ten weeks, when it was removed, but no union had taken place. A seton was next passed between the ends of the broken bone, extension being at the same time kept up, by fixing the foot and the pelvis, and applying a splint along the outer side of the limb. On the 19th day after its introduction, it was necessary to remove the silk, in consequence of matter having burrowed beneath the fascia, and affected the constitution somewhat severely. Thickening of the soft parts had taken place, but nothing more. During the suppuration which followed, pressure and extension by means of splints were assiduously kept up, but without effect, and at the expiration of nine weeks from the withdrawal of the seton, Mr. Green proceeded to cut down upon the ends of the bone. A semi-circular incision was made in the front and outer side of the thigh, through part of the rectus and vastus externus, and the bone exposed, the ends of which were found to be connected by a dense capsule. This was removed from the upper portion of

the bone, but in consequence of the under portion being drawn up on the inner side of the former, it was found impossible to get at the capsule connected with it. Half an inch of the upper portion of the bone was sawn off, and discovered to be soft and spongy from interstitial absorption.

After a time the splints were again very carefully applied, but at the expiration of nine weeks, no union having taken place, the limb was amputated at the poor fellow's own request. On examination of the bone, the capsule was found to be again complete, the greater part of it being as thick as the capsule of the hip-joint, and its inner surface, smooth like a synovial membrane. The ends of the bone were rounded, and where they came in contact, flattened and covered with a fibro-cartilaginous membrane resembling the intervertebral substance.

In

Upon this case Mr. Amesbury made some very apposite remarks. In 41 cases out of 45 which he had witnessed, the non-union was attributable in his opinion, as in the one detailed, not to weakness of constitution, but to imperfect adaptation of mechanical means. eighteen cases, Mr. A's plan has been successful, most of them having existed ununited above six months, one nine, one ten, one eleven, and two fourteen months before coming under his care. In two cases only, this being one,* has Mr. Amesbury failed. In all very loose frac tures of long standing, Mr. A. would be disposed, after an unsuccessful trial of pressure and rest by proper apparatus, to cut down upon the ends of the bone, remove by the knife the new capsule, and stimulate the ends of the bone either by a wash, or by the application of a caustic. This, with the subsequent assistance of due mechanical support, Mr. A. considered as affording the best chance of cure in these very troublesome cases.

* The other, if we are rightly informed, occurred at St. George's Hospital. We the particulars. shall take an early opportunity of giving

No. 1. Mr. LAWRENCE to Dr. JOHNSON.

18, Whitehall-place,

13th Feb. 1828.

Sir,-A friend of mine, who reads your periodical_publication, has sent me the two last Fasciculi, calling my attention to two statements which they contain respecting myself. As you address to me, in one of these, a kind of challenge either to admit or deny it, and as both are contrary to fact, I think it necessary to notice them; and I beg that you will insert this letter in your next Number, that my contradiction may reach those who have seen your erroneous assertions.

In your comments on the case of Mrs. Denmark, you say 66 we have been informed, on the very best authority, that on the very day after the operation, and afterwards on the 10th or 12th day, consequently before the ligature came away, the pulse was distinctly felt by Mr. Lawrence and others in the right arm. If this information be incorrect, Mr. Lawrence can easily contradict the statement, when we will give our authority,who also felt the pulse."-Fascic. II. p. 469.

I did not see Mrs Denmark on the day after the operation, nor within a week of that time. I have seen her only once since she was operated on, namely, about the 10th day. I then visited her with Dr. Tweedie, at the invitation and in presence of Mr. Wardrop, of whom she was a private patient. I do not remember the details of her symptoms at that time, having no inducement to make minutes of a case under the care of another gentleman; but the impression on my mind is, that a feeble pulsation could be felt in the right radial artery. I am not certain whether I ever saw Mrs. D. before the operation; if I did, it was without having the opportunity of inquiring minutely into her case, or forming an opinion respecting the treatment that it required.

In describing the case of J. Nowlan, you say on the 13th day he was better, but the eye-ball was found to be greatly protruding, which was attributed, by Messrs. Lawrence and Wardrop, to a powerful compression on the brain, exercised by an aneurismatic state of the vessels of the dura mater, communicating through the skull with the tumour on the head.-Fascic. III. p. 500.

I never entertained nor expressed any such opinion.

Having thus taken the trouble of contradicting two mis-statements, because they involve others as well as myself, I beg that your readers will not consider that I admit the correctness of those representations, which I leave uncontradicted. Your report of the proceedings at the Medical and Chirurgical Society, contained in the same Fasciculus, which ascribes to me the absurdity respecting the case of J. Nowlan, would alone render it necessary for me to enter this protest. I shall make no remark either on the cor rectness of that report, or on the kind of taste and feeling which it displays. The former will be best estimated by those who were present at the meeting, while I doubt not that the latter will be properly appreciated by your readers generally. I remain, Sir, Your obedient servant, WILLIAM LAWRENCE.

Dr. James Johnson.

No. 2. REPLY.

Let us now see what foundation there is for all this supercilious and taunting exposure of supposed mis-statements.

FIRST. In respect to Mrs. Denmark's case, the pulse was felt in the right arm on the very day after the operation, by Dr. Barry and others, (who have made no secret of it)-on, the 10th day, by Mr. Lawrence himself, according to his own admission. The FACTS, therefore, respecting the pulse, are strictly correctthough by not exactly assigning to the observers the precise dates of their respective observations, we have made Mr. Lawrence (in the place of "others") appear on the second, instead of the tenth day after the operation. We say again, the facts respecting the pulse are strictly correct; and the whole of this mighty error consists in putting "Mr. Lawrence" before "others," in the statement. We give Mr. L. all the glory he can claim, for the detection of such " ERRONEOUS

In the Report from the HOSPITAL OF SURGERY, (Lancet, No. 214, p. 24-5,) we find the following passages :

"On the thirteenth day, the stupor and delirium had subsided, but the blindness was undiminished, and the eyeball was found to be protruding from the orbit, with oedematous effusion under the conjunctiva, and in the palpebræ.

"These singular and distressing symptoms (including, of course, the protrusion of the eye-ball-Ed. of Med. Chir. Review) gave rise to much speculation, as to the cause of their occurrence. Some physiologists ascribing them to a want of sensibility in the brain and its nerves, owing to a deficiency in the supply of its stimuJus, the blood, and resembling that state produced in the lower extremities of the inferior animals, by a ligature of the aorta; or that loss of sensibility in the fingers of man, arising from an obstructed subclavian or humeral artery. Mr. Wardrop and Mr. Lawrence were inclined, however, to take a very different view of the symptoms, and to ascribe them to a morbid state of the brain itself, arising, in all probability, from an aneurismatic affection of those vessels of the dura mater which, by passing through the cranium, communicate with the superficial arteries of the head, forming, in fact, internally, a part of the disease which was so conspicuous outwardly, and thus by their enlargement exerting a powerful compression

on

the brain itself. This opinion was highly corroborated by symptoms afterwards noticed, viz. by the great protrusion of the eyeball, and by the circumstance that the thrilling pulsation was most observable in the centre of the tumour, at that point where the cranium appeared almost completely absorbed, and where, in all probability, the freest communica tion existed with the vessels supplying the membranes of the brain."*-Lancet, 6th October, 1827.

As there is reason to believe that Mr. Lawrence is not always obliged to a friend for a sight of the LANCET, (as he is for our Journal, of the existence of which he seems to have accidentally heard some time in February, 1828 !) we ask him how it happens that he has permitted such " ERRONEOUS ASSERTIONS" to re

* See our last Fasciculus for the beaufiful verification of these views.

main uncontradicted in the said LANCET, for more than four months, reserving all the fire of his indignation for us, who only re-published the statement?* How is this long silence of Mr. Lawrence to be accounted for? Is it possible that, while poor Nowlan was alive, those inexplanations, which we have quoted from genious physiological and pathological Panton Square, were permitted to glide down the stream of time, on the pages of the "INVALUABLE," as coruscations from the mighty intellects of Messrs. Lawrence and Wardrop; but that, four months afterwards, when poor Nowlan's death and dissection dissolved, into thin air, these fairy fabricks of the imagination, Mr. Lawrence started, all at once, from his halcyon slumbers-loudly declared that he had never enunciated any thing of the kind-that the whole was an ABSURDITY"-and an erroneous assertion" by Dr. Johnson!!

Whether Mr. Lawrence may chance to "catch a tartar" in this crusade, remains to be seen. At all events, he has placed upon record, (inadvertently, no doubt,) his own SOLEMN TESTIMONY to the MENDACITY of the LANCET:-and, in aiming a dagger at the veracity of Dr. Johnson, he has plunged that instrument into the bosom of his faithful ally-the LANCET! We are not among those who see the finger of Providence in every instance of moral retribution, in this world; but we will say, that Mr. Lawrence has brought about a piece of "dramatic justice," in this scene, which well deserves to be recorded.

As to Mr. Lawrence's strictures on our taste and feeling-this is the "Devil reproving Sin," with a vengeance, after the taste and feeling displayed in "PAUL'S EPISTLES" to his bosom friends-Messrs. We leave Cooper, Travers, and Butter! it to the members of the Medico-Chirurgical Society, who heard Mr. Lawrence's statements, to decide on the correctness or incorrectness of our report, with just as much confidence as Mr. Lawrence does.t

*The account of this case is acknowl

edged to be taken from the Lancet, so that Mr. Lawrence can have no pretence for the attempt to father it on us.

The statement in the Lancet of last week, on this subject, looks a little suspicious of breach of confidence some