accomplished so quickly as might have been desired; occasionally, too, I dreaded a too abundant suppuration; it was also necessary to take measures against the retention and accumulation of pus in particular spots; and although one of the three was quite well three months after the operation, on the other hand, the two remaining patients did not recover entirely for eight or nine months. But ultimately, the arm was preserved in every instance, and in every instance its movements were partially recovered. Unfortunately, the patient I first operated on in 1819 was attacked with phthisis only a few months after recovering the free use of the arm, and died of this disease, the seeds of which probably lurked in her constitution before the operation was performed. The two others, of whom one had the joint cut out two years, and the second three years ago, are at present alive, and in perfect health, and follow their customary occupations at Paris. One is a grinder, and the other a mantua-maker."

We shall leave the reader to compare the preceding extract with the results obtained by Mr. Syme, as detailed in his papers in this Journal, xxvi. 49; xxxi. 261; xxxii. 235; xxxiii. 233, It appears, that of seven cases of excision of the elbow, he has not lost one; that all have regained, or at the time of their dismissal were in the fair way of regaining, considerable freedom of motion in the arm; that of two cases of excision of the knee, one was recovering the use of the limb, while the other died of amputation, which was rendered necessary by the disease of the thigh-bone having been more extensive than was anticipated; and that in one instance the head of the humerus was cut away, with the effect of forming a joint which promised to be useful.

Through the kindness of Mr. Syme, we have lately had an opportunity of examining three of these cases. One was the case of excision of the head of the humerus, related in our 26th volume. This woman we found actively employed in washing clothes, which fact might be alone sufficient to satisfy every one that the shoulderjoint is of great use to her. The humerus is, in fact, movable in every direction, and to nearly as great an extent as the natural joint. She has also the power of moving it freely and powerfully in every direction, except directly outwards from the body; and the joint is so strong, that she can raise a pitcher of water in the hand of that side; but this is rather a greater exertion than she feels it safe to make habitually. The elbow joint, and the joints of the hand and fingers, are as entire as ever. The shortening and deformity of the arm are very apparent when the shoulder is naked; but when it is covered, the arm might, on a cursory examination, be very readily mistaken for a sound one.-The second case was one of the instances of excision of the elbow-joint. The operation was performed a twelvemonth ago. There is considerable freedom of movement, and the patient retains completely the voluntary power of bending the fore-arm, but has the power of extending it only in a slight degree. He can raise a heavy body with ease, can strike a straight.

forward blow with considerable force, and preserves entire all the movements of the wrist and fingers. There is very little shortening of the arm. The third case was the instance of excision of the knee-joint, mentioned in the 103d number of this Journal. There is still a small sore, with a trivial discharge, under the new joint. This joint is in a state of slight permanent flexion, and admits of but trifling motion in any direction. But the motions of the ankle and toes are entire. On the whole, this case does not hold out much encouragement to practise the operation of excision of the kneejoint, and Mr. Syme is inclined to form the same conclusion with M. Roux, that a timber leg will probably be more useful than any leg which can be formed after excision of the joint.-Edinburgh Medical & Surg. Journal, July, 1830..

13. On the Treatment of Ununited Fractures with the Seton. By ISAAC HAYS, M.D.-In the surgical lectures of William Lawrence, Esq. of London, now in the course of publication in the London Medical Gazette, we find the treatment of ununited fractures dis

missed in the following cavalier manner. "Another mode of proceeding in these ununited fractures," says Mr. Lawrence, "has been that of passing a seton between the broken ends of the bone, and leaving it there, in order to excite in the ends of the bones, and the neighboring soft parts, that action which is supposed to be inefficient. After a certain degree of inflammation has been excited by the seton, it is then to be withdrawn, trusting the union to natural powers. I believe it may be said, that there are some Two or THREE instances recorded, in which, after some weeks or months of confinement, with a good deal of pain and danger, the union has been effected in this way; but in other cases, the introduction of the seton has failed."

We confess ourselves at a loss how to notice this summary and contemptuous dismissal of a method of treating ununited fractures, and one which, contrasted with the painful and sometimes fatal operation for which it was proposed as a substitute, it appears to us can hardly be too highly extolled.

The apparent accuracy with which the lectures are given in the Gazette, seem to forbid our ascribing so material a mis-statement to an error of the reporter; the high character Mr. Lawrence has hitherto sustained for fairness and candor, equally prohibits the imputation of intentional misrepresentation on his part; and yet it is impossible to suppose that Mr. L., who is distinguished for extensive erudition, should be ignorant of cases published in the Medico-Chirurgical Transactions of London, the Edinburgh Medical and Surgical Journal, the London Medical Repository, the MedicoChirurgical Review, the London Medical and Physical Journal, the London Medical and Surgical Journal, the Dublin Hospital Reports, Charles Bell's Operative Surgery, and Cooper's Surgical Dictionary, in which no less than THIRTEEN different cases of ununited fractures, successfully treated by the seton, are related. Be the case,

however, as it may, the statement has been put forth as coming from Mr. Lawrence, and until disavowed; subjects him to the charge of ignorance or want of candor; we therefore think we are performing an act of kindness to him, in calling his attention to this subject, that it may be explained; and at the same time, as an act of justice to the eminent surgeon who devised the method of cure under consideration, we shall give a brief summary of such cases of ununited fracture successfully treated by the seton, as we find in the works in our private library, not having time at the present moment to have recourse to more extensive sources of information.

The use of the seton as a means of curing ununited fractures, was originally suggested, as is acknowledged, by Dr. P. S. Physick, of Philadelphia, and first put in practice by him on the 18th of December, 1802. The subject of this case was a sailor twenty-eight years of age, admitted into the Pennsylvania Hospital in the preceding May, in consequence of having fractured his left arm above the elbow-joint a year previously, and the bones not having united, his arm was nearly useless. A seton needle was passed between the fractured ends of the bone; "the patient suffered very little pain from the operation;""after a few days, the inflammation (which was not greater than what is commonly excited by a similar operation through the flesh, in any other part,) was succeeded by a moderate suppuration;" and at the end of five months, the arm was as well and strong as it had ever been. The account of this case first appeared in the Medical Repository of New-York, vol. i. 2d Hexade, 1804, and was republished entire in the Medico-Chirurgical Tran sactions of London, vol. v. 1819.

The subject of this case died in Philadelphia only a few months since, and we have his left humerus now before us. He was attended during his last illness by our friend, Dr. J. Randolph, who, knowing him to be the person upon whom Dr. Physick had operated twenty-eight years ago for artificial joint, obtained leave to make a post-mortem examination, and procured the humerus in question. Dr. Randolph has kindly lent us this valuable pathological specimen, and granted us permission to have a drawing of it made. The bone is nearly straight, and at the place of fracture there is a considerable mass of bony matter, through the centre of which there is a hole large enough to admit a small quill, which no doubt was made by the introduction of the seton, and of course shows the place through which it passed. A short time before his death, the patient assured Dr. Randolph that his left arm was as strong as the other; and that he had not, since the union of the fracture, suffered any inconvenience from the accident.

"It is not a little extraordinary, that in the last edition of Cooper's Surgical Dictionary, reprinted in New-York, and edited by an American surgeon, that Dr. Physick should be twice referred to in the article on fractures, as Dr. Physick, of New-York! The editor surely cannot have read the article, or he would not have permitted so gross an error to be perpetuated."

Dr. Physick, in 1822, employed the seton with success, in an ununited fracture of the lower jaw, and an account of the case, written by the patient, will be found in the Philadelphia Journal of the Medical Sciences, vol. v. The patient states, that his lower jaw was fractured March 20th, 1820, in two places, on the right side transversely, and on the left obliquely. The transverse fracture healed, but the other fracture remained ununited at the end of two years, which caused "great inconvenience from the pain occasioned by the motion of the fractured parts in the broken jaw, whenever I attempted to bite any substance as hard as a crust of bread. . My bodily strength gradually decreased, as I had a very sickly appetite, and was rendered incapable of receiving proper nourishment. My frame being debilitated in this manner, I seriously felt the effects of changes in the weather; and every time I contracted a cold, it settled in my jaw, and rendered the broken parts so sore, that for some days afterwards I was unable to eat any thing except spoon victuals; and from the slight hopes I entertained of ever recovering from this misfortune, I was rendered truly unhappy, and felt wretched when compelled to enter into any of my usual avocations." Dr. Physick introduced a seton, and "at the expiration of eight weeks. the outside of the bone became very much inflamed, and continued so for three or four days, accompanied with very acute pain, after which the pain subsided, and the inflammation decreased." In the course of the eleventh week, union of the fragments had become consolidated, and the cure was soon completed.

Dr. Physick has likewise successfully employed the seton in other instances of ununited fractures, no details of which have, however, been made public, the utility of the remedy appearing to him so well established, that no additional evidence seemed necessary, and he therefore preserved no records of the cases.

That the remedy has failed in some instances, is certain; but what remedy is always successful? and the want of success in some instances is attributed by Dr. Physick to the improper mode in which the operation was performed, and in others to the seton not having been continued a sufficient length of time. Dr. Physick recommends the operation to be performed with a very long seton needle, armed with a silk ribbon or French tape; this needle should be passed through the integuments, and between the ends of the bone. He considers this mode preferable to cutting down to the bone with a scalpel, as has been done by some surgeons. The seton ought to be left in the wound for four or five months, or even longer if necessary.-American Journ. Med. Sc. Nov. 1830.

PRACTICE OF PHYSIC.

14. Modes of Treating Intermittent Fever pursued at the various Hospitals of Paris. (Journ. Complément. Février, 1830. No. 140.)-It will be curious, and may be useful, to notice a resumé of the Parisian modes of treating intermitting fever, which has lately been published in a French contemporary. It is singular that scarcely two physicians in this metropolis treat an ague in precisely the same manner, though all agree in the principle of administering bark in one of its many forms. One will commence with a vomit ; another with a purge; a third will neither vomit nor purge, but proceed at once to the cinchona; and a fourth, whom we take to be the most judicious of the whole, will adapt his emetic, or his calomel and jalap, or his sulphate of quinine, to the duration of the complaint, the character of the accompanying symptoms or lesions, and the relative condition of the patient. Let us see how matters stand with our Parisian confrères.

It appears, that in Paris, as in this country, intermittent fevers have been more prevalent within these last few years, than they had been for some time previously. The ratio principii, or cause, is keenly disputed on the other side of the water, and some local circumstances are thought by one party to afford an explanation of the circumstance. This may, in part, be true, but the general occurrence of aguish complaints in many parts of Europe, which had latterly been free from their visitations, must depend on some more potent and extensive influences. It is more than probable that these exist in the atmosphere rather than the earth, for the seasons have exhibited considerable alterations from the ordinary and " of their way," since 1825.

even tenor

Hopital Beaujon.-During the year 1827, one hundred and eighteen patients affected with intermittent fever have been admitted into this hospital. There ordinary time of remaining in the institu. tion is thirteen days. Of these 118 patients, 96 were males, and 22 females, but as the beds for the former are one-sixth more numerous than those for the latter, the calculation will be 82 men to 20 women, or as four to one. No doubt the causes of this great disparity between the liability of the sexes to ague, must be looked for in their different habits of life, as well as in the circumstances of profession and exposure. Forty-two of the individuals were above thirty years of age, seventy-six below it. Twelve cases occurred in winter, thirty-seven in spring, forty-two in summer, and twentyseven in autumn. The quartans predominated in winter, the tertians in spring and autumn, and the quotidians in the summer. majority of the patients from the country were from Boulogne, Point-de-Jour, or other such damp localities, whilst the Parisians were mostly inhabitants of the dark narrow streets in the vicinity of the Seine, or persons with sedentary and unwholesome occupations.

The