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Electricity, the Composition of Animal Fluids, the Uses of the Spleen, and so forth.

In the event of a second edition, or of an abridgement, we should suggest to Dr. Hodgkin several alterations. Instead of merely translating the original memoirs of Dr. Edwards, which were, as a matter of course, disjoined and frequently unconnected, they should have been all brought together and compared with each other, selecting whatever was novel and important, and rejecting whatever was superfluous, and had been already explained; much repetition would have been thus avoided, and much misplaced matter would have been made more available. For example, had the subject of respiration been treated of by itself, and its modifications traced in the various classes of animals, from the batrachia to the perfect mammalia, thus exhibiting how many differences there are in different animals, but yet how these very differences harmonize, and are referable to a simple and uniform law of function, we should have had a most interesting and instructive discourse, instead of being quickly led from one topic to another, whereby the mind is bewildered and confused; in short, had the various chapters been headed thus-"Respiration," "Production of Heat," "Asphyxia," and so forth, in place of their present titles-" Batrachian Animals," "Fishes and Reptiles," "Warm-blooded Animals," &c. &c. each would have been valuable separately, and in connexion with the others. As we have already said, we are aware that this arrangement arose from each individual chapter having been originally a distinct memoir, read to the Academy of Sciences; but the translator would have acted wisely, had he become an analyser and digester at the same time. It appears quite unnecessary to introduce, upon all occasions, reference both to Fahrenheit's and to the centrigrade thermometer, as any reader can at once convert the denominations of one into those of the other: considerable confusion has in consequence crept in, as when the term zero, at page 17, is used, the reader may very easily fall into the mistake of supposing that it alludes to 32 degrees below the point of freezing. The very opposite error is com mitted, in regard to the measurement, at page 292, for the French terms only are given, and no reference to the corresponding English ones. many parts, the language is rather obscure and ungraceful, so that sentences here and there are nearly unintelligible. On the whole, however, the medical public is greatly indebted to Dr. Hodgkin for the present work; and, though susceptible of improvement, it ought to be well studied by every philosophical physician and surgeon.

In

II.

MEDICO-CHIRURGICAL TRANSACTIONS, PUBLISHED BY THE MEDICAL AND CHIRURGICAL SOCIETY OF LONDON. Volume the Seventh. 8vo. pp. 513. Two Lithographic Plates. London, 1832.

THE present volume of the Society's Transactions, though not so valuable as some of its predecessors, contains good papers, and offers on the whole a fair specimen of the present state of knowledge among the best informed members of our profession. When we state that in the array of contributors, are Mr. Brodie, Mr. Lawrence, Mr. Travers, Mr. Samuel Cooper, Mr. Langstaff, Mr. Cæsar Hawkins, Dr. Hodgkin, and Dr. Lee, we offer a tolerable guarantee for the quality of much of the matter. We think it highly desirable that this Society, or at all events, one of a similar kind, should be supported. It is a point d'appui for our best men, and the publication of its Transactions is calculated to benefit science, and maintain our professional character abroad. It would not be difficult to shew that the publication of such transactions is more calculated to attain the ends to which we have adverted, than the practice of sending communications to periodical journals. They appear so frequently, and contain matter of such various quality, that after some years it would become a terrific affair to refer to their many volumes and multitudinous pages for a particular paper. The Medico-Chirurgical Society is to us a sort of Amphictyonic Council, where the deputies from the various departments of our profession meet. It certainly is not to be compared to the Institute or Académie des Sciences, of France, but it serves as a substitute for such establishments, and we do believe that its decay would be a serious evil.

We shall proceed without further preface to notice as many of the papers as our limited space will permit. One of the most valuable, though, as usual, the least pretending, is from Mr. Brodie. The subject is abscess in the interior of the tibia. The communication is too brief and too concise to admit of much further abbreviation on our part, and we feel no regret at this, the paper displaying Mr. Brodie's characteristic method, precision and clearness.

"I am not aware," says Mr. Brodie, "that any cases exactly similar to those which I am about to relate have been recorded by authors: and as they appear to me to throw some light on the history and treatment of a rare but very serious disease, I am led to believe that they are not unworthy of being communicated to the Medical and Chirurgical Society." 239.

Case 1. Mr. P. æt. 24, consulted Mr. Brodie in October, 1824, under the following circumstances.

"There was a considerable enlargement of the lower extremity of the right tibia, extending to the distance of two or three inches from the ankle-joint. The integuments at this part were tense, and they adhered closely to the surface of the bone.

The patient complained of a constant pain referred to the enlarged bone and neighbouring parts. The pain was always sufficiently distressing; but he was also liable to more severe paroxysms in which his sufferings were described as most excruciating

These paroxysms recurred at irregular intervals, confining him to his room for many successive days, and being attended with a considerable degree of constitutional disturbance. Mr. P. described the disease as having existed more than twevle years, and as having rendered his life miserable during the whole of that period.

In the course of this time he had been under the care of various surgeons, and various modes of treatment had been resorted to without any permanent advantage. The remedies which I prescribed for him were equally inefficacious. Finding himself without any prospect of being relieved by other means, he made up his mind to lose the limb by amputation; and Mr. Travers having seen him with me in consultation, and having concurred in the opinion, that this was the best course which could be pursued, the operation was performed accordingly.” 240.

The patient died on the fifth day after the operation, with those nervous symptoms resembling delirium tremens, which we see occur occasionally after injuries or operations.

"On examining the amputated limb, it was found that a quantity of new bone had been deposited on the surface of the lower extremity of the tibia. This deposition of new bone was manifestly the result of inflammation of the periosteum at some former period. It was not less than one-third of an inch in thichness, and when the tibia was divided longitudinally with a saw, the line at which the new and old bone were united with each other, was distinctly to be seen.

The whole of the lower extremity of the tibia was harder and more compact than under ordinary circumstances, in consequence, as it appeared, of some deposit of bone in the cancellous structure, and in its centre, about one-third of an inch above the ankle, there was a cavity of the size of an ordinary walnut, filled with a dark-coloured pus. The bone immediately surrounding this cavity, was distinguished from that in the neighbourhood by its being of a whiter colour, and of a still harder texture, and the inner surface of the cavity presented an appearance of high vascularity. The ankle-joint was free from disease." 242.

It seemed evident

This case made a strong impression on Mr. Brodie. to him that, had its nature been understood, and the pus locked up in the bone been let out by means of the trephine, the patient might have preserved both his limb and his life. In the course of two years another case presented itself.

Case 2. Mr. B. æt. 23, consulted Mr. Brodie in February, 1826.

"There was a considerable enlargement of the right tibia, beginning immediately below the knee, and extending downwards so as to occupy about one-third of the length of the bone.

Mr. B. complained of excessive pain, which disturbed his rest at night, and some parts of the swelling were tender to the touch. The knee itself was not swollen, and its motions were perfect.

He said that the disease had begun more than ten years ago, with a slight enlargement and pain in the upper extremity of the tibia; and that these symptoms had gradually increased up to the time of my being consulted. Various remedies had been employed, from which, however, he had derived little or no advantage." 243.

Mr. Brodie looked upon the case as one of chronic periostitis, and treated it as such by an incision through the periosteum, and the subsequent exhibition of sarsaparilla internally. The periosteum was found much thickened, and the new bone soft and vascular. The pain was immediately relieved, the wound gradually healed, and the patient was supposed to be

cured. But the enlargement of the upper end of the tibia never entirely subsided, and in August, 1827, pain returned in it. The pain gradually increased, and in January, 1828, Mr. Brodie was again consulted. The pain was constant, yet more severe at one time than another, and often preventing sleep for several successive nights-the enlargement of the tibia as great as ever the skin tense and unnaturally adherent to the bone-the patient unable to follow his usual avocations. The resemblance to the former case struck Mr. Brodie; he proposed trephining the tibia, the patient consented, and in March, 1828, the operation was performed.

"My attention was directed to a spot about two inches below the knee, to which the pain was particularly referred. This part of the tibia was exposed by a crucial incision of the integuments. The periosteum now was not in the same state as at the time of the former operation. It was scarcely thicker than natural, and the bone beneath was hard and compact. A trephine of a middle size was applied, and a circle of bone was removed extending into the cancellous structure, but no abscess was discovered. I then, by means of a chisel, removed several other small portions of bone at the bottom of the cavity made by the trephine. As I was proceeding in this part of the operation the patient suddenly experienced a sensation, which he afterwards described as being similar to that which is produced by touching the cavity of a carious tooth, but much more severe, and immediately some dark-coloured pus was seen to issue slowly from the part to which the chisel had been last applied. This was absorbed by a sponge, so that the quantity of pus which escaped was not accurately measured, but it appeared to amount in all to about two drams. From this instant the peculiar pain belonging to the disease entirely ceased, and it has never returned. The patient experienced a good deal of pain, the consequence of the operation, for the first twenty-four hours, after which there was little or no suffering. The wound was dressed lightly to the bottom with lint. Nearly six months elapsed before it was completely cicatrized; but in about three months from the day of the operation, Mr. B. was enabled to walk about and attend to his usual occupations. He has continued well to the present time (January 7, 1832;) and the tibia is now reduced in size so as to be scarcely larger than that of the other leg. No exfoliation of bone has ever taken place." 246.

Case 3. In January, 1830, Mr. S. æt. 24, consulted Mr. Brodie.

"The lower extremity of the left tibia was considerably enlarged; the skin covering it was tense, and adhered closely to the parts below. The patient complained of a constant aching pain, which he referred to the enlarged bone. Once in two or three weeks there was an attack of pain more severe than usual, during which his sufferings were excruciating, lasting several hours, and sometimes one or two days, and rendering him altogether incapable of following his usual occupations. The pain was described as shooting and throbbing, worse during the night, and attended with such exquisite tenderness of the parts in the neighbourhood of the ankle that the slightest touch was intolerable.

Mr. S. said that, to the best of his recollection, the disease had begun eighteen years ago, in the following manner. On going to bed one evening he suddenly experienced a most acute pain in the inner ankle. On the following morning he was unable to put his foot to the ground, on account of the agony which every attempt to do so occasioned. Leeches were applied several times, and afterwards blisters, but the pain increased notwithstanding. After some weeks an abscess presented itself and broke. This was followed by some mitigation of the symptoms. Soon afterwards another abscess formed and broke in the neighbourhood of the first. The two abscesses remained open for a

considerable time, and then healed rapidly. Mr. S. now began to regain the use of the limb, and by degrees was able to walk as usual.

During the following summer he had a recurrence of pain in the inner ankle, without any further formation of abscess. For eight or ten years afterwards there were occasional attacks of pain, lasting one or two days at a time; the intervals between them being of various duration, and in one instance, not less than nine months. After this the attacks recurred more frequently, and during the whole of the last two years the symptoms were nearly as severe as at the time of my being consulted.

On examining the limb I was struck with the resemblance which it bore to that of the limb in each of the two preceding cases. There was also a remarkable resemblance in the symptoms as described by the patient, and I could not but suspect that they depended on a similar cause. I requested that Mr. Travers, who had attended one of the former cases with me, should be consulted: and he agreed with me in the opinion that probably an abscess existed in the centre of the tibia, and that it would be advisable to perforate the bone with a trephine, with the view of enabling the contents of the abscess to escape.

Accordingly I performed the operation, with the assistance of Mr. Travers, on the 31st of January. A crucial incision was made through the skin, the angles of which were raised so as to expose a part of the bone above the inner ankle, to which the pain was especially referred. A small trephine was then applied, and a circular portion of bone was removed extending into the cancellous structure. Other portions of bone were removed with a narrow chisel. At last about a dram of pus suddenly escaped and rose into the opening made by the trephine and chisel. On further examination a cavity was discovered from which the pus had flowed, capable of admitting the extremity of the finger. The inner surface of this cavity was exquisitely tender; the patient experiencing the most excruciating pain on the gentlest introduction of the probe into it." 248.

Soon after the operation some inflammation occurred, an abscess formed between the periosteum and the bone, and subsequently other abscesses presented themselves in the neighbourhood. But all healed favourablythe cavity made by the trephine became filled up-the wound gradually cicatrized the pain formerly felt never re-appeared-and the patient was soon able to resume his former pursuits. He continues well.

It is singular that an affection of this nature, of which samples must have occurred in the practice of many surgeons, should now, for the first time, have been clearly described. In point of fact it has long been known that an abscess may occur in the medullary cavity, or the cancellated ends of long bones. In Mr. Bloomfield's "Chirurgical Cases," we find the following remarks on the spina ventosa, or as he chooses, with the quaint pedantry of his time to call it, "the abscessus in the medulla.”

"It is universally allowed, that this disease takes its rise from matter being formed either in the diploe, or in the marrow; whenever obstruction is begun in the vessels expanded on, or terminating in, the medullary cysts, the consequence will be inflammation, and, if not early removed, will form matter; for this reason, I generally called this case abscessus in medulla. Whenever then a patient complains of a dull, heavy pain, deeply situated in the bone, possibly consequent to a violent blow received on the part some time before, and though at the time the patient complains of this uneasiness, within the bone, the integuments shall appear perfectly sound, and the bone itself not in the least injured, we have great reason to suspect an abscessus in the medulla. Children of a bad habit of body, though they have not suffered any external injury, will often become lame, and complain of the limb being remarkably heavy, and though not attended with acute pain, yet, the

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