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ventilation would certainly exert as beneficial an influence inhip cases as when the amputation takes place at the shoulder;and thus one might almost venture to predict that operationsat the coxo-femoral articulation will in future days be morereadily performed than hitherto. There is, however, one cir-cumstance which will ever render both amputations (and infact the removal of a great portion of a limb wherever it istaken off) somewhat dangerous-viz., the congestion of in-ternal organs consequent upon the removal of a large portionof the frame. That pneumonia, apoplexy, &c. &c., do not morefrequently follow such operations, is probably owing to theloss of blood inseparable from the ablation of limbs; but thereis sometimes so little lost, that the absence of congestivesymptoms must be partially referred to the drain occasionedby the secretion of pus. At all events, it is plain that thehaemorrhage which accompanies amputation, and the suppu-ration attending upon the healing of the stump, need not belooked upon with apprehension, except the patient be veryweak and exhausted by previous disease.We must in some degree apologize for alluding too largely

to amputation at the hip-joint; but in reviewing the cases ofencephaloid cancer of the upper part of the femur which werereported in a late "Mirror," (THE LANCET,voI.i!. 1852,p. 7-10,)we could not help noticing that removal of the limb at thehip-joint might have afforded a shade more hope as to thenon-recurrence of the affection. Regarding the shoulder,surgeons now do not hesitate one moment when disease oraccident imperatively call for the operation. We merelywish, therefore, in mentioning the following cases, to adducefacts which are likely to strengthen principles of practicealready pretty firmly established. The first case was treatedby Mr. Cock, and from Mr. Pininger’s notes we gather thefollowing particulars :-H. S——, aged 30, a leather-dresser, was admitted July, 12, I

1851, into Luke ward, under the care of Mr. Cock, in conse-quenceofasevere gun-shot wound of his right arm. The patientstates that on the morning of the accident he was shootingrooks, when, having occasion to get over some railings, heplaced his gun (which was loaded, but not cocked) on the innerside of, and leaning against, the railing. When he hadclimbed over the latter, he drew the gun through it by themuzzle, and the trigger, being directed downwards, came tobe partially raised by being pulled against a bar. The gununfortunately went off, and its contents (common shot) passedthrough the man’s right arm, close to the shoulder.Upon examination, the humerus was found completely

shattered, from about half an inch below its head to four inchesdown the shaft; there was extensive laceration of the softparts around the limb, but the axillary artery and plexus ap-peared to have escaped injury. The men who brought thepatient to the hospital said that he had lost much blood; andas the haemorrhage was still going on, Mr. Cock amputated atonce at the scapular articulation, though the man was still ina state of collapse. The operation was speedily completed,the patient being, in the mean time, kept up by the adminis-tration of brandy. The greater part of the deltoid muscle hadbeen destroyed, but a tolerable, although somewhat scanty,flapwas obtained from each side. The margins of the wound werebrought together in the usual manner after the vessels weresecured; and when reaction had set in, half a drachm oflaudanum was given to the patient.The progress of the case was marked by two principal

features-cough and the formation of abscesses: of the latter,some formed about the latissimus dorsi, others in the axilla,and one even about the crest of the ilium; but by good diet,tonics, the successive opening of the purulent sacs, and carefuldressing, the patient left the hospital with a good cicatrix, Iabout three months after the operation. I

Severe injury to the upper part of the Arm by Machinery.Amputation at the Shoulder-joint.

(Under the care of Mr. POLAND.)The following particulars were noted by llr. Morris:—George C-, aged seventeen, a healthy lad, of regular

habits, and employed for some years in a paper factory, wasadmitted October 4, 1851. It appears that whilst the boywas pursuing his occupation at the mill, on the day of admis- Ision, his left hand and arm were caught in the machine, 1

whereupon the wheel completely crushed the arm in itsupper third, tearing the integuments and muscles for someway above that region. There was little or no haemorrhage atthe time, and, after a temporary dressing, he was sent to I,Guy’s Hospital, where he arrived about three hours after the Iaccident. J

On admission, the boy had somewhat rallied from theshock; the arm was unbound, and the following conditionobserved:-The whole of the left upper extremity wasirregularly torn off about the insertion of the deltoid; the bonewas obliquely and jaggedly broken, the integuments on theinner side hanging in long shreds, with the brachial vesselsand nerves exposed to the extent of an inch. On the outerside the integuments and muscles were lacerated and torn offmuch higher up. Immediate amputation was evidentlyunavoidable; and it was determined to remove the remainingportion of the limb at the shoulderjoint, as there was not suffi-cient soft parts to form a covering to the bone if an endeavourwere made to save any part of the head of the humerus.Mr. Bransby Cooper entirely coincided with this view, andtook charge of the subclavian artery during the operation.As much outer flap as could be made was taken from the

deltoid; but there was only sufficient to form one-third of thestump; consequently the inner flap had to be made from thesoft parts of the arm, including the brachial vessels andnerves. After the ligatures were applied to the vessels thepatient was put to bed, scarcely any loss of blood havingtaken place. About three hours afterwards the flaps werebrought evenly together and maintained by eight sutures,with suitable support by means of well-adjusted strips ofplaster. The patient was ordered eight ounces of wine, onepint of porter, and a chop, daily.The case progressed favonrably, without a bad symptom;

the stump was dressed about every fourth day, and great caretaken that no collection of pus should be formed. Thesutures were removed on the sixth day, and the ligaturescame away on the third week; the stump healing, partly bygranulation, and partly by first intention, in the space of onemonth.

’ At the end of the fourth week the boy’s appetite began tofail, he had chilling sensations, and looked pale. As therewere two cases in the ward dying of phlebitis, it was fearedthat the patient might become the subject of this fearfulaffection; he was therefore immediately despatched into thecountry, where he soon regained his failing appetite, andbecame stout and hearty. He presented himself at thehospital two weeks afterwards, in perfect health, and the stumpnearly cicatrized.The next case, treated by Mr. Coulson, will afford an inter-

esting illustration of the dependence of success on the state ofhealth previous to the accident, as also on the age of thepatient. It will likewise be seen, in Mr. Coulson’s case, (aswas observed in the two preceding ones,) that, after accidentsabout the shoulder, the surgeon must take his flaps, notaccording to methodical directions, but do the best he can toform a satisfactory stump from parts often sadly lacerated.

’

ST. MARY’S HOSPITAL.

Injury to the upper part of the Left Arm; Amputationat the Shoulder-joint; Death.

(Under the care of Mr. COULSON.)TnE notes of this case were taken by Mr. Bullock, house-

surgeon to the hospital.E. BL——, aged four years and eight months, who is stated to

have been an unhealthy child, and to have suffered fromchest affection, was admitted at nine A.M., March 8th, 1852,under the care of Mr. Coulson, with a compound comminutedfracture of the left arm. It appeared that the girl had beenrun over by an empty railway truck about fourteen milesfrom the hospital, and was brought up by railway. She was

considerably collapsed, the surface of the body was pale, andthe feet cold; the child was perfectly quiet; she had been sosince the accident; and she had not lost any blood.On examination, a lacerated wound was perceived, which

extended nearly the whole length of the arm on its anteriorand inner surface; the bone was extensively comminuted fromthe elbow-joint (into which the fracture extended) to withinan inch and a half of the shoulder-joint, the muscles beingnearly all torn through, except at the posterior part. Theartery seemed to have escaped; the wound extended nearly upto the acromion process, but the child could move her fingers.No haemorrhage had occurred. At eleven A.31., the littlepatient had somewhat rallied, and amputation at the shoulder-joint was therefore performed, chloroform having been pre-viously administered by Mr. Trotter. No definite mode ofperforming the operation could be adopted, on account of thelaceration of the integuments; the principal flap was made ofthe deltoid, and a smaller inner one was taken from the softparts towards the chest. The subclavian artery was com-

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pressed by the thumb on the first rib, and very little blood ilost during the operation. Several vessels were tied, and Ithe edges of the wound brought together with sutures and a Ifew strips of plaster; and the stump was lightly bandaged to Ithe side.

n

IThe circulation was very feeble, and the child still lay very I

quiet. Ordered three minims of laudanum, strong beef-tea, some milk, and port-wine. About five P.M. the chest wasexamined; thc-re was mucous rhonchus, without any fine cre-pitation, in both lungs; the respiration became slightly wheez- Iing, the pulse rapid and feeble. At ten P.M. the rhonchus in-creased, and the patient became restless. She had wine !more frequently, and small doses of laudanum in camphormixture; but in spite of support, a mustard poultice to thechest, &o., the restlessness and dyspncaa increased, and thechild gradually sank, and died the next morning.On a post-mortem examination, old adhesions of the right

pleura were found; the lungs were somewhat congested, andthe bronchi contained a large quantity of mucus, the liningmembrane being highly injected. The other organs were

healthy, and no adhesive matter had been thrown out betweenthe flaps at the shoulder.

Reviews and Notices of Books.

On Rhe2tnzcttism, Gout, and lleul’a7gia, as affecting the Head and E

Ear; with Remarks on some Forms of Headache. By WILLIAM 1HARVEY, Surgeon to the Royal Dispensary for the Diseases of the Ear, &e. 8vo, pp. 292. London: Renshaw. 1852.

OF the numerous specialities into which the practice of medicine has been subdivided in the present day, none have greater claims upon the attention of the scientific practitioner than the diagnosis and treatment of diseases of the ear; not only because of theirintrinsic importance, but also on account of the urgent necessitywhich exists for banishing the empirics from this stronghold ofquackery. We feel bound, therefore, in every way to supportthose members of our profession, who, working in the right direc-tion, are making an attempt to place the treatment of aural dis-eases on a foundation derived from physiological and pathologicalinvestigations.As regards the present work by Mr. Harvey, we cannot do

better than allow him to state his reasons for publication in hisown words--

" The author’s design in the present treatise is, to trace therelations existing between the ear and its appendages, and thosegouty, rheumatic, and neuralgic disorders of the parts about thehead and face, which often complicate, sometimes cause, and toooften protract indefinitely, that most afflictive condition-partialor total deafness. His object is rather to draw the attention ofthe profession to what are already acknowledged facts, and, forpractical purposes, to present those facts clearly before the mind,than to advance novel views or theories. He will be well re-warded for publishing the results of his experience, if, in the wordsof Sir W. Temple, though he may not have been able to informmen more than they knew, he may yet have given them occasionto consider more than they do.’

"

The work may be taken as evidence of much reading andindustry on the part of its author, and we feel convinced that, tomany of our readers, it will afford much useful information ; as

Mr. Harvey remarks-" Rheumatism affecting the structures of the ear has not

hitherto, as far as my researches have enabled me to ascertainthe fact, been noticed in any medical work."

The Physical Diagnosis of Diseases of the Abdomen. ByEDWARD BALLARD, M.D. Lond., late Medical Tutor in

University College, &e. pp.276. London: Taylor, Walton,and Maberly. 1852.

THE profession is much indebted to Dr. Ballard for this un-

pretending little volume, which we feel certain, if carefullystudied, will accomplish its object of removing many of the diffi-culties at present surrounding the diagnosis of abdominal diseases.The author has divided his work into three parts, the first of

which is devoted to a description of the various methods of

making a physical examination of the abdomen, consisting of

inspection, mensuration, palpation, percussion, and auscultation,together with the general results afforded by these, in health anddisease. In the second part, those abdominal diseases are con-sidered seriatim which farnish indications of their presence on

physical examination, such as diseases of the liver, pancreas,spleen, kidney, digestive canal, peritonaeum, organs within thepelvis, abdominal vessels, and extra-peritonæal diseases. Whilein the third division we have an enumeration of the mostremarkable physical signs, with the diseases by which each maybe occasioned.

In a work of this kind it is difficult to select any particularpassage which may afford a fair example of the author’s merits;and the difficulty is increased on the present occasion by thelimited space at our disposal. The remarks upon intestinalobstruction are so excellent, that but for their length we shouldplace them before our readers. As it is, however, we cannot dobetter than quote the following observations on intestinal concre-tions:-

‘° Concretions arising from the accumulation of various in-ligestible matters in the bowels commonly occur in the caecum,3r ascending or descending colon. According to their size and

position, they give rise to palpable tumour, the form of which isthat of the concretion. When a portion of the bowel is distendedwith matters of an indigestible nature, through any considerableextent, it may present a cylindrical form. If large, there maybe some visible elevation of the surface over its seat. Thetumour is hard; and when an accumulation of hard bodies, suchas cherry-stones, has taken place-as in a case recorded byCruveilhier (Anat. Pathologique, liv. 26, pl. 6)-a sense ofcrepitation, resembling that produced by emphysema, has beengiven to the hand, and a similar sound may be heard on pressure,by aid of the stethoscope. The tumours are often moveable,either by altering the posture of the patient, or by the hands;but this occurs when the concretion is situated in a moveableportion of the bowel, such as the small intestines or the trans-verse colon. Like faecal accumulation, the tumour may be theseat of pulsation. Percussion elicits a dull sound over the -

tumour, not varied with resonance, as in fseeal accumulation."

The work is logically written, and the contents are well

arranged: its utility, moreover, is much increased by the addi-tion of a copious index.

Lectures on Clinical Medicine. By J. H. BENNETT, M.D., &C.No. VIII. Pamphlet, pp. 50. Edinburgh: Sutherland andKnox.

’ DR. BENNETT’S valuable series of lectures on clinical mediomc

have been already noticed with commendation in the page&.ofTHE LANCET. The present part contains reports of cases ofcancer of the lung, &c., carbonaceous lungs, intermittent fever,remittent fever, continued fever, and syphilitic and mercurialpoisoning. We quote the following remarks on the treatmentof syphilis :-"The treatment of syphilis may be said to be of two kinds,....,..

namely, the simple and the mercurial. The profession are

rapidly deciding in favour of the first, although some of itsmembers still give mercury in inveterate cases. Many of thosewe meet with, therefore, have taken the drug, and we have toeradicate the effects of the mineral poison as well as that of theoriginal disease.

" The Simple Treatment is divided into internal or medical,and external or surgical. The first consists in the observationof certain hygienic rules, and the employment of generaltherapeutic means. The diet must be light and mild, meat andall stimulating viands retarding the cure; even with the lightestdiet the hunger should never be quite appeased. The regimenmust be the more diminished and rigid in proportion to the youthand vigour of the patient. Diluent beverages, decoctions of

’ barley, liquorice, and linseed, alone or mixed with milk, shouldbe taken freely, to the amount, indeed, of several pints a day.Perfect repose must be secured by confinement to bed. Con-

r stipation must be obviated by the use of emollient clysters or mild_

laxatives. The air should be maintained at the same tempera-ture ; this is an indispensable precaution in chronic, consecutive,

and mercurial affections. Exercise is only useful in the con-fvalescent stage. In chronic syphilis, however, it may often hef carried to fatigue with advantage. Tepid baths, repeated threef or four times a day, are always attended with advantage. General