fibres can be mechanically produced; but when false ankylosis exists, although extension be limited, the joint may remain capable of greater flexion, so that the resistance offered by the muscles is immediately apparent-in forming the diag nosis the history of the case may assist. Where, for instance, absolute immobility has succeeded, inflammation produced by mechanical violence, you may often conclude that true ankylosis exists. The deformity resulting from white swelling, on the contrary, is usually incomplete ankylosis. The pain, or sense of tightness, on the flexed side of the limb, produced by manual attempts at straightening, is often an indication of the evidence of some mobility. But a much more delicate test is the production of pain on the opposite side. A completely ankylosed limb also conveys to the hand of the examiner a sensation of union throughout. The tibia and femur, in true ankylosis of the knee, give the impression of a single bone: and many of the patient's sensations in the limb are referrible to a want of elasticity, which is not absent in false ankylosis, even when no motion is visible.(Lancet, Oct. 14; from Dr. Little's Lectures.)

Ankylosis.-Rigidity or stiffness and adhesion of a joint. The term also includes the existence of distortion.

Complete or True Ankylosis-A perfect ossific union of the articulating surfaces, and consequent incapability of restoration to function.

In partial or false ankylosis such a degree of impediment to the motions of the joint is supposed to have taken place as materially interferes with its function, but without any union, or with merely membranous adhesion of the articular surfaces.

Simple induration of the tissues, without the existence of any ossific union, may suffice to produce complete immobility and occasion an erroneous belief in the presence of true ankylosis.

OPERATION FOR FISSURE OF THE SOFT AND HARD PALATE. By J. M.

WARREN, M. D.

In this case the patient was a young man, 25 years of age, with a congential fissure of the soft and hard palate; the bones being separated quite up to the alveolar processes with a deviation to the left side. Speech extremely indistinct, and deglutition very imperfect. The soft parts were scarcely perceptible, being almost concealed in the sides of the throat from the action of the muscles. With a long double-edged knife, curved on its flat side, the operator carefully dissected up the membrane covering the hard palate, pursuing the dissection quite back to the root of the alveolar processes. By this process, the membrane seemed gradually to unfold itself, and could be easily drawn across a very wide fissure. A narrow slip was now removed from the edges of the soft palate, and with it the two halves of the uvula. By this means a continuous flap was obtained, extending back from the roots of the teeth to the edges of the velum palati.

Lastly, six sutures were introduced which obliterated the whole fissure. In three weeks the patient returned home, a firm fleshy palate being formed behind, and half the fissure in the bony palate obliterated. Some time after, one half of the latter was closed.

CASE OF STRANGULATED HERNIA ON THE LEFT SIDE, AND PROTRUSION OF THE COCUM.

James Collier, aged two years, was discovered to have a reducible inguinal hernia

on the left side, a few months after birth. On the 5th September last, the mother found it larger than usual, and painful. She made ineffectual attempts to reduce it, till the 8th, when Mr. Jerrard, of Honiton, was sent for. The tumor had descended to the bottom of the scrotum, and was as large as an orange. There had

been no fæcal evacuation since the morning of the 5th, and there had been repeated attacks of vomiting. Mr. J. attempted the Taxis-in vain. The violent efforts and crying of the child offered a great obstacle both to that and the operation, which was performed at 3 P. M.

"The tumor having been freely laid open, and its contents exposed, it was found to consist of the cœcum, with the appendix vermiformis, and about six inches of the ileum. The stricture was divided upwards. I now proceeded to return the protruded bowels, and here, as had been anticipated, the greatest imaginable difficulty presented itself. The child, who was very strong and muscular, continued to scream and strive in the most determined manner, so that no force which could with safety be applied, was adequate to the returning of any portion of the bowels; and I was obliged to support them with my fingers in the best manner I could for nearly an hour, when the child became exhausted, and ceased to scream and strive, at least with much violence, and I was enabled to reduce the hernia.”—Prov. Journ. Nov. 25, 1843.

The wound was dressed as usual, and all did well.

ARCH-TOURNIQUET.

Dr. Oke, of Southampton, has drawn the attention of the profession to an instrument of this description.

It consists of an arch, a pad, and screw. The flanks of the arch are perforated with holes for the action of the external screw, which is worked by a short handle, as in the common tourniquet.

The pad is of the ordinary size, flat on one side, and convex on the other. Upon its flat surface there is a smooth cavity for the reception and working of the point of the screw.

Mode of application: Let the arch embrace the limb, so that one of the perforations of the flank may be exactly opposite the cavity on the flat side of the pad, previously applied over the trunk of the artery to be compressed. Then fit the external into the internal screw, and work it upon the pad till sufficient pressure be made to stop the circulation of the artery.

By this simple means any of the principal arterial trunks of the extremities may be compressed in the shortest possible time without strangulating the circumference of the limb and obscuring the operation with venous blood.

The arch is prevented from slipping by the pressure of the screw upon the pad.

These arch-tourniquets do not answer so well in practice as might be supposed. If the pressure is sufficient to arrest, or materially to control the flow of blood through the main artery, the pain is often great, and sometimes intolerable. Nor is the venous circulation so free as has been represented. The chief veins of the limb accompany the artery, and participate in its compression; the consequence is swelling of the limb. We would be far from saying that such an instrument is never useful. But its value has been over-rated.

CARIES OF THE OS CALCIS SUCCESSFULLY OPERATED ON. By Sir JOHN FIFE, Newcastle-on-Tyne.

A shoemaker, aged 24, cachectic from the effects of syphilis and mercury, was

admitted into the Newcastle infirmary, under Sir John Fife, August 24, 1843, with a sinus over the os calcis, of twelve months' duration, discoloration of the integuments, and a diseased state of the bone. The following operation was successfully performed.

"An incision, nearly perpendicular, was carried from the upper and outer part of the insertion of the tendo Achillis down to the os calcis, as far as the sole of the foot. A carious surface of bone was removed by cutting forceps; the bone towards its centre appeared soft and cancellated, containing much oily matter. Lint was introduced, over which a dressing of turpentine ointment, and the latter covered by a poultice. This treatment was continued for a fortnight, and afterwards the part was dressed with simple dressings, and bandaged."

The wound healed well.-Provincial Med. Journal, Nov. 11, 1843.

We would observe that the removal of carious or necrosed bone, is, perhaps, too frequently neglected. The tibia is very favourably circumstanced for the operation, but the femur may be subjected to it with advantage, and, indeed, it is one of wide applicability and use. On the femur, however, it is not free from danger. We have seen a piece taken out of the popliteal artery, where it is just entering the ham, by the trephine. Fatal hæmorrhage was the result, amputation being resorted to ineffectually.

NEW TRUSS.

At the Sheffield Medical Society, Mr. Overend exhibited a truss with a spiral spring in the centre of the pad, invented by a mechanic, resident in the neighbourhood of the town, who has for several years been affected with direct inguinal hernia. He had experienced much more relief by wearing a truss of this description than from any he had previously worn.-Prov. Medical Journ. Nov. 11, 1843.

NEW MODE OF REDUCING A LUXATION OF THE HEAD OF THE FEMUR ON THE DORSUM ILII.

A young man, not very powerful, met with a dislocation of the head of the left femur on the dorsum of the ilium, occasioned by the fall of a bale of cochineal upon his back as he was stooping. Reduction was at first attempted by the usual method of extension, with towels, as he lay upon the right side. Then he was put on his back, and reduction again attempted in vain. Another plan was now tried by Mr. Clark, surgeon of the South Hants Infirmary, under whose care the patient was.

"I now flexed the knee to a right angle, which raised the thigh to an angle of about forty-five degrees with the bed, perhaps near a right angle with regard to the pelvis; and, by bringing the foot in contact with the other leg, while the knee was sustained in a perpendicular direction, it is manifest that the femur was rotated, and the trochanter major thrown outwards, the head alone then resting on the ileum behind the acetabulum, which cavity, with the axis of the femur through its head, neck and shaft, were now nearly on the same plane; in this relative position of the parts, by throwing the limb outwards, the head of the bone, it is fair to infer, would start forwards to its natural situation; and such was the gratifying termination of the case, with no more force than was necessary to abduct the limbs. The pelvis still fixed to the right side of the bed, admitted of no change; the heel rested on the bed, as above, while I stood on the left side of the patient, with my right hand on the hip-joint, and my left holding the knee; thus the reduction was readily and audibly effected as I drew the limb towards me.".-Prov. Med. Journ. Dec. 9, 1843.

THERAPEUTICS.

TREATMENT OF HYDROPHOBIA BY COMPRESSION OF THE CAROTIDS.

Dr. Allier states that, in 1837, while attending a servant attacked with confirmed hydrophobia, he was forcibly affected by the total impotence of medicine. Recollecting then the efficacy of compression of the carotids in cases of epilepsy, he compressed simultaneously these two arteries at the commencement of a convulsive paroxysm. In an instant the convulsions ceased, and the patient fell into a kind of fainting fit. Alarmed at this, the family refused to allow the doctor to continue the methodical employment of this powerful treatment. The hydrophobic symptoms again showed with renewed violence, and the patient died on the following day, forty-eight hours from the commencement of the attack.

Dr. Allier remarks, that the compression of the carotids has not yet been employed, to his knowledge, in this terrible affection; its effects were sufficiently evident in the case above related to render it important to ascertain afresh its definitive influence on rabies. It is true that, by the employment of this measure, you do not attack the evil at its source, you do not destroy the intoxication; but, perhaps, in annihilating thus, by compression of the carotids, the deadly effects of this poison, namely, the convulsions, the fatal termination of this frightful malady might be prevented; since these convulsions are the cause of death either by asphyxia, or by the exhaustion of the nervous system.-Clinique des Hopitaux des Enfans.

DR. WIGAN ON TINEA CAPITIS.

Mode of Treatment proposed by Dr. Wigan.-The head is to be shaved carefully twice. The remedy proposed is Beaufoy's concentrated ascetic acid—as a preliminary, the acid diluted with three times its weight of water is to be used as a test or detector acid. On the application of this, a number of spots previously looking healthy become red patches-then with a piece of fine sponge tied to the end of a stick, or held in a pair of silver sugar-tongs, imbue each spot thoroughly with the strong acid for three or four minutes, and the business is done, one application being enough. The crust grows up with the hair-this should be removed as soon as a pair of fine scissors can be introduced beneath it.-Medical Gazette, Sept. 15, 1843.

VARUS MENTAGRA AND GUTTA ROSEA, THE SYCOSIS MENTI AND ACNE OF WILLAN, TREATED WITH SULPHATE OF IRON EXTERNALLY. By W. DAUVERGER.

The sulphate of iron is used in solution, either by bathing the part affected, or by applying linen dipped into it, or by sprinkling the ulcerated parts of the mentagra with a mixture of charcoal and sulphate of iron. The following are the formulæ employed by him.

No. 1.-Sulphate of iron 25 grammes; Distilled water 200 grammes-dissolve. No 2.-Double the strength of the above.

No. 3.-Ferro-carbonic powder.-Sulphate of iron 10 grammes; Charcoal 35 grammes-powder and mix."

The inflammatory symptoms are treated with emollients. Then the patient is

to bathe the part twice a day with two glasses of warm water containing one or two spoonfuls of No. 1. A quarter of an hour after, he prescribes a local bath of an emollient decoction; and afterwards, if possible, a poultice of the same kind. If no improvement take place, he goes to No. 2. General means of treatment are used at the same time.-Gazette Medicale, Sept. 9, 1843.

OBSERVATIONS ON SPERMATORRHEA. By W. H. RANKING, M.D. Cantab.

Spermatorrhoea is sometimes the consequence of continence carried to excess. The involuntary emissions, which constitute a really morbid phenomenon, are, however, usually traceable to a very different cause.

Causes.-(Predisposing :) A congenitally feeble state of the sexual organs, by which they are rendered easily susceptible of injury from over-excitement: this state is indicated by congenital phymosis, varicocele, and incontinence of urine. (Exciting ;) Over-excitement of the organs, gonorrhoeal inflammation of the urethra, affections of the rectum, constipation and ascarides, presence of sebaceous matter under the prepuce, and continence.

The Modus Operandi of these causes is sufficiently obvious.

Symptoms.-After abuse of the genital organs the patient finds himself infested with seminal emissions during sleep, which are at first accompanied by erections, but these erections soon cease-in sexual intercourse at this time he experiences more than usual difficulty in consummating the act; there is incomplete erection -ejaculation often difficult and painful. As the disease advances, the emissions increase in quantity and frequency, the patient being made conscious of them only by the sense of weakness on awaking. In sexual intercourse the ejaculation becomes more hurried; the mere sight or touch of a female will cause it. The mind becomes enfeebled, as well as depressed-cerebral and thoracic symptoms now occur-giddiness, noises in the ears, palpitation and cough. Digestion is impaired-bowels costive. Micturition frequent during the night-penis flaccid and inelastic-scrotum pendulous-testicles soft and tender to the touch. Urine turbid and nauseous to the smell, the turbidness appearing only towards the end-the emptying the bladder and evacuation of the bowels are accompanied by a seminal discharge. It is important to remark that the tendency of every case of morbid nocturnal emission is to become diurnal, if it be unchecked. Hence the absence of nocturnal discharge is no proof that the disease has vanished.

Morbid Anatomy.-1. Orifices of the Seminal ducts, or those ducts themselves dilated, or as it were dissected out by suppuration of the prostate-ducts cartilaginous or ossified. 2. Vesicula Seminales filled with pus, or with tubercular matter, mixed with elaborated semen. 3. Vasa deferentia tortuous and irregularly dilated. 4. Testicles soft and white, and diminished. Hence the essential lesion of spermatorrhoea is chronic inflammation of the parts concerned in the formation, conveyance, and expulsion of the seminal fluid.

Treatment. First ascertain the exciting cause-if ascarides in the rectum are present, expel them in the usual way. When the complaint depends on stricture of the rectum, fissure of the anus, or hæmorrhoids, employ the appropriate surgical treatment-the sebaceous matter behind the prepuce is to be cleansed away. When the disease depends on general debility, and on atonic condition of the spermatic vessels, cold bathing and douches on the parts will be necessary. Mineral tonics also the best is the tincture of the sesqui-chloride of iron. When the disease depends on undue exertion of the sexual organs, the excess must be relinquished, sexual intercourse prohibited-no stimulating food or drinks. Nitrate of silver is to be applied to the affected portions of the urethra;