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tion to the principal manufactures against which violent clamours had been raised at various times, and in various places, yet we remark, from the preceding statement, that there are few which are injurious to the health of the neighbourhood.

Hence the magistrate ought to reject the ill founded complaints, which are too frequently directed against the establishments, menacing the fortune of the manufacturer, and retarding the progress of industry; he ought to be on his guard against the conduct of a jealous and troublesome neighbour: he ought carefully to distinguish what is inconvenient and disagreeable, from what is noxious or dangerous; in a word, he ought to be impressed with this truth, that in listening to complaints of this nature, the consequence would not only be, that the establishment of many useful arts would be prevented in France, but insensibly, the blacksmiths, carpenters, joiners, coppersmiths, coopers, brass-founders, weavers, and generally all those trades which more or less incommode the neighbours, would be excluded from our towns; for in fact the arts just mentioned annoy the neighbourhood more than those formerly noticed; and the only advantage they have over the latter, is the long time they have been followed. Their right of domicile has been confirmed by time, and the public necessity.

The committee are of opinion that the Institute ought to take advantage of this circumstance, to place the manufactories under the special protection of the government; and to publish, that the manufactories of acids, of sal ammoniac, of Prussian blue, of sugar of lead, of white lead, the slaughter-houses, the manufactories of starch, the brewhouses, the tan-yards, do not render the neighbourhood unhealthy, when they are well conducted.

The same cannot be said of the rotting of hemp, of the making of catgut, of the collections of ordure, and in general, of all those establishments where a large quantity of animal or vegetable matter is subjected to a moist putrefaction; in these instances, besides the disagreeable smell, there are disengaged miasmata, which are more or less noxious.

The manufactures alluded to, though not injurious to the health of the neighbourhood, ought not the less to be placed under the direction of the administration: to the proprietors

ought to be prescribed the measures the most proper for preventing the diffusion of the odours and smoke through the neighbourhood. This may be accomplished by an amelioration of the process, by the erection of high boundary walls, so that the vapour may not be spread to the adjoining houses; by improvements in the management of the fire, so that the smoke may be consumed or deposited in the long flues of the chimnies; by the observance of great cleanliness in the laboratories, so that no matter may putrefy, and that all the offals susceptible of fermentation may be deposited in deep sewers, and may not, in any way, incommode the neighbours.

The committee observe, that when it is proposed to form new establishments of Prussian blue, of sal ammoniac, tanyards, manufactories of starch, and in general of all manufactures producing vapours very disagreeable to the neighbours, or danger from the apprehensions of fire, or of explosions, it would be at once prudent and just to declare, that these establishments cannot be formed within the towns, or near any dwellings, without a special permission; and in case the proprietors have not complied with this indispensable condition, the removal of the establishment may be enjoined without the right of indemnity.

The result of this report is, first, that the manufactories of catgut, the collections of ordure, the establishments for rotting, and likewise all those where large quantities of vegetable and animal matter are collected and allowed to rot and putrefy, render the neighbourhood unhealthy. All these ought to be removed out of the cities, at a distance from any dwelling; secondly, that those manufactures in which disagreeable odours are disengaged by fire, as in the making of acids, Prussian blue, sal ammoniac, render the neighbourhood dangerous only from the want of caution; and that the attention of the police should be confined to the improvement of the processes, and the management of the fire, and to the observance of suitable cleanliness; thirdly, that it would be worthy of a good and wise administration, to pass ordinances prohibiting for the future, within the towns, or near any habitations, the establishment of all manufactures really disagreeable or dangerous to the neighbours, without previous permission. In this class may

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be comprehended the conversion of ordure into powder, tanyards, the manufactories of starch, founderies, the manufactories of candles and soap, slaughter-houses, the collections of offals, the making of Prussian blue, of varnish, of glue, of sal ammoniac, potteries, &c.

On the Fracture of the Carpal extremity of the Radius. By A. COLLES, M. D. one of the Professors of Anatomy and Surgery in the Royal College of Surgeons in Ireland.

[From the Edinburgh Medical and Surgical Journal for April 1814.]

THE injury to which I wish to direct the attention of surgeons, has not, as far as I know, been described by any author; indeed the form of the carpal extremity of the radius would rather incline us to question its being liable to fracture. The absence of crepitus, and of the other common symptoms of fracture, together with the swelling which instantly arises in this, as in other injuries of the wrist, render the difficulty of ascertaining the real nature of the case very considerable.

This fracture takes place at about an inch and a half above the carpal extremity of the radius, and exhibits the following appearances.

The posterior surface of the limb presents a considerable deformity; for a depression is seen in the fore-arm, about an inch and a half above the end of this bone, while a considerable swelling occupies the wrist and metacarpus. Indeed, the carpus and base of the metacarpus appear to be thrown backward so much, as on first view to excite a suspicion that the carpus has been dislocated forward.

On viewing the anterior surface of the limb, we observe a considerable fulness, as if caused by the flexor tendons being thrown forwards. This fulness extends upwards to about onethird of the length of the fore-arm, and terminates below at the upper edge of the annular ligament of the wrist. The extremity of the ulna is seen projecting towards the palm and inner edge of the limb; the degree, however, in which this projection takes place, is different in different instances.

If the surgeon proceed to investigate the nature of this injury, he will find that the end of the ulna admits of being readily moved backwards and forwards.

On the posterior surface, he will discover by the touch that the swelling on the wrist, and metacarpus, is not caused entirely by an effusion among the softer parts; he will perceive that the ends of the metacarpal, and second row of carpal bones, form no small part of it. This, strengthening the suspicion which the first view of the case had excited, leads him to examine, in a more particular manner, the anterior part of the joint; but the want of that solid resistance, which a dislocation of the carpus forward must occasion, forces him to abandon this notion, and leaves him in a state of perplexing uncertainty as to the real nature of the injury. He will, therefore, endeavour to gain some information, by examining the bones of the fore-arm. The facility with which (as was before noticed,) the ulna can be moved backward and forward, does not furnish him with any useful hint. When he moves his fingers along the anterior surface of the radius, he finds it more full and prominent than is natural; a similar examination of the posterior surface of this bone, induces him to think that a depression is felt about an inch and a half above its carpal extremity. He now expects to find satisfactory proofs of a fracture of the radius at this spot. For this purpose, he attempts to move the broken pieces of the bone in opposite directions; but, although the patient is by this examination subjected to considerable pain, yet, neither crepitus nor a yielding of the bone at the seat of fracture, nor any other positive evidence of the existence of such an injury is thereby obtained. The patient complains of severe pain as often as an attempt is made to give to the limb the motions of pronation and supination.

If the surgeon lock his hand in that of the patient's, and make extension, even with a moderate force, he restores the limb to its natural form, but the distortion of the limb instantly returns on the extension being removed. Should the facility with which a moderate extension restores the limb to its form, induce the practitioner to treat this as a case of sprain, he will find, after a lapse of time sufficient for the removal of similar swellings, the deformity undiminished. Or, should he mistake

the case for a dislocation of the wrist, and attempt to retain the parts in situ by tight bandages and splints, the pain caused by the pressure on the back of the wrist will force him to unbind them in a few hours; and if they be applied more loosely, he will find, at the expiration of a few weeks, that the deformity still exists in its fullest extent, and that it is now no longer to be removed by making extension of the limb. By such mistakes the patient is doomed to endure for many months considerable lameness and stiffness of the limb, accompanied by severe pains on attempting to bend the hand and fingers. One consolation only remains, that the limb will at some remote period again enjoy perfect freedom in all its motions, and be completely exempt from pain: the deformity, however, will remain undiminished through life.

The unfavourable result of some of the first cases of this description which came under my care, forced me to investigate with peculiar anxiety the nature of the injury. But while the absence of crepitus and of the other usual symptoms of fracture rendered the diagnosis extremely difficult, a recollection of the superior strength and thickness of this part of the radius, joined to the mobility of its articulation with the carpus and ulna, rather inclined me to question the possibility of a fracture taking taken place at this part of the bone. At last, after many unsuccessful trials, I hit upon the following simple method of examination, by which I was enabled to ascertain, that the symptoms above enumerated actually arose from a fracture, seated about an inch and a half above the carpal extremity of the radius.

Let the surgeon apply the fingers of one hand to the seat of the suspected fracture, and locking the other hand in that of the patient, make a moderate extension, until he observes the limb restored to its natural form. As soon as this is effected, let him move the patient's hand backward and forward; and he will, at every such attempt, be sensible of a yielding of the fractured ends of the bone, and this to such a degree as mast remove all doubt from his mind.

The nature of the injury once ascertained, it will be a very easy matter to explain the different phenomena attendant on it, and to point out a method of treatment which will prove comVOL. V. No. 20.

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