pletely successful. The hard swelling which appears on the back of the hand, is caused by the carpal surface of the radius being directed slightly backwards instead of looking directly downwards. The carpus and metacarpus retaining their connections with this bone, must follow it in its derangements, and cause the convexity above alluded to. This change of direction in the articulating surface of the radius is caused by the tendons of the extensor muscles of the thumb, which pass along the posterior surface of the radius in sheaths firmly connected with the inferior extremity of this bone. The broken extremity of the radius being thus drawn backwards, causes the ulna to appear prominent toward the palmar surface, while it is possibly thrown more towards the inner or ulnar side of the limb, by the upper end of the fragment of the radius pressing against it in that direction. The separation of these two bones from each other is facilitated by a previous rupture of their capsular ligament; an event which may readily be occasioned by the violence of the injury. An effusion into the sheaths of the flexor tendons will account for that swelling which occupies the limb anteriorly. It is obvious that, in the treatment of this fracture, our attention should be principally directed to guard against the carpal end of the radius being drawn backwards. For this purpose, while assistants hold the limb in a middle state between prona tion and supination, let a thick and firm compress be applied transversely on the anterior surface of the limb, at the seat of fracture, taking care that it shall not press on the ulna; let this be bound on firmly with a roller, and then let a tin splint, formed to the shape of the arm, be applied to both its anterior and posterior surfaces. In cases where the end of the ulna has appeared much displaced, I have laid a very narrow wooden splint along the naked side of this bone. This latter splint, I now think, should be used in every instance, as, by pressing the extremity of the ulna against the side of the radius, it will tend to oppose the displacement of the fractured end of this bone. It is scarcely necessary to observe, that the two principal splints should be much more narrow at the wrist than those in general use, and should also extend to the roots of the fingers, spreading out so as to give a firm support to the hand. The cases treated on this plan have all recovered without the smallest defect or deformity of the limb, in the ordinary time for the cure of fractures. I cannot conclude these observations without remarking, that were my opinion to be drawn from those cases only which have occurred to me, I should consider this as by far the most common injury to which the wrist or carpal extremities of the radius and ulna are exposed. During the last three years, I have not met with a single instance of Desault's dislocation of the inferior end of the radius, while I have had opportunities of seeing a vast number of the fracture of the lower end of this bone. Stephens Green, February 21, 1814. SELECTED REVIEWS. An Essay on the Venereal Diseases which have been confounded From the London New Medical and Physical Journal, for November and EVERY surgeon, and every general practitioner, of any experience, must recollect, with regret and disappointment, the instances in which his skill and discrimination have been baffled by the Proteian forms of a disease, which is considered by the host of Routinists as so uniform in its nature and appearance, as scarcely to require a moment's examination or thought, where any of the general symptoms are present. In following the steps of Hunter, Abernethy, and a few other distinguished members of the profession, Mr. Carmichael comes before the public with strong claims on their attention, since, independently of his peculiar talent for discrimination, the field of practice, in which he is engaged, must furnish the most ordinary mind with an ample store of facts for the prosecution of the investigation under review. The Lock Hospital in Dublin is supported by Government, and contains nearly three hundred patients, attended by five surgeons, who have their allotted wards; but at the same time, access to the patients and practice of the whole hospital. "The manner in which the investigation was prosecuted, (says Mr. C.) was on the most simple plan. Whenever a primary ulcer on the genitals occurred, which was destitute of the characteristics of chancre-the hardened edge and base, it was treated without the exhibition of mercury; and the same system was pursued in those cases of constitutional symptoms, which had a doubtful appearance. < "The scaly syphilitic blotch, as described in page 129 of Willan, and the excavated ulcer of the tonsils, as described in page 482 of Hunter, were alone esteemed to be syphilitic, and treated with mercury. "As to the affection of the bones, whenever a patient complained of nocturnal pains in the shafts of the long bones, or had a decided node or enlargement of the bone, his disease was esteemed syphilitic, and the use of mercury adopted; but if the patient merely complained of pains in the joints, or if there was any indication that the coverings of the bone only were affected by an inflammatory swelling of a doubtful character, an occurrence which was not unfrequent, the employment of mercury was postponed, until the nature of the disease manifested itself by indubitable syphilitic appearances." v. vi. The pseudo-syphilitic diseases were accurately noted before a numerous class of pupils, and their symptoms contrasted with those of true syphilis in the clinical lectures. The first chapter of the work comprises Observations on those diseases; for instance, Yaws, Sivvens, &c. which have been confounded with syphilis; and historical researches, relative to the existence of venereal diseases, prior to the importation of syphilis from America. That the organs of generation have been occasionally affected with disorders resembling gonorrhea and chancres, from time immemorial, was proved by Becket, Patin, Sanchez, Lombard, and many others before Astruc, who has embodied the evidences on this subject with considerable labour. That they were essentially different, however, from the trans-atlantic infection, is sufficiently obvious, from the circumstance of their either admitting of a natural cure, or of their giving way to medicines without any mercury, which is the reverse of what we know to be the case in real syphilitic affections. We shall, therefore, pass over this part of our author's work, and dwell more on the practical chapters, considering as much as possible the information therein contained, for the sake of those readers whose circumstances or situations debar them from access to valuable, but expensive publications. This is a consideration too generally neglected by the Reviewer, who fritters away a great proportion of his pages in idle declamation or useless hypercriticism, without taking much pains to convey the results or practical deductions of his author, to the mind of his disappointed reader. We have been guided of late, by convictions of the importance of this procedure; and we pledge ourselves for a conscientious discharge of the task we thus impose upon ourselves a task of more difficulty, and occasioning more labour, than is generally imagined; for it requires the most careful perusal of any work, to be able to give a concentrated view of its contents, in the language of the Reviewer, a sine qua non in the plan proposed, since long or frequent quotations are incompatible with the object in question. Having, then, adduced sufficient testimonies, from the writings of ancients and moderns, of the existence of pseudosyphilitic diseases, Mr. C. enters, in his second chapter, on "the local and constitutional symptoms of syphilis, mode of treatment, and action of mercury upon the system." He commences with recommending Mr. Hunter's description or definition of chancre, to be engraven on the mind of every medical man, as he considers the "thickened edge and base," and the abrupt termination of the hardness and thickening in the surrounding parts, to be diagnostics of great importance. "Ulcers," says he," which are not syphilitic, may, but seldom have, a fullness and slight induration round the circumference;" but then the induration does not "terminate abruptly, but diffuses itself gradually and imperceptibly into the surrounding parts." p. 25.-" The induration of a chancre is not confined to the edges only, but extends under the entire surface of the ulcer," "which makes but slow progress, compared to those ulcers of the parts of generation, which are destitute of any surrounding induration, and particularly the phagedenic and sloughing ulcer." p. 26. In the next paragraph, however, there is some obscurity, that may lead to what we conceive to be a wrong treatment. "In the treatment of chancre," says Mr. C. "we should not desist from the exhibition of mercury, till the entire of the surrounding induration is absorbed. And when this is accomplished, if the system has felt the full influence of that mineral, the ulcer may be allowed to cicatrize. As soon as the |
