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most favourable issue. The last occurs rarely; but suppuration is by no means uncommon; in which case, if the abscess do not point outwardly, an empyema will necessarily follow; and the formation of pus is indicated by a remission of the pain, one or more shivering fits, and, in some instances, a sense of fluctuation. This, however, is a termination far more common to pleurisy from external injuries, than from internal causes.” 366.

Yet, in nine cases out of ten of fatal pleurisy, the termination is by sero-purulent effusion into the cavity of the chest, without any thing like an abscess pointing outwardly. It is well ascertained, also, that in all cases of acute pleuritis, there is more or less of serous effusion, which becomes absorbed, in the event of recovery, leaving or not, according to the extent of the disease, adhesions between the pleura pulmonalis and pleura costalis. In a new edition, Dr. Good must extend greatly his pathological researches; and on the subject of pulmonic affections, be cannot draw from a better source than the investigations of Laennec and Baron.

By the way we have some fault to find with Dr. Good in his treatment of pulmonary inflammation. " The best, the easiest, and even the natural cure of peripneumony is expecLoration." We cannot subscribe to this doctrine. It is ibe nalural cure no doubt, because Nature has no other way of unloading the vessels, without great danger.

But by a prompt and decisive depletion we will very often save Nafure the trouble of even expectoration at least the inflammation may be frequently subdued before any expectoration appears, which will then be very trifling in quantity:

Again, Dr. Good takes no notice of antimony in the treatment of pneumonia, excepting as an occasional auxiliary to saline draughts in determining to the skin and promoting diaphoresis. “ One of the most common, and, at the same time, most useful refrigerants, is nitre ; which may be combined with the citrate of potash, or made to produce a more certain determination to the skin by the addition of camphor or of antimonial wine, or by a combination with the citrate or acetate of ammonia.” This is all that is said of antimony as a powerful controller of the circulation, taken in doses just sufficient to produce nausea, especially when aided by digitalis, another important remedy which we do not observe in Dr. Good's methodus medendi.

Our author, however, strongly recommends the action of full vomiting, (by what medicine is not said) and that kept up for an hour or two, even when the pulmonic inflammation “bas made considerable advance." "Not having given the measure a trial, it would not be fair to condemn it; but, we confess that, beyond nausea, we should be afraid to proceed. Vol. III, No. 12.


in inflammation of such an organ as the lungs or their invesmcnt.

Our author notices the dangerous phenomenon of suppres. sed expectoration in the progress of pneumonia. We have seen it caused by an incautious cathartic, and we know of no medicine so powerful in restoring it, as the carbonate of ammonia in doses of ten grains frequently repeated.

We shall pass on to the subject of dysentery. It is always disagreeable to us to take up the review of systematic works, because analysis is not applicable to them, and criticism is the paramount duty of the reviewer in such cases. It is his main object, also, to point out what he conceives to be errors or imperfections, for the good both of the author and public; what he passes unnoticed being considered as having his approval. This is the path which we are unavoidably compelled to pursue in the work before us; and if our articles are chiefly composed of censures, it is because we cannot possibly even enumerate the chapters and sections of valuable matter diffused through these volumes.

The dissertation on dysentery not only disappointed, but almost provoked us. During the last memorable war, our fleets and armies were dispersed over every part of the globe, and our medical officers collected a mass of important information on the subject in question, such as had never before been collected or recorded. Yet, not a single writer of the last twenty or thirty years does our author seem to be acquainted with,-or, if acquainted with, has he noticed. Dr. Harty, who some fifteen or twenty years ago, made dysentery ihe theme of his inaugural dissertation at Edinburgh, is the only author quoted since the antiquated publication of Mosely some thirty years ago! Even Harty is only noticed as having accidentally fallen into our author's bands, after part of bis chapter on dysentery was composed. In fact, it appears to us that Dr. Good, not liking to take the trouble of looking around him to see what was the existing state of our knowledge on the subject of dysentery, as scattered through all our periodicals and many distinct and excellent monographs during the last twenty years, bas contentedly fallen back upon Sydenham, and determined “to take him as our polar star»'* -Sydenham who, it is our firm belief, never examined a dead body after he left bis academical studies—at least he has given us no indication of pathological knowledge in any of his works!

We shall not enter into particular criticism on a chapter which, we are most reluctantly constrained to say, is unworthy of our author. In the etiology and pathology there is no information at all—and what little is said of practice is, generally speaking, erroneous, bad, and antiquated. In another edi. tion Dr. Good had better cancel the whole of this chapter, and consult those modern authors who saw and felt dysentery in various climates-who dissected their patients, and consequently became acquainted with the pathology of the disease-who discarded the unfounded Cullenian notion of contagion—who treated the malady with success, notwithstanding the dogma of Mosely to the contrary-and who, finally, have exhibited a more enlightened ralio symptomatum than his favourite Sydenham did, whose genius could only reach the sublime theory, that dysentery was a fever turned in upon the guts."

# See


449 of vol. ï.

The next subject discussed by Dr. Good is bucnemia sparganosis, or phlegmatia dolens. The only authors quoted are White, 'l'rye, Ferriar, Hull, and Denman. He makes no allusion to the able investigation of Dr. Dickson of Clifton, in the second volume of the quarterly series of this jour. nal; nor does he advert to the circumstance that phlegmatia dolens has occurred in the unimpregnated state, and even in the male. An instance of this last was met with in a marine by Dr. Denmark, then surgeon to Haslar Hospital, who has published the case and a plate of the limb—another instance happened in the person of Dr. Purdy of New York-and a third in the practice of the late Mr. Baynton of Bristol. Bating these deficiencies in the history of the disease, Dr. Good's account, though short, is sufficiently correct, and the therapeutic plan judicious. The latest information wbich we have been able to obtain respecting the pathology of the disease is, that it depends, sometimes at least, on inflammation of the great inguinal vein. A physician-accoucheur of this metropolis has some preparations, we believe, shewing this circumstance, and means to publish on the subject.

Acute rheumatisni occupies but seven pages of the volume under review, which is by far too short a space, when we consider the importance of the subject. Dr. Good has taken no notice of that very dreadful disease, rheumatic metastasis to the heart, which, for many years past, has occupied much tbe attention of the medical world.

In the chapter on gout we see nothing that need detain us. It also is rather short, when we consider what ponderous tomes have been written on the subject. Dr. Good, who appears to have had some visitations of the disease in bis own person, seems not disinclined to a limited application of cold to the part arthritically inflamed; but acknowledges that be


has never been able to muster up courage to put in execution that striking peculiarity of practice recommended, some years ago, by Dr. Balfour, namely, percussion and compression. “But our sheet-anchor," says he, “is opium ; and it should be given freely, and in union with some preparation of antimony, so as to act towards the surface generally, and thus restore to the living power its interrupted equilibrium."

On the subject of the exanthematous diseases, including plague, there is a very fair body of information brought forward by our author, but nothing novel, of course; we must therefore pass over this entirely, and here close our article, having already overstepped our boundary. In a future number we shall pursue our examination of these volumes.

A Treatise on Dislocations and Fractures of the Joints.

By Sir Astley COOPER, Bart.
(Second and final Analytical Article. Concluded from p. 640, No. 11.)
Our readers are aware that, in our last number, we gave a
very full analysis of that division of Sir Astley Cooper's work
which embraced the important subject of dislocations and
fractures at and about the bip-joint. The next series of ac-
cidents treated of by our author are-

Dislocations of the Knee. The articulating cavities of this joint are shallow, and on that account would be liable to dislocation, but their surfaces are broad, which counter balances this liability. We shall not enter on the anatomy of this joint, which is ably sketched in the work before us, but proceed at once to the accidents to which it is obnoxious. The first is dislocation of the patella, which may take place in three directions-outwards, inwards, and upwards. Of tho lateral dislocations, the outward one is the most frequent. “ In either of these cases the ligament will be torn unless there be previous disease.” The mode of reduction in both instances is as follows :-The patient is to be placed in a recumbent posture, while an assistant raises the leg by lifting it at the heel, thus relaxing the extensor muscles on the thigh. The surgeon is then to press down that edge of the patella which is most remote from the joint, be it one mode of luxation or the other, and this pressure raises the inner edge of

the bone over the condyle of the os femoris, when it is immediately drawn into position by the action of the muscles. An evaporating lotion is first to be applied, and, in a few days, it may be bandaged.

Dislocation upwards. Here the ligamentum patellæ is torn through by the action of the rectus, and the effect of the injury is to draw the patella upwards upon the fore part of the thigh bone. The appearances are so obvious as to need no description. A smart inflammation follows this accident.

“ In the treatment of this injury, local depletion and evaporating lotions are to be used from four to seven days from the accident, and then a roller is to be applied around the foot and upon the leg, to prevent its swelling; the leg is to be kept extended by a splint behind the knee, and a bandage composed of a leather strap is to be buckled around the lower part of the thigh; to this is to be attached another, which is to be carried on each side of the leg, and under the foot, and is to be buckled to the circular strap; thus the bone is gradually drawn down, so as to allow of an union of the ligament. In a month the knee may be slightly bent, and as much passive motion daily given as the patient is able to bear; by these means the ruptured ligament becomes united, and the patella retains its motion." P. 182.

While the bandage is worn the patient should persevere in the sitting posture, in order to keep the rectus muscle relaxed and prevented from acting on the patella.

Dislocation of the Tibia at the Knee Joint. This may happen in four ways-two of them incomplete and lateralthe others perfect luxations, the tibia being thrown either backwards or forwards. The lateral dislocations are but rare, and are easily reduced merely by extension.

Dislocation forwards. In this accident, which is uncommon, the external marks of the injury, when the patient is recumbent, are these—the tibia is elevated, the thigh bone is depressed and thrown somewhat to the side as well as backwards—the os femoris compresses the popliteal artery, and renders the pulsation in the anterior tibial imperceptiblethe patella and tibia are drawn by the rectus muscle forwards. In a case of this kind, brought into Guy's Hospital in the year 1802, the limb was easily reduced by extending the thigh from above the knee, and by drawing the leg froin the thigh and inclining the tibia a little downwards.

Dislocation backwards. This must be also a rare occurrence, as Sir Astley relates but one case, and that happened in the practice of Dr. Walshman. The appearances are

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