L

C

L

C

B

The accompanying wood cut represents the instrument used. A, is a circular spring well padded, to pass around the pelvis and fasten in front by means of a strap and buckle. LL L, the joints corresponding to those of the hip, knee and ankle, C C, the thigh and leg pieces. B B, metallic bands and straps for the thigh and leg. I, the shoe and cross piece.

Since writing the above, I have observed in the fourteenth part of " Braithwaite's Retrospect" for 1847, an article by Anthony Colling Brownless, Esq., of London, " On the value of position and mechanical support in the treatment of Diseased Joints, with special reference to the knee-joint."

"The subsequent usefulness of diseased joints," remarks the editor of the above very excellent publication, "depends, 1st, upon the position they are allowed to assume during the active stage; and 2dly, upon proper support in the convalescent stage, when the activity of the disease being subdued, the patient is beginning to use the limb." In reference to the support of the limb, during the active stage of the disease, the following paragraph from Dr. Brownless' paper accords with the experience of surgeons.

"During the active progress of the disease, any splint or apparatus, which will at once maintain the joint in a desirable position, prevent any considerable motion, and be comfortable to the patient, will fulfil all our intentions. Perhaps the strong pasteboard or undressed leather splint,* adapted to the part whilst wet, and afterwards softly padded with lint, or, what is better, goldsmith's or jeweller's wool, will answer as well as anything else, it being light, and at the same time giving good support; but whatever the apparatus may be, no pains should be spared in fitting it in such a manner to the part, as to be perfectly easy to the patient, at the same time that it gives steadiness to the limb, by extending sufficiently above and below the joint.

The limb should lay in a sort of case, which should be long enough to receive the calf of the leg, and also extend well up the thigh." We concur also in the following:

"By the use, then, of this plan to diseased joints, we obtain more or less the following important ends:-first, the alleviation of the sufferings of the patient; secondly, the lessening the liability to repeated attacks of inflammation, and, consequently,

The leather case is also recommended by Sir B. Brodie. See Diseases of Joints.

thirdly, the acceleration of the cure; fourthly, the prevention of deformity, if the disease terminates in anchlyosis, partial or complete; and, fifthly, the ultimate utility of the limb."

But in the "after treatment" my "notions" and apparatus differ very materially from his-after stating the necessity of support to joints thus situated, during the convalescent stage, he proceeds to say: "I know of no better support for a knee-joint, than to envelope it in splints of leather, undressed with oil, first softened in water and allowed to remain on to harden in the exact shape of the joint, when the edges should be rounded and the splints covered with soft wash leather; a large piece of new jeweller's wool is then to be laid over the patella and upper part of the joints, to prevent too much pressure of the edges; the splints are afterwards to be applied and fixed by a roller of strong stuff attached to the end of one of the splints, and passed round and round the joint." Our idea, as stated above, was to throw, to a certain extent at least, the weight of the body, during locomotion, on the pelvis, and at the same time to give such general support to the limb as would allow the patient to extend it freely, and hear his weight upon it as fast as returning strength would permit. The lateral support to be such as to protect all the joints. from deformity.

The last paragraph of the able author, will we think, apply with equal if not greater force to our apparatus, than it does to his plan.

"Besides giving great support to the joints in walking and standing, resisting the tendency to displacement, and consequently, preventing deformity, the leather (spring) apparatus is particularly serviceable in cases of partial anchylosis of the knee joint, more particularly where adhesive bands had been formed, which are liable to be stretched and even torn, and fresh inflam. mation to be set up from every little slip in walking, if the joint be not guarded by an efficient apparatus. No strapping or rolling can preserve a joint from the effects of these accidents so well as the leather case, (steel springs.) Being firm, it (they) preserves the joint also from external violence, and lastly, I consider this apparatus very valuable, by supplying an immediate, or rather, we may call it, a prophylactic remedy for inflammatory attacks."

In another case of the same disease, occurring in Mr. M. a carpenter, twenty-four years of age, who had had a severe attack of acute inflammation of the synovial membrane, and other tissues of the right knee joint, producing stiffening of the joint and contraction of the flexor muscles; I was enabled to restore the limb by means of a single wooden splint and a bandage. The splint was long enough to reach from the tuberosity of the

ischium to beyond the heel under the leg, and a bandage, the ordinary muslin roller, was carefully applied, from the ankle to the pelvis, around both leg and splint, binding in this way the angular and deformed limb to a horizontal plane. Frictions with various oleaginous mixtures, and cooling lotions were applied, and the bandage tightened daily, until, in about two weeks, the leg was sufficiently extended to permit him to walk upon the ball of the foot. The frictions with the hands and liniments were continued in the day time, and the splint worn at night, until a complete cure was effected. The high heeled shoe was also strictly forbidden in this case.

In these and many other cases which might be mentioned, in which tenotomy was not resorted to, we are of the opinion that much is due to the fact that they were recent, and although, as in the case of Mrs. L., the contraction was very considerable, the leg being almost at right angles with the thigh, yet the contractions of the muscles and the deposits in the vicinity of the joints, not having become old and firm, were the more easily extended and broken up. At the same time these cases may be considered useful, as exhibiting how much may be done by the use of merely mechanical means, combined with appropriate frictions.

BIBLIOGRAPHICAL NOTICES.

Lehrbuch der Azneimittellehre. Von Dr. C. G. MITSCHERLICH, Privatdocenten an der Königl. Friedrich-Wilhelms-Universität und praktischem Arzte zu Berlin. Svo. 2 Band. Berlin, 1838, 1846.

Manual of Materia Medica. By C. G. MITSCHERLICH, Privatim docens to the Royal Frederick-William's University, and practical Physician at Berlin. Two volumes. Berlin. 1838. Annuaire de Thérapeutique, de Matière Médicale, de Pharmacie et de Toxicologie pour 1847, contenant le Resumé des Travaux Thérapeutiques et Toxicologiques publiés en 1846, et les Formules des Médicaments nouveaux; suivi d'un Mémoire sur les principaux contrepoisons, et sur la Thérapeutique des empoisonnements et de diverses notices scientifiques. Par le Dr. A. BOUCHARDAT, Chevalier de la Legion d'Honneur, Agrégé de la Faculté de Médecine de Paris, Pharmacien en chef de l'Hôtel Dieu, &c. 18mo. pp. 302. Paris, 1847.

Our German brethren have a singular mode of bringing out many of their treatises on science, and on medical science more especially. Mitscherlich's work on Materia Medica appeared in its first portion as long ago as the year 1838, and its last has not been long issued. There can, therefore, be but little unity in such productions; and it must often happen, that the purchaser of the first parts must be disappointed in receiving the remainder, and, when he does obtain them, they cannot be in entire keeping with the precursors; as, generally, in the lapse of years, material changes must have occurred in the views of the author, and in the progress of science. In most works of a cyclopædiac character, time-and a long time-must necessarily elapse before they can be concluded, and the same objection holds as to the want of uniformity in the earlier and later articles; but as these are not necessarily-nor perhaps often-by the same author, the objection

is not so valid. In the case of Dr. Copland's valuable dictionary, written wholly by himself, great and deplorable delay has occurred, and-as we have before said-there is no knowing when it will terminate; and if the author's life should unfortunately end, and science be thus deprived of a valued ornament, it may experience the fate of the Cyclopædia of Surgery-dead from inanition-and an imperfect work may be left in the hands of the original purchasers. Such was the case with the Dictionnaire des Etudes Médicales, which expired at the termination of the fourth volume, leaving ourselves amongst the bereaved ones.

We wish our German Confrères would abandon this custom of issuing their works piecemeal; for it not unfrequently happens, as the Abtheilungen are sold separately, that a purchaser is unable to obtain some of them, and is thus saddled with an incomplete work, as has happened to ourselves more than once.

It is not our intention to examine the work of Mitscherlich in detail. In a former article, we spoke of the general character of the German works on Materia Medica and Therapeutics; and cominended them for paying much more attention to the therapeutical relations, rather than exhaustiug-as is commonly the case with the English works on the subject-every topic of chemistry and natural history that has any bearing on the matter, and passing over the therapeutical portion in a very cursory and often slovenly manner. Such works are assuredly not desirable as accompaniments to a course of medical lectures, Practical materia medica cannot be completely taught by lectures, although they afford the student most important and essential facilities. An acquaintance with the sensible qualities of drugs can only be attained fully by handling them; but the principles of general therapeutics, and the indications which special articles are capable of fulfilling, can be conveyed by lectures in a manner to render the impression forcible and enduring; and the most valuable accompaniments to the student of materia medica, in the shape of books, are those that teach just so much of the sensible properties of the articies of the materia medica as may enable the practitioner to recognize and select the genuine, and to discard the spurious and imperfect; whilst they expand copiously on the adaptation of such articles to the treatment of disease. It is,