ORIGINAL COMMUNICATIONS. PAGE Case of Impacted Intracapsular Fracture of the Neck of the Thigh Bone. MONTREAL GENERAL HOSPITAL. Surgical Cases Occurring in the Practice of the Montreal General Hospital, Mathieson....... 299 303 304 .... Compound Comminuted Fracture of Tibia and Fibula-Delirium Tremens- 306 308 Proceedings of the Medico-Chirurgical Society of Montreal... CORRESPONDENCE. To the Practitioners of Medicine and Surgery of the Province of Ontario... 321 REVIEWS AND NOTICES OF BOOKS. Spermatorrhæa, its Causes, Symptoms, Results, and Treatment. By Robert 323 Renal Diseases, a Clinical Guide to their Diagnosis and Treatment. By SURGERY. A New and Most Useful Eye Salve in "Granular Lids," and in all Cases of Chronic Ophthalmia. By John Williams, Physician and Surgeon..... 325 Syphilitic Gonorrhoea... .... New Treatment of Piles.. Mr. Skey on Gonorrhoea and Gleet.... MEDICINE. On the Treatment of Hæmoptysis. By Dyce Buckworth, M.D., Assistant MIDWIFERY. 326 326 328 331 On the influence of Chloral on the Pain of Parturition. By E. Lambert, Esq. 337 Subnitrate of Bismuth in Cholera Infantum Retracted Nipple...... MATERIA MEDICA AND CHEMISTRY. 338 339 The Alkaline Sulphites and Hyposulphites. Extract from a Lecture Introductory to the study of Diseases of the Skin. By Dr. McCall Anderson. 339 EDITORIAL. The Body Snatching Case at Lachine... 342 Sir William Lawrence and Chloroform 343 A New Method of Delivering the After-Coming Head in Contracted Pelves. 344 Holt's Operation for Stricture of the Urethra.. 344 Treatment of Enlarged Tonsils in Children.. 344 CANADA MEDICAL JOURNAL. ORIGINAL COMMUNICATIONS. Case of Impactel Intracapsular Fracture of the Neck of the Thigh Bone. By GEORGE Ross, A.M.,M.D., House Surgeon, Montreal General Hospital, Attending Physician Protestant House of Industry and Refuge. On the 2nd July, 1868, I was summoned to the Protestant House of Industry and Refuge to see an old man named John H., æt. 79, who had slipt and fallen on the floor, and was said to have been bruised on the hip. I found him lying in bed where he had been lifted, complaining of pain over the region of the left hip: he was unable to stand upright and the attempt to do so gave pain. There was no shortening, and very slight eversion of the foot. I was not satisfied that there was fracture, so prescribed an evaporating lotion and saw him the next day. There was now marked eversion of the foot, some shortening and considerable swelling over the hip joint, which was painful. I had him removed at once to the Montreal General Hospital, where he was placed under the care of Dr. Wright. Upon proper extension and rotation by an assistant distinct crepitus was now got. This confirmed the diagnosis of intracapsular fracture of the neck of the femur. He was laid upon a hair mattress and moderate extension was made by means of a pulley and weight, the limb being steadied by a light splint placed along the outer side. This was kept up for between three and four weeks when, it having become irksome and a small bedsore having been formed, it was discontinued, but he was still confined to bed. In two weeks more he was allowed to get up-the slight bedsore soon healed, his appetite improved somewhat, but his general health remained very poor. He never could bear any weight whatever on the limb, and there was shortening about 1 inch. On the 12th October he was discharged from the hospital, returning to the insti-tution whence he had been brought. From this time he gradually failed, and finally died on the 16th November, 1869, 137 days after the accident. VOL. VII. I removed the upper part of the femur, made a section of the bone, and of it the accompanying plates furnish an accurate representation. A description of the woodcut is scarcely needed, as it speaks for itselfThe neck of the femur has evidently been fractured short off at its junction with the shaft of the bone, and the loose portion has then been forcibly jammed into the substance of the great trochanter. When examined, the head of the bone could without difficulty be moved in its new position, but still it was found that there existed a considerable amount of strong new fibrous tissue between the broken ends. The case is interesting, as showing how an attempt at union was made in this fracture in a man of nearly 80 years of age and in very feeble health, and also I think as showing how, by thorough impaction, such as existed, doubtless, in this case, a condition of things might be established which would render it possible for an intracapsular fracture to become united by bone, contrary to the ordinary experience in such cases, and contrary to the absolute dictum of some high authorities. Of course there was no bony union in this particular instance, but I think we may conceive that in a somewhat younger person and one possessing more vigor, actual osseous union might be looked for under parallel circumstances. HOSPITAL REPORTS. SURGICAL CASES OCCURRING IN THE PRACTICE OF THE MONTREAL GENERAL HOSPITAL, UNDER EHE CARE OF G. E. FENWICK, M.D. Case No. 6.-Excision of the Knee-Joint. MATHIESON. Reported by Mr. J. H. William H., aged 23, fair complexion, red hair, was admitted into the Montreal General Hospital, May 23rd, 1870, with anchylosis of right knee joint. Previous History. He was bathing in a stream one afternoon, when eleven years of age, and remained in the water longer than usual. Felt no bad effects that night, but when he awoke the following morning his right leg was flexed nearly at right angles, and he was unable to straighten it, nor could it be straightened by the force employed. There was no pain-no abnormal sensation. A surgeon was consulted the same day, who then ordered a liniment to be applied, and afterwards proposed subcutaneous section of the ham-string tendons, but it was not consented to. The leg is now flexed on the thigh at right angles. The bones of the leg are dislocated backwards; the condyles of the femur projecting and the patella is firmly attached by apparent bony union to the external condyle. The whole limb is very much dwarfed from arrested development; there is shortening of two inches in the thigh, and one inch in the leg. The foot is very much arched; the heel unnaturally long and projecting downwards; the toes, semi-flexed. He says he has never had any pain in the knee. May 28th.-A consultation was held and excision of the joint deemed advisable; Dr. Fenwick, therefore, proceeded to operate. He carried a semi-circular incision from a point above the inner condyle, downwards and forwards over the lower border of the patella, and up on the outer side to a point opposite the place of starting. He then dissected the flap up, over the patella, divided the lateral ligaments, and turned out the ends of the bones; with butcher's saw he cut throught the extremity of the femur, from behind forwards at right angles to the axis of the bone. Similarly he removed a thin slice from the head of the tibia, but finding that some disease remained, a second portion was removed. It was found neces sary to divide the ham-string tendons so as to place the bones in position; the wound was then washed with carbolic acid lotion, and the flap secured by metallic sutures. A roller was then applied to the leg and thigh, and the limb arranged in the splint. The splint, which was made according to Dr. Fenwick's plan, consisted of two iron bars, extending from the groin to the ankle, and bowed at the knee. To these were riveted two tin gutters, in one of which the thigh rested, in the other the leg, having a space of about four inches between them, so that the wound and the rest of the circumference of the limb were free for the application of dressings; to the lower extremity, a foot piece similar to that of a McIntyre splint was attached; carbolic acid dressings were applied ; ordered milk diet, and one pint milk and one pint beef juice extra. On examining the bones it was found that there was caries of the head of the tibia, and extremity of the femur; the inter-articular fibrocartilages were destroyed; the patella was displaced outwards, and firmly anchylosed to the external condyle of the femur. May 29th.-Pulse 120. The operation was followed by considerable shock, from which he has completely recovered. There has been very little oozing of blood; he has considerable pain; got a draught of liquor morphiæ last night, and slept soundly four hours. May 30th.-Pulse 114 and fuller; tongue furred and dry; surface hot: not so much pain as yesterday; the wound looks well; two of the stitches were removed. May 31st.-Pulse 112; slept well; pain same as yesterday; skin moist and hot; appetite improving. June 1st.-Pulse 116; he is restless and feverish, did not sleep much last night; great pain and considerable spasm of the muscles of the thigh; the remaining stitches were removed; there is now a free discharge of pus. June 2nd.—Pulse 100; slept well; tongue clean; surface moist; pain much less; a part of the wound about the centre of the flap appears to be healing by primary union. June 3rd.-Pulse 96; he is much better; there is less pus than there has been the two past days and it is becoming thinner, and less healthy. June 4th.-Pulse 88; tongue clean; bowels regular; has very little pain; the knee is slightly bent outwards; a narrow slough, about an inch in length, has formed on the margin of the flap at its inner extremity; by slight pressure upon the flap about 3 ij. of sanious pus containing some bubbles of gas, escaped; ordered to inject lotio acidi carbolic (1 x 40). The injection passed freely from one side of the wound to the other, and washed out a large quantity of dark grumous pus. June 6th.-Pulse 90; a little more irritable to-day, but not more pain. Dr. Fenwick changed the whole of the dressings; while arranging |