of the parts renders, except in the case of youths, such a mode seldom admia sible. In such cases as have been mentioned, however, the method often succeeds. The mode of procedure is as follows: The patient being placed on his back upon a mattress, a sheet passed in a broad fold between the legs and carried obliquely below and above the body, is fastened near the head, either to the foot of a large bed, a staple, or some other firm purchase. A towel is then passed around the thigh above the knee, over which a jack-towel is then passed with a clove hitch. This the surgeon extends by throwing the other. end over his shoulders, first placing his heel in the groin, and grasping the limb, guides it with his hand as he makes extension, till it springs into the socket. In strong and adult persons, however, this plan seldom succeeds, and the pulley must be resorted to. When this is the case, it is customary to pass another folded sheet from the opposite side across the body, and make its ends secure like the former, so as to keep the patient perfectly fixed. To the jack-towel attached to the knee, the line from a double block pulley is then fastened, the pulley being made fast to some resisting object, or a staple, on a line with the floor. The surgeon now takes his place by his patient, and grasps the thigh to guide it, as an assistant, or two if necessary, with slow and steady pulling extend the limb, till the surgeon, having brought the bead to its natural position, gives the word for a trifling yield, when, if rightly placed, the bone with a loud report sinks into its socket. It is in the reduc tion of such dislocations as these, occurring in strong muscular men, when no amount of straining can overcome the resistance of the muscles, that the bleeding, tartar emetic, and such relaxing means, already mentioned, must. be adopted before the patient is unbound or left,

After so severe an accident, it will be necessary to enjoin some days' total rest before exerting the limb by the slightest exercise.

Dislocation of the Ankle and Toes.-The accident to the foot, like that to the hand, is either backward or forward. As in that case, the leg must be firmly held by one, while another extends the foot in a line with the leg till the proper moment arrives, when the foot is to be pushed up or back to meet the bones of the leg. A bandage, as in the case of the wrist, must be placed around to support this injury. It not unfrequently occurs with dislo cation of the foot, that there is a fracture of the upper portion of the fibula or small bone of the leg. In such a case, the fracture must be attended to after the reduction of the joint. The displacement of the toes must be treated in the same manner as that of the fingers.

Dislocation of the Jaw.-This is a very alarming accident to see, bus by no means difficult to cure; for as the person finds himself in a moment with an immovable jaw, and incapable of speech, with a mouth wide open, he can only by motions indicate what has happened. This accident is most

frequently caused by a fit of gaping, though a blow on the side of the face when the mouth is open, or a fall, have caused it. The treatment consists in seating the individual in a chair, when the surgeon. having enveloped both hi thumbs in strips of lint, places a thumb on the back of the lower jaw, one on each side, and while his fingers grasp the chin, he presses firmly downward on the teeth as he brings the jaw a little for ward and upward with his fingers, till the heads spring into their sockets. So rapidly and so forcibly does the jaw close, that unless he has well protected his thumbs, the operator may expect a very severe bite.

The collar-bone, and also the ribs, are sometimes dislocated, but as both are much more frequently fractured, and nearly the same treatment is adopted in both cases, we shall defer a description of such accidents till we come to "Fractures."

The Dislocation of Hinge-lik Joints.-Foremost among this order of articulations is the elbow joint, and next in importance that of the knee; and though these are sometimes by a violent force dislocated, fortunately they are so powerfully bound around and protected by ligaments, that such accidents are very rare, and only from a very high fall on the feet, by a railway collision

or a restive horse dashing its rider against a wall, or some other extremely forcible injury, can a dislocation of such firmly-locked articulations be effected.

The previous advice given in respect of the treatment of dislocations generally should be borne in mind in the accidents we are about to refer to with even more than ordinary attention. When once satisfied of the nature of the injury, not an unnecessary moment should be lost before proceeding to the reduction of the mischief, as every minute's delay not only adds greatly to the suffering of the patient, but by the rapid swelling that succeeds complicates the treatment.

Dislocation of the Elbow.-As three bones enter into the formation of this joint, it admits of several varieties of luxation, both backward and forward-that is, the joint of the forearm may be forced behind the bone of the arm, or it may be driven up in front of it; again, the two bones of the forearm may be dislocated from each other in several ways. The two most general forms, however, are the backward and forward dislocation.

There are three modes of effecting the reduction of such accidents, which we give in their proper order.

Ist. The following treatment will generally succeed with youths and children: The patient is to be placed in a chair, and while one assistant grasps the arm, and by counter-extension keeps the limb stationary, another, Taking the forearm by the wrist, gradually extends the limb, as the surgeon, seated by the patient, grasps the member above or below the elbow, and by means of a steady pressure of either his thumbs or fingers backward or forward, as the nature of the accident may demand, forces the bones into their proper place When the muscular power resists such force, a sheet must be passed across the patient's chest and made fast to the wall; a towel is then to be wrapped around the wrist, and the line of a pulley attached to the hitch on the towel, and while the assistant at the arm and the surgeon at the elbow, as in the former case, repeat their efforts, the other assistant, by means of the longer lever of the pulley, makes a gradual and steady extension.

d. The patient and surgeon being seated on separate chairs, the latter takes the limb in his hands, and, steadying his knee on the style of his chair, places the hollow of the arm, or the side of it, against the point of his knee, and, bending round the arm, endeavors to force the bones back to their natural position, the knee-cap of the operator acting as a fulcrum, and often sffecting what a direct strain on the muscles could not perform-a reduction. 3d. This method is only a modification of the second, and consists in seating the patient on the foot of a bed, and, making a fulcrum of the bedpost, bending the dislocated limb upon it; the surgeon using his hands, as an assistant bends the arm, to aid the action by the pressure of his fingers.

Some surgeons have succeeded in reducing the injury by using the round arm of an easy-chair instead of the knee or bed-post.

Great care must be taken after the reduction, not only in keeping the arm in a sling for some weeks, but in applying warm fomentations around the joint, or lotions of sugar of lead and vinegar, made warm, to reduce the inBammatory action which is sure to supervene.

Dislocation of the Knee Joint and Knee Cap.-Like the elbow, the knee may also be displaced backward and forward, and also inwardly and outwardly, as well as having the bones of the leg themselves separated from each other. Considerable force is often necessary to reduce a luxation of the knee joint, and overcome the muscular resistance; but in consequence of the large articulating surfaces of this joint, the bones, when once brought down, glide easily into their places.

The mode of treatment is much the same as that already described. A firm counter-extension, by means of a sheet, must be made by the thigh, and extension then established from the leg, which must be kept partially bent during the operation; a towel, secured in the ordinary manner by a clove hitch knot, is in the first instance to be adopted for making the extension; the surgeon keeping his place by the knee, to assist, with hands and fingers, the operation. When greater power is required, the towel must be joined to the pulley, and extension again made till the reduction is effected.

The KNEE CAP, or PATELLA, is very liable to be displaced, either outward, inward, or upward. When this little flat bone is forcibly driven from its place, it is generally pushed over the protuberances of the bones, when it lies as it were in a hollow, from which it requires some art to extricate it. This is generally effected by pressing suddenly on the edge of the bone farthest from the joint, by which means the other end is canted up over the bony enlargement, when the contractile power of the muscles at once draws it into its place over the joint. When this cannot be effected, the leg of the patient, who has been placed on his back, is to be raised and bent as far as possible toward his face. It is then to be suddenly flexed or bent back on the thigh till the beel touches the hip. The surgeon, as he does so, with one hand

presses, as before explained, on the rim of the bone, and quickly opening the again, the patella glides into its proper situation.

The after treatment in both of these dislocations requires rest, warm ap plications to soothe the joint, if necessary, and evaporatiug lotions if there is much inflammation or heat in the part, and a bandage or elastic knee-cap support to the limb, which should be worn for some months.

EMERGENCIES-Recovery of Persons apparently Drowned, or Dead.-Lose no time. Avoid all rough usage. Never hold the body up by the feet. Nor roll the body on casks. Nor rub the body with salt and spirits. Nor inject tobacco smoke, or infusion of tobacco.

Restorative Means, if apparently Drowned.-Send quickly for medical assistance; but do not delay the following means:

Convey the body CAREFULLY, with the head and shoulders supported in a raised condition to the nearest house.

Strip the body and rub it dry; then wrap it in hot blankets, and place it in a warm bed in a warm chamber.

Wipe and clean the mouth and nostrils.

In order to restore the natural warmth of the body:

Move a heated covered warming pan over the back and spine. Put bladders, or bottles of hot water, or heated bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet Foment the body with hot flannels; but, if possible, immerse the body in a warm bath as hot as the hand can bear without pain. Rub the body briskly with the hand; but do not suspend the use of the other means at the same time.

To restore breathing, introduce the pipe of a common bellows, into one nostril, carefully closing the other and the mouth; at the same time drawing downwards, and pushing gently backwards, the upper part of the wind-pipe, to allow the free admission of air; blow the bellows gently, in order to inflate the lungs, till the breast be a little raised: the mouth and nostrils should then be set free, and a moderate pressure made with the hand upon the chest. Repeat this process till life appears.

Electricity to be employed early by a medical assistant.

Inject into the stomach, by means of an elastic tube and syringe half a pint of warm brandy, or wine and water.

Apply sal-volatile to the nostrils.

If apparently Dead from Intense Cold.-Rub the body with ice snow, or cold water. Restore warmth by slow degrees; and, after some time, if necessary, employ the means recommended for the ap parently drowned. It is highly dangerous to apply heat too early.

If apparently Dead from Hanging. In addition to the means recommended for the apparently drowned, bleeding should early be employed by a medical assistant.

If apparently Dead from Noxious Vapors, Lightning, etc.Remove the body into a cold fresh air. Dash cold water on the neck, face, and breast frequently. If the body be cold, apply warmth, as recommended for the apparently drowned. Use the means for inflating the lungs as directed above. Let electricity (particularly in accidents from lightning) be early employed by a medical assistant.

If apparently Dead from Intoxication.-Lay the body on a bed, with the head raised; remove the neckcloth and loosen the clothes. Obtain instantly medical assistance, in the meantime apply cloths soaked in cold water to the head, and bottles of hot water, or hot bricks, to the calves of the legs and to the feet.

General Observations.-On restoration to life, a tea-spoon of warm water should be given; and then, if the power of swallowing be returned, small quantities of weak brandy and water, warm; the

patient should be kept in bed, and a disposition to sleep encouraged, except in cases of apoplexy and intoxication. Great care is requisite to maintain the restored vital actions, and to prevent undue excitement. The treatment is to be presevered in for three or four hours. It is an erroneous opinion that persons are irrecoverable because life does not soon make its appearance.

POISONS-Antidotes to.-The treatment of cases of poisoning must vary with the nature of the poison, the quantity taken, and the peculiarities of the individual. In almost all cases, copious vomiting should be excited as soon as possible by tickling the throat, and by emetics, such especially as sulphate of zinc, or ipecacuanha with emetic tartar; the former, however, in ten-grain doses dissolved in a little warm water, and repeated every ten or fifteen minutes till it freely operates, is generally most effectual. The use of the stomach-pump should also be resorted to. The vomiting should be kept up, and the stomach washed out with bland albuminous or mucilaginous fluids, such as milk, flour and water, or thin paste, etc.; sometimes sugar and water.

The following is a short summary of the antidotes resorted to in reference to particular poisons. They should, of course be administered as speedily as possible.

Emetic in Cases of Poison.-Two table-spoons of made mustard in a pint of warm water; iftaken immediately, this is a certain remedy, instantly producing violent vomiting. Also administer large draughts of warm milk or water, mixed with oil, melted butter, or lard.

Arsenic.--Lime water, chalk and water, and the hydrated sesquioxide of iron, have each been strongly recommended; the last is decidedly the best.

For Mineral Acids, or Acetic and Oxalic Acids.-For this form of poison, give quickly large draughts of chalk, whiting, magnesia, soap and water, about as thick as cream; followed by albuminous diluents, such as milk, and white of egg mixed with water. Or, if these cannot be procurred at once, warm water; and promote vomiting by tickling the throat.

Alkalies, Soda, Potash, Ammonia, etc.-Vinegar, or any mild acid and water, or even very dilute mineral acids, such as water acidulated by them; olive oil, almond oil.

Corrosive Sublimate.-White of egg and water; ailk and cream; decoction of cinchona; infusion of galls.

Sulphate of Copper and other Poisons.-Sugar and water; white of egg and water.

Antimonial Poisons.-Warm milk, gruel, and barley water; infusion of galls; decoction of cinchona.

Nitrate of Silver.-Copious draughts of warm salt and water. Sulphate of Zinc.-Solution of carbonate of soda in water, with milk, and mucilaginous or farinaceous liquids.

Acetate of Lead.—Emetics, solution of sulphate of soda in water, milk, white of egg and water.

Opium and its Preparations.-Emetics, strong coffee; dashing cold water upon the face and breast; preventing torpor by forced exercise.

Prussic Acid.-Ammoniacal stimulants cautiously applied to the nose; ammonia, or sal-volatile in repeated small doses of solution of chlorine in water; small doses of chloride of lime in water.

Strychnia and Vegetable Alkaloids.-Infusion of gall nuts; coction of cinchona; emetics. See "Accidents."

RULES FOR THE PRESERVATION OF HEALTH.

BY THE PUBLISHER.

ABSTINENCE.-Disease may oft be cured by abstinence from all food, especially if the disorders have been procured by luxurious living and repletion. The latter overtaxes nature, and it rebels against such treatment. Indigestion, giddiness, headache, mental depression, etc., are often the effects of greediness in meat and drink. Omitting one, two, or three meals, allows the system to rest, to regain strength, and allows the clogged organs to dispose of their burdens. The prac tice of drug taking to cleanse the stomach, though it may give the needed relief, always weakens the system, while abstinence secures the good result, and yet does no injury.

Said a young gentleman to a distinguished physician of Philadel phia, -"Doctor, what do you do for yourself when you have headache or other slight attack?" Go withou. my dinner," was the reply. "Well, if that will not do, how do you proceed then?" "Go without my supper," was the answer. "But if that does not cure you, what then?" "Go without my breakfast. We physicians seldom take medicines ourselves, or use them in our families, for we know that starving is better, but we cannot make our patients believe it."

Hippocrates (the father of medicine) said wisely, that if a man eats sparingly and drinks little, he is nearly certain of bringing no disease upon himself, and that a moderate supply of food nourishes the body best. The quantity of food which nature really requires for her sup port is small, and he that eats and drinks moderately at each mea! stands fair to enjoy sprightliness, vivacity, and freedom of spirits Bodies governed by temperance and regularity are rarely hurt by melancholy, or any other affection of the mind. To have a clear head we must have a clean stomach; for this is the grand reservoir in which the food is first deposited, and thence its nutritive power is distributed throughout all parts of the body.

BATHING.-If to preserve health be to save medical expenses, without even reckoning upon time or comfort, there is no part of the household arrangement so important to the domestic economist as cheap convenience for personal ablution, For this purpose baths upon a large and expensive scale are by no means necessary; but though temporary or tin baths may be extremely useful upon pressing occasious, it will be found to be finally as cheap, and much more readily convenient, to have a permanent bath constructed, which may be done in any dwelling-house of moderate size, without interfering with other general purposes. As the object of these remarks is not to pre sent essays, but merely useful economic hints, it is unnecessary to expatiate upon the architectural arrangement of the bath, or, more properly speaking, the bathing-place, which may be fitted up for the most retired establishment, differing in size and shape agreeably to the spare room that may be appropriated to it, and serving to exercise both the fancy and the judgment in its preparation. Nor is it particularly necessary to notice the salubrious effects resulting from the bath, be