moved, the arm made bare, and covered again with towels wet with cold water. Brandy and chicken broth were administered, but the stomach rejected them. Resort was then had to injections of beef tea, and sinapisms to the extremities. Carb. ammon. in emuls: amy gdal: was administered, and retained. The pulse rose a little, and after tone was restored in some measure to the stomach, brandy and water were freely given. I deemed it useless to attempt to secure the artery as the screams and struggles of the child might have increased the hæmorrhage, and as the orifice was too small to enter with the tenaculum or needle, without a further division. Reliance was placed on the cold affusions, and perfect rest-they were sufficient. By pursu ing this plan for several days, re-action was restored, and the patient is now recovering. Much thick and offensive matter was thrown off from the tumour, and continues to some extent at this time. The swelling has entirely subsided, and there remains an inability to extend the fore-arm from contraction of the biceps muscle, the radial tendon of which rises distinctly into the bend of the arm, when the extensor muscles attempt to act. The substance of the biceps muscle, and the coats of some one of the important branches of the brachial artery must have been embraced within the sphere of the suppurative action, and suffered a dissolution during its progress, in order to give rise to the results which followed. Had the abscess been penetrated by the lancet, the hæmorrhage would no doubt have been attributed to its use; and had the patient died, the reflections of the operator must certainly have been very unsatisfactory.

FRACTURE OF THE CERVIX-FEMORIS.

HISTORY OF A FATAL CASE, AND ITS POST-MORTEM APPEARANCES; AND OF A CASE WHICH TERMINATED FAVOURABLY.

I

By N. W. Condit, M. D.

propose to lay before you the history of two cases of fracture of the cervix-femoris; one of which, by the death of the patient, afforded an opportunity to verify its exact character. The other, though not equally ascertained in this respect, is one of interest, on account of its favourable result, under circumstances of a discouraging nature. Fractures of this bone, occurring wholly within the capsule of the joint, it is stoutly maintained by many distinguished physicians of the present day, are never re-united by ossification, because of the small quantity of blood received by the head of the bone, (being only that which comes by the vessels of the round ligament,) or at least, that no case is yet recorded. where such bony union is demonstrated by dissection. Captain J. B., aged over eighty years, in ascending a flight of steps from the ground to his house, missed his footing and fell with a few sticks of wood he was carrying, down three or four steps to the ground. He rose without difficulty, and walked a short distance, when he was suddenly disabled from proceeding further, by acute pain seizing him suddenly at the hip joint of the left side. He was assisted by some members of his family to a bed, but could only lie with comfort upon his back. He was of large stature, about five feet ten or eleven inches in height, weighing probably one hundred and eighty pounds, though not corpulent. I saw him about four hours after the accident, and afterwards with my father, Dr. Lewis Condit, when he complained only of pain at the groin upon motion of the left leg. There was no displacement in any way, its position and length corresponded perfectly with the other limb. No crepitation could be heard upon rotating the limb, though in truth, on account of the suffering produced by it, but little effort was made to produce it. The manner in which

the patient fell, his age, and the fragile state of bones incident to advanced life, rendered it almost certain that the neck of the femur was fractured, while the state of the limb, and the fact that he could not step upon it, made it probable that the fracture was within the capsular ligament. The treatment consisted in apply. ing to the pelvis, a cushion lined with doe-skin, fitting it accurate. ly, and of width sufficient to cover the ossa-femoris for two inches below the trochanters. This greatly relieved the pain at the joint, which had been excruciating upon every movement of the body. The knee was placed in a semiflexed position, supported by pillows, and an evaporating lotion applied to the groin and upper part of the thigh. At the end of four or five days the limb was perceptibly shortened. Desault's splint was applied, but removed in a few days by the patient, and no persuasion could prevail to obtain his consent to any means for keeping the limb in situ, though various expedients were resorted to. For two or three weeks it continued to become shorter, until it measured half an inch less than the other. It being the month of May, and certain that if he lived, he must be confined to his bed through the hot weather, he was placed upon a mattrass on one of Wooley's bedsteads, which is so contrived that the position can be changed from sitting to horizontal, or fixed at any angle desired, without moving the limb; the lower part of the bed may be raised or depressed in the same way, and the bowels evacuated without moving. The pain at the acetabulum gradually abated and was succeeded about a fortnight after the accident, by great soreness at the ankle joint and at the tendo-achilles, and although great care was taken to remove pressure from the part, this distressing symptom continued even to the last, to give him great annoyance, so that he groaned from agony whenever subjected to the least motion. He remained in this state, with but little variation through the summer, being comfortable when left quiet, but unable to get off his back, by rea son of the state of the ankle joint. In September it became evident that his constitution was to sink under the protracted confinement, and he began to complain of tenderness of the sacrum. Efforts were made to prevent it, but ulcers formed there, and towards the end of October diarrhoea came on, and soon becoming unmanageable, he died early in November.

But little emaciation had taken place. No examination was made of any other part than the diseased limb. The ankle exhibited no mark of diseased action, by which the pain so long complained of, could be accounted for; there was neither stiffness, thickening of the part, nor increased vascularity. The muscles and all the structure about the cervix-femoris were more pale than usual, and scarcely gave out any blood upon being cut into. The capsular ligament was entire, giving no appearance of having been lacerated, its texture was somewhat thickened. The ligamentumteres was in a state of vascularity, which gave it about the colour of the muscles around the joint, though it retained its wonted firmness and strength. The acetabulum was normal in appearance. The neck of the femur was shortened, and on opening the capsule the fracture was discovered wholly within it. The head of the bone had been broken across transversely, exactly at its point of union with the neck, and about two lines from the bony edge of the acetabulum. The ridge characteristic of the seat of fracture had been thrown out, and the re-union was firm for rather more than three-quarters of the circumference of the bone. The limb having been drawn up by the contraction of the muscles, a considerable angle was formed by the head and neck at their point of juncture, but they were as firmly united by osseous formation. as if they had never been separated. On the upper side, where the fractured edges were not in apposition, union was not yet complete, but ossification was going on upon all the broken surface, and had the patient lived a few months, would doubtless have been perfected. Could the state of the injured part have been by any means ascertained, and had not the condition of the ankle forbidden it, the patient I think might safely have walked; there was sufficient firmness at the fracture for the limb to have contributed its share of support to the trunk. From a fear lest some accident should befall the specimen in handling it, I left it with a mechanic to have the head protected by a covering of wire. He placed it for safe-keeping in a desk in his room, belonging to another man, who removing the desk in his absence, threw out the bone, supposing it to be of no value, and though diligent search was made, it was not recovered. I had the preparation in my possession for two or three years, and during that time it was

shown to many members of the profession, who expressed but one opinion, that it was a case in which a complete fracture entirely within the capsule was re-united by ossification.

Before offering any remarks upon the subject generally, permit me to give the history of another case which has occurred recently, and which there is reason to believe is similar in its character to that of Captain B.

Mrs. W., of New York, somewhat past fifty years of age, on the 14th of January last, fell, striking the trochanter, of the left thigh upon the edge of a wooden step in a her yard. She was instantly sensible of acute pain at the spot, and also in the groin. She was unable to walk, but was carried into the house and advice procured, but it was not supposed that any injury existed, other than

contusion.

Five weeks had elapsed when I saw her, but such was the tenderness of the parts that no thorough examination was attempted, until leeching once or twice repeated, had been premised. Upon strongly rotating the limb at this time, crepitation was at once very distinct. There was however no displacement, no shortening, nor indeed any thing to indicate its condition, unless attempts at motion were made. The patient could lie in no other position than upon the back, and movement in any degree was so painful that with the added fatigue from lying in one posture, she passed her nights almost without sleep. So much suffering was created by the attempt, that but little pains were taken to ascertain, or even to form any very definite opinion as to the exact point at which the fracture had been made. With the approbation of Dr. Hoffman, who at my request visited the patient with me, a broad bandage made of linen, unyielding in its texture, cut to the form, and of breadth sufficient to cover the pelvis, and extending two inches below the trochanters, and fastened by buckles over the right groin, was applied, and made as tight as could conveniently be borne. The limb was placed in a semiflexed position both at the knee and hip joints, and the bed so arranged that attention to the calls of nature did not disturb its posture. The patient was informed that there was reason to fear that union might not take place at all, and that even if it should, it might be by ligament only, and that the shortening from absorption of the broken sur