The inflammatory fever was of course great. I directed poultices to be applied, gave him a sedative and diaphoretic mixture, with chlorodyne at night, and put the leg on the splint recommended by Mr. Barwell for the hip-joint disease.

Saw him again, August 26th. The wound was discharging freely, pain and swelling still great, and he was much emaciated, and worn out. This state of things continued for some days when the pain and discharge lessened. They subsequently returned with great force, though while the discharge was at its height the pain ceased. Shortly afterwards the flow gradually decreased, and in ten weeks from the receipt of injury, the wound was entirely healed; the inflammation had gone, and his appetite and strength were returning. The splint was still kept on until he began to sit up. I saw him again January 28th, 1865. The knee was swollen considerably on both sides of the patella, which floated loosely. There was no tenderness on pressure. He could bend the leg nearly to a right angle with the thigh. He limped but slightly, and had been driving a team in the woods more than a month. I have not seen him since; but during this month his brother informed me that now the wounded limb is nearly as good as the other, and the motion in the joint is nearly as great as in the sound one. His only inconvenience is, that continued exertion and exposure to cold cause pain in the knee. I attribute the favourable result in this case mainly to the use of Barwell's splint.

Windsor, Nova Scotia, June 19th, 1865.

HOSPITAL REPORTS.

Caries of the heads of the Metacarpal bones of the right hand. Under the care of Dr. Fenwick. Reported by Mr. R. S. Parker.

J. B., aged 25 years, native of Ireland, was admitted into the Montreal General Hospital, May 1st, 1865.

He is a man of delicate conformation, scrofulous taint, and has a tendency to phthisis, though there is no apparent disease of the lungs. The patient belongs to the City Police force; and in July of last year, while in the discharge of his duty, he received a blow from a whip handle on the ulna side of the right hand, which did not, however, prevent his arresting the prisoner, a carter, who thus energetically resisted his authority. The following day the part was swollen and stiff, and he suffered considerable pain of a burning character. On application to the

police surgeon, the hand was freely painted with tincture of iodine, and he was enjoined rest. He was altogether about six weeks off duty, during which time various means were resorted to, such as the frequent application of iodine, cold douche, &c., but no internal remedies were employed. At the end of this period the swelling was somewhat abated, but the part was still exceedingly tender and the fingers very stiff. This state of things continued for some months, when about the early part of January, 1865, an ulcer formed on the back of the hand about the middle of the metacarpal bone of the ring finger; at the end of a few days a second ulcer formed over the head of the metacarpal bone of the little finger, the edges were raised and indolent in appearance, and had a tendency to spread. They were treated by various lotions and unguents which would reduce the ulceration in size, but only for a time, as they invariably broke out afresh. Worn out with pain and discouraged by the results of treatment, he applied for relief at the Montreal General Hospital, when he came under the observation of Dr. Fenwick, who diagnosed caries of the heads of the metacarpal bones.

May 2nd. Operation.-Having been carefully placed under chloroform an incision was made along the outer side of the hand extending from the base of the little finger to near the styloid process of the ulna. The metacarpal bone was at once exposed and found denuded of its periosteum and extensively cariesed; it was with ease separated from the adjacent parts, snipped across about its centre and removed; the bone of the ring finger was also found diseased; and in like manner with more difficulty, however, treated in the same way, less of the shaft requiring removal. No further disease being apparent, the wound was stuffed with lint, and water dressings employed. On the second day after the operation the fingers were supported by a gutta-percha splint, as the little finger had a tendency to fold under the others. During the operation the tendons of the muscles were carefully pushed out of the way; in fact they were not seen if we except the extensor tendon of the little finger which came into view, but was uninjured. The case progressed most favourably, the wound rapidly filled up, and the ulcers on the hand disappeared. The patient was placed on generous diet with quinine and iodide of potash; and passive motion was enjoined at the end of three weeks. He was discharged cured on the 17th June, with a most useful hand; the fingers are foreshortened, but he enjoys free motion, can write with comparative ease, and expressed himself quite satisfied with the result of the cure. The case is of interest as showing the amount of injury and destruction of parts liable to occur from a comparatively trifling blow. It is somewhat singular that the matter which must have

formed beneath the periosteum should have taken four months to shew itself, as appears from the history of the case. It is possible that the action was slow from the fact of the man's health being by no means good; still from all we can learn, he had lost considerable flesh, and had suffered much constitutionally from the continued annoyance, both mental and physical, of the disease. The result has been very satisfactory, as is attested by the man's improved appearance and the restoration of a useful hand. The removal of the limb had been recommended by one surgeon, which had greatly affected his spirits.

REVIEWS AND NOTICES OF BOOKS.

Lectures on Surgical Pathology. By JAMES PAGET, F.R.S., Surgeon to St. Bartholomew's Hospital; revised and edited by William Turner, M.B., Lond., F.R.C.S.E., F.R.S.E., Senior Demonstrator of Anatomy in the University of Edinburgh. Third edition; Philadelphia, Linsday and Blakiston. 1865. Montreal; Dawson

Brothers.

There is certainly no English pathologist who has attained to the eminent position now held by the distinguished author of the above volume of lectures on Surgical Pathology; and this position has been gained after years passed in toil and unwearied exertion in the special department to which he has devoted his great talents and energies. Perhaps there is no special subject in medical science, which requires more labour, more thought, and in which there is a greater field to theorise, than that of Pathology. True, a pathologist should take his ideas and his deductions from nature-and nature deals in facts, yet, the plenitude of these facts give room, when the mind is imaginative, to theorise. We would not condemn a theorist, for without them we would often feel at sea; yet too much theory is apt to make practice uncertain and defective. Mr. Paget has, so far as we have been able to examine his large volume of between seven and eight hundred pages, avoided this, to our view, dangerous tendency. With the magnificent museum of the Royal College of Surgeons, England, at his disposal, as one of its professors, and his experience gained while surgeon at St. Bartholomew's, he had facts sufficient, and with them he has mainly dealt. When theory has seemed essential, his deductions are well drawn, with a true connecting link between fact and theory. In these lectures, first delivered before the College of Surgeons, between the years 1847-52, when the

author was professor of Anatomy and Surgery to the college, there is an ease and a grace running through them which indicates the accomplished scholar. The present edition has been revised under the direction of Mr. Turner, the able anatomical demonstrator of the University of Edinburgh. In the preface under his signature Mr. Paget says, "I was anxious that they should be revised with all the light of the knowledge of pathology acquired since their publication, yet a thorough revision of the whole subject was a task for which I feel unfit. For in the passage of nine years I had been carried into the active practice of my profession; and at the end had not sufficient time, for either studying or thinking carefully about the many facts and probabilities, and guesses at truth which had been added to pathology: I was therefore glad to be able to commit the work of revision to my friend and former pupil, Mr. Turner, whom I knew not only to be very conversant with the progress of medical science, but able to test others' observations by his own. It is not for me to say, how well he has done his work, for I have so worked with him, as to be equally with him responsible." The first two lectures are devoted to nutrition-then follows several on growth, healthy, and diseased. On the subject of fatty degeneration, Mr. Paget says:

"The whole history of fatty degenerations concurs to prove that they are the result of defects, not of disease, of the nutritive process; and that they may therefore be classed with atrophy which we recognize in merely diminished quantity of formation. *** On the whole therefore we must conclude that something much more than general tendency to form fat, or a general excess of fat in the blood, is necessary to produce a local fatty degeneration. The general conditions are favourable, but not essential to this form of atrophy. *** The most common form of fatty degeneration is that in which you find, on opening the heart that its tissue is in some degree paler and softer than in the natural state, and lacks that robust firmness which belongs to the vigourous heart. But what is most characteristic is, that you may see especially just under the endocardium spots, small blotches or lines like undulating or zig-zag, transverse bands of pale, tawny, buff, or ochre-yellow hue, thick set, so as to give at a distant view, a mottled appearance. These manifestly depend, not on any deposit among the fasciculi, but of so ne change of their tissue. For at their borders you find these spots gradually shaded off, and merging into the healthy colour of the heart; and when you examine portions of such spots, with the microscope you never fail to find the fatty degeneration of the fibre. The yellow spotting or transverse marking of the heart may exist in the

walls of all its cavities at once, or may be found in a much greater degree in one than in others. It may exist on all parts of the thickness of the walls, or may be chiefly evident beneath the endocardium and pericardium." It is far less common in the auricles than in the ventricles, and when it exists simultaneously in all parts, is less advanced in the auricles. It is more common in the left ventricle than in the right; and in the left ventricle it is commonly most advanced on the smooth upper part of the septum and in the two large prominent fleshy columns. Indeed it may exist in these columns alone; and when, in such a case, the rest of the heart remains strong, may account for the occasional occurrence of rupture of the column.

"These yellow spottings of the heart, produced by degeneration of scattered portions of its fibres, are, as I have said, the most evident, as well as the most frequent, indications of its degenerative atrophy. But a similar affection may exist in a worse form, though it be less manifest; worse because the degeneration is more extensive and less distinctly visible to the naked eye, and must be recognized by the touch rather than by the unaided sight. The whole heart feels soft, doughy, inelastic, unresisting, it may be moulded and doubled up like a heart beginning to decompose long after death; it never seems to have been in a state of rigor mortis."

These extracts, briefly describing the two principal varieties of fatty degeneration, give but a faint idea how the subject is handled by our author. We will give but one other extract, and that concerning a question, regarding which there is some difference of opinion; we refer to the method by which fractures are repaired.

"A subject of chief interest in the repair of fractures is the position of the reparative material. * * There are two principal methods. In one the broken ends or smaller fragments of the bone are completely enclosed in the new material. They are ensheathed and held together by it, as two portions of a rod might be by a ferrule or ring equally fastened around them both. In such a case the new material surrounding the fracture has been termed "provisional callous or external callous;" but the term ensheathing callous will, I think, be more explanatory. In the other method the new material is placed only between those parts of the broken bone whose surfaces are opposed; between these it is inlaid, filling the space that else would exist between them, or the angle at which one fragment overhangs another, and uniting them by being fixed to both. Reparative material thus placed may be called intermediate callous. **** The method of repair with an "ensheathing or provisional callous is rarely observed in man, but appears to be frequent in fractures of the long bones in animals. Mr. Paget then describes the repair