6

ation, with extension in the usual manner, obliquely across theopposite knee, counter extension, &c. One of Mr. Cock’s caseswas of five weeks’ standing ; the case we saw reduced on the26th ult. not so long. Both had the head of the bone carriedupwards, with shortening of the limb ; the knees and toes

were inverted ; the large toe was in the usual situation, on theinstep of the opposite foot ; the prominence of the trochanter wasdiminished, the head of the bone being plainly felt on the dor-sum ; the limb, as usual, incapable of being separated from theopposite one, except under the effect of chloroform. The latteragent seems, in hospitals, to have entirely changed the modusoe7-ca-rtdi of skilful surgeons in these most troublesome cases, asnow the bone may be exercised in almost any direction, ab-ducted or adducted. Several relays of active students, pre-paring for a long pull and a strong pull, a few days ago,for the second time, were a little disappointed, by Mr.Cock, when all the preparations were in readiness, and

I

the man fully under chloroform, offering to try the ma-noeuvre, or surgical method, or "knack," which he finds sosuccessful. The head of the femur, it will be remembered,is above the edge of the acetabulum, and a little behind it,under the glutseus minimus, with the trochanter forward.From a careful study of the skeleton, Mr. Cock finds the secretto be to handle the femur as if it were the humerus, then flex-ing it on the pelvis, abduct strongly, thus lifting the head ofthe bone, with the accessory band of the ilio-femoral ligament,over the acetabulum, while you also rotate the lower condyleor limb in your hand outwards. This plan, even in old dislo-cations, and without pulleys, almost invariably succeeds on theinstant, as it did in this case.

UNIVERSITY COLLEGE HOSPITAL.OPERATION OF GASTROTOMY.

(Under the care of Mr. ERICHSEN.)ONE of those dreadful operations, which the chances of saving

life can alone justify, was undertaken, at a few minutes’ notice,by Mr. Erichsen, the day preceding one of our last visitingdays at University College Hospital. A poor woman, in labourof her sixth child, on the morning of the l9th ult., was suddenlyseized with symptoms which led Dr. Murphy, who was sum-moned in attendance, to suspect rupture of the uterus, withthe escape of the child into the peritoneal cavity. The caseseeming a favourable one for gastrotomy, or at least that opera-tion affording the only chance of life, it was decided she shouldbe removed to the operating theatre, her friends and herselfconsenting. This was effected at about five o’clock in the

evening of the 19th. On examidation of the abdomen, theinfant could be felt lying almost immediately under the skinof the anterior abdominal wall, the limbs being easily traced.No vaginal examination was thought necessary by Mr. Erichsen.Chloroform was then administered, and the operating theatrehaving been previously warmed by hot-water pipes, braziersof burning charcoal, &c., Mr. Erichsen made one careful in-cision, about five inches long, from above downwards, throughthe umbilicus, and at once removed the foetus, which waslying in front of the uterus, the body bent across the abdomenof the mother. The usual means of resuscitation were ready,and put in force, but the infant could not be brought to life.The uterus was seen enlarged about the size of a large cocoa-nut, but no rupture could be perceived in it. There was amoderate quantity of coagulated blood in the cavity of theperitoneum, which was removed, and the opening carefullyclosed by interrupted suture, plasters, compresses, &c. Verylittle blood was lost during the operation, but the poor woman,already in a most depressed state, from the exhaustion of theprevious labour, sank and died not many hours after.As the friends of the patient objected to a formal post-mortem

examination, it was only possible to remove the uterus andparts contiguous. The rupture appeared to us, on examinationnext day, to be an irregular laceration, with ecchymosis andextravasated blood, situated at the upper part of the vagina,where it joins the uterus. The latter, as already indicated,appeared about the size of a large cocoa-nut. The funis and

placenta had both escaped with the child into the abdominalcavity, and were removed by Mr. Erichsen during the opera-tion. Before performing the latter, Mr. Erichsen stated to asmany of his class as had assembled, that the necessity for sucha grave proceeding was one of those things of which he was nojudge, as it rather belonged to the department of obstetrics;and that he acted, as other surgeons might be called on to do,under the direction of those who, from their special knowledge,looked upon it as the only means that were presented of givingthe mother, as well as the child, the chance of existence.

I A very remarkable obstetric case has recently occurred, inwhich a foetus of five months, but dead, was attached to a

living child of nine months, and removed by the practitionerin taking away the latter and the placenta ! This case wouldgo to show, perhaps, that an infant recentlv dead does not actso much like a foreign body as is usually conceived. InAmerica a case has also been published this year of gastrotomy,where the surgeon deemed it right to remove a large piece oflead from the intestine; by this most heroic proceeding thepatient recovered. It .is not very flattering at the same timeto our modern science to be told, as we have been recently byStoltz, of Strasburgh, that within the last fifty years theCaesarian section has not succeeded even once in the largecommunity of Paris. The close air of cities is obnoxious tosuch operations. In Belgium, of late years, in eleven opera-tions, nine infants and six mothers have been saved; in Ger-many we find four cases in seven have succeeded; in Italy, ineight operations, three mothers and eight infants; while in thecountry about Strasburgh the author just named has operatedsix times, in four of which he was so fortunate as to save bothmother and child; in two others, the infants; so that he hassnatched, as it were, ten living beings from the certain graspof death-ten out of twelve. These operations were of courseperformed under somewhat different circumstances from thepresent one of Dr. Murphy and of Mr. Erichsen, the Caesariansection being done after preparation of the patients for such aformidable issue by carefully opening the uterine walls fromthe abdominal cavity for pelvic deformity, an operation morelike ovariotomy, whereas here the foetus had escaped throughthe lacerated walls of the vagina, the poor woman evidentlysinking from haemorrhage and the shock of such an accident.The latest case of successful Csesarian section we find occurredlast February in the practice of Schweitzer, a German, thechild was removed alive from the dead mother, but lived onlyeight hours, for the necessary want of a mother’s care. Oneof the older writers gives seventy-four cases in which theCsesarian operation was performed; but we must feel a littledoubtful of the correctness of this statement, as of all state-ments that attempt to prove too much; for one of the womenwas operated on seven times. It may not be forgotten, how-ever, that Meigs (" Obstetrics," p. 531) gives an Americaninstance where it was performed twice.

CHARING-CROSS HOSPITAL.PNEUMONIA AND ITS TREATMENT; VALUE OF BLEEDING,

WINE, ETC.

(Under the care of Dr. WILLSHIRE.)IN a former "Mirror," (THE LANCET, vol. i. 1855, pp. 36,123,)

we were led into some observations on the treatment of pneu-monia, and published some cases then under the care of Dr.Parkes, at University College Hospital, and Dr. Addison, at<1uy’s. Since last year several other opportunities have offeredthemselves of corroborating those views, more especially as tocritical days and the value of wine, in the clinique of Dr. Todd,at King’s College Hospital, in the practice of Dr. Brinton, atthe Royal Free Hospital, and amongst the out-patients at St.Bartholomew’s and the London Hospital.A patient lately under the care of Dr. Willshire, in one of

the wards of Charing-cross Hospital, on the other hand, justifiedthe hesitation, perhaps, of those who are as yet unwilling tocarry out to an extreme extent the doctrine of "expectancy,"now so prevalent, with respect to the treatment of pneu-monia. In few diseases, it was remarked to his class by Dr.Willshire, have the therapeutics or line of treatment been sochanged of late years as in this affection. Our readers wellknow that pneumonia of great towns amongst the poor is notthe same disease as that amongst soldiers or sailors, or the strongand well-fed residents in agricultural districts. The opinion isnow gaining ground every day in the schools that the formeris an asthenic disease, demanding restorative or even stimulanttreatment. Dr. Willshire appears to be amongst the fewclinical observers who hold out against the purely expectantand always stimulating plans. Dr. Walshe also ("PracticalTreatise on Diseases of the Lungs," &c., p. 438,) shows how itis that " pneumonia is a disease which may be, and actually hasbeen, therapeutically played with," and with apparent im-punity ; while Dr. Copland says the mode of treating pneu-monia has been all set astray by the abuse of the numericalmethod of Louis, falsely called statistics. "It is unprofitable,"says Dr. Copland, in his " Dictionary," p. 774, "to follow theFrench physicians, as their lucubrations tend only to overlaya plain subject with a load of flat, stale, and inapplicablenumerical-vainly called statistical-details." Under such

opposite views, we must appeal to cases like the following.--