Stevens on Compound Fracture of the Elbow-joint.

69

to the flow of blood through the main artery has a most powerful influence in moderating inflammation of parts which derive their supply of blood from it; and there is no great danger of mortification when ordinary care is taken to preserve the natural warmth of the limb, and the use of cold washes, especially those containing lead, is avoided. At least I have never witnessed it in some ten or twelve cases which I can call to mind.

Whatever value may be attached to these opinions, the following case would seem to support them, and to show the powers of nature, under very unpromising circumstances.

David Skeen, a robust middle aged man, given to intemperance, but not to an extent sufficient to have impaired his constitution, fell in the streets while intoxicated, and suffered a compound luxation of the elbow-joint. The forearm was flexed upon the arm. The two bones of the forearm having been thrown behind the condyles of the humerus, the coronoid process of the ulna was lodged in the cavity destined for the olecranon process, the head of the radius being thrown behind the outer condyle. The integuments in the bend of the elbow were lacerated transversely to the extent of two and a half inches, the tendon of the biceps and the brachialis internus rent asunder, the nerves stretched before the condyles of the humerus, and the brachial artery torn and projecting from the wound. He was brought to the hospital about seventeen hours after the accident. No considerable hemorrhage had occurred: the lower end of the torn artery was not visible, but the upper extremity could be seen, and still pulsating. Its extremity was contracted to the size of a crow quill, but not pervious. Deeming it prudent to place a ligature at a point where its vascular communications remained, I laid it bare and tied it with a single silk thread, about an inch above the lacerated extremity. The lower lacerated extremity of the vessel was not sought for, and never gave out any blood. Being curious to examine the torn extremity, I cut off about half an inch the whole of this part, when laid open, was found to be filled with a clot, and the

portion nearest the lacerated end was contracted to one half the natural size.

The first attempt at reduction was made by pushing the upper part of the bones of the forearm, from the articular surface of the humerus, while extension was made on the forearm in a fixed position. The ulna was thus reduced, but a repetition of the same process, did not restore the radius to its proper situation. The reduction, however, was readily affected by extension applied to the forearm in an extended position; the upper part of the radius being at the same time pushed backward.

After the reduction, the man was put to bed with his forearm fixed at a right angle, and laid across his chest; the wound was lightly dressed with dry lint, or slightly approximated with slips of adhesive plaister; a lotion of spirits and water was applied near the wound, but not low down on the forearm. He was bled to sixteen ounces. He passed a good night after the reduction. On the following day, the fingers were somewhat cooler than natural; the wash was therefore applied warm After a few days a poultice was substituted. Pulsation was first felt in the radial artery, on the third day after the accident. This was continued about four weeks, when the suppuration closed.

No severe symptoms or untoward accident occurred, except the burrowing of matter at the lower part of the joint, for the discharge of which, a counter opening was made by the intelligent House Surgeon, Dr. Cornell; and the formation of a small eschar over the internal condyle. The forearm was kept immoveable at right angles to the humerus, with a view to induce anchylosis, as the power of flexion would be lost, in consequence of the rupture of the brachialis, and the tendon of the biceps.

From the time of the accident until his discharge from the hospital, was a period of eight weeks; a very slight degree of flexibility of the elbow remained after the cure; but the power of the flexing and extending the hand and fingers was as good as ever.

ART. VI. Case of Nyctalopia. By JOHN WATTS, Jun. M.D. one of the Physicians to the New-York Hospital.

JOSEPH CORRIE, a seaman, born in Norway, aged 30 years, of middle stature, stout and muscular, says he has enjoyed good health; his countenance, however, is expressive of anxiety and disease. He was admitted into the New-York Hospital on the 27th day of January, 1823, on account of nyctalopia, or night blindness, for which he could assign no cause, being perfectly well at the time of its occurrence, which was about six months previous to his admission. At that time he was on a voyage from Russia to France, and at sunset, while engaged in reefing topsails in a gale, he was suddenly deprived of sight, and since that time he has regularly experienced the loss of vision on the approach of night, being unable to distinguish any thing whatever without the aid of a very strong light. He can see the blaze of a candle, but describes it as appearing like a ball of fire, and is incapable of distinguishing the wick. There is but little mobility of the pupils of his eyes, the iris contracting with a remarkable degree of slowness; his pulse is hard and frequent, and there is occasionally some increase of excitement at night. He sometimes complains of pain in his head, particularly about his forehead and temples, and says that there are appearances of half moons revolving around his eyes during the day, and that they are more apparent in cloudy weather.

Cupping glasses were applied to his temples, sixteen ounces of blood were taken from the arm, and active cathartic medicines were administered, and persevered in for several days, without any apparent benefit. Blisters were then applied to his temples, and he was put on the use of calomel and opium morning and evening; and in about three weeks his mouth became affected: no improvement, however, having taken place, his medicines were directed to be stopt.

March 3d. The patient now coming under my charge, twenty ounces of blood were taken from his arm, and a solu

tion of salts and tartar emetic was given to purge him freely through the day. Blisters were applied over his forehead, and he was kept under the continued influence of tartarised antimony. On the 5th, two days afterwards, he again lost twenty ounces of blood, the medicine had operated very freely, and he began to distinguish objects which were before perfectly invisible. The appearances of half moons which he formerly complained of revolving around his eyes, were sensibly diminished, annd he was put on the use of digitalis, beginning with fifteen drops, three times a day. At the expiration of two days, on the evening of the 7th, he was again bled to the amount of sixteen ounces, after which he could tell the hour by a watch: previously to the bleeding he could not distinguish the hands of the watch. A dose of calomel was administered to him at bed-time. For two days he continued to improve, and all the crescentic appearances, excepting one, vanished from before his eyes, and this was more dim than usual.

On the evening of the 10th, three days afterwards, it was again necessary to bleed him, and after losing 20 oz. of blood, he could see to read common size print. Blisters re-applied ⚫ to the forehead and temples and his other medicines were all continued. On the following day, being cloudy, objects appeared to him as if seen through a mist; he complained of headache, and shaking his head briskly produced a sensation of something rolling about within it. In the evening he became excited, and was bled thirty eight ounces, and immediately afterwards could recognise a person at the farther end of the ward, and could see distinctly enough to read small print by candle-light. He continued his medicines, and increased the doses of digitalis; but as he soon again complained of headache, and his eyes now became watery, the lids adhering together in the morning, he was bled on the 14th, three days afterwards, to twenty ounces, and continued to feel better for the two succeeding days, until the 17th, when he felt considerable pain in the forehead, and between his eyes, accompanied by vascular excitement, all of which subsided with the abstraction of twenty ounces of blood.

As his vision was not yet uniformly distinct, and he was occasionally liable to some excitement, attended with headache, he was directed to take an emetic of ipecacuanha regularly every morning. This he continued to take, at the same time using the salts and tartarised antimony, and one hundred drops of digitalis daily, until the 2d of April, when he was discharged, with an appearance of high health, and an augmentation both of flesh and strength, having lost nearly 180 ounces of blood, and abstained as much as possible from the use of food.

By

ART. VII. A Case of Protracted Indigestion, simulating other diseases, and finally cured by the Oxide of Bismuth. DANIEL L. M. PEIXOTTO, M. D.

ALTHOUGH I have adopted the term indigestion, in the caption to this article, to designate the following case of disease, it has been rather from accordance with general usage, than from a belief that gastric derangement is the essential, or even the principal feature of this or of similar affections. It may with far greater propriety be referred to that more comprehensive class of affections, which have been so happily grouped together by Dr. Marshall Hall, under the general appellative Mimosis. The characteristic traits of these are a general morbid affection, combined with a great and multiform variety of topical symptoms, the predominance of one or other of which produces a close imitation of other diseases widely different in their nature. Dr. Hall observes of this class, that "they have been variously, and perhaps too exclusively, attributed by some authors, to a state of derangement in one or more of the chylopoietic viscera ; and, by others, to an unequal and undue distribution of the blood, by which a state of arterial ́ excitement, or of venous congestion, is induced in some particular organ." Into their pathology, however, Dr. H. declines entering. But are we not warranted by an accurate analysis of the cases of disease described by him, to refer them